Week 8 - Urinary Incontinence Flashcards
How is the detrusor muscle of the bladder controlled?
Parasympathetic S2,3,4 (pelvic nerves)
How is the sphincter of the urethra controlled?
Somatic pudenal nerve S2,3,4
Describe the filling/storage phase of bladder function?
Receptive relaxation/compliance
Sensation of bladder filling
No detrusor contraction
Describe the voiding phase of bladder function?
Voluntary initiation
Complete emptying
Describe problems of bladder function due to lower motor neurone lesion?
Low detrusor muscle pressure (don’t contract as much)
Large residual volume as cant fully empty
May have overflow incontinence
Reduced perianal sensation
Lax anal tone
S2,3,4 affected
Describe problems of bladder function due to upper motor neurone lesion?
High pressure detrusor contractions which causes dilated ureters
Thickened detrusor
Poor contraction of sphincters - detrusor sphincter dyssynergia
What are the classifications of lower urinary tract symptoms (LUTS)?
Storage
Voiding
Post-micturition
What come under storage problems of LUTS?
Frequency
Urgency
Nocturia
Incontinence
What comes under voiding problems of LUTS?
Usually caused by blockage Slow stream Splitting/spraying Intermittency Hesitancy Straining Terminal dribble
What are the post-micturition problems of LUTS?
Most-micturition dribble
Feeling of incomplete emptying
What is stress urinary incontinence (SUI)?
Involuntary leakage on effort or exertion or on coughing or sneezing
What is urge urinary incontinence (UUI)?
Involuntary leakage accompanied by or immediatly proceeded by urgency
What is mixed urinary incontinence (MUI)?
Involuntary leakage associated with urgency and exertion, effort, sneezing or coughing
Name some risk factors of urinary incontinence?
Pregnancy and childbirth pelvic prolapse menopause neurological abnormalities Obesity Age uTI
What investigations might you do in a patient with urinary incontinence?
Urine dipstick
Frequency-volume chart
Pad tests
What lifestyle interventions may be used to help someone with urinary incontinence?
Modify fluid intake Weight loss Stop smoking Decrease caffeine intake (especially in UUI) Avoid constipation Timed voiding
If a patients still having trouble but they’re not suitable for surgery, what can we do?
Indwelling catheter
Sheath device
Incontinence pads
How can SUI be treated without medication?
Pelvic floor muscle training
8 contractions 3 times a day for at least 3 months
What medication can be used to treat SUI?
Duloxetine - combined noradrenaline and serotonin uptake inhibitor, increases activity in striated sphincter during filling phase
In a female how can SUI be treated surgically?
Permanent - low tension vaginal tapes, retropubic suspension procedures, classical sling procedures
Temporary (if further pregnancies planned) - intramural bulking agents
In a male how can SUI be treated surgically?
Artificial urinary sphincter
Male sling procedure
How do low tension vaginal tapes work?
Supports mid urethra with polypropylene mesh
How do retropubic suspension procedures work?
Correct anatomical position of proximal urethra and improve urethral support
How do classical sling procedures work?
Supports urethra and improves bladder outflow resistance
