Flashcards in 0430 Urinary Incontinence Deck (56)
leakage of urine that interferes with one’s quality of life or health
Innervation of the urinary system involves these 3 systems
sympathetic, parasympathetic, and somatic innervation
what system prevents urination from happening during stressful situations?
Sympathetic activation via hypogastric nerve and pudendal nerve
activation of the hypogastric nerve results in:
- detrusor muscle to relax
- blocks parasympathetic transmission at the pelvic ganglia
- promotes an increase in urethral sphincter tone as the bladder fills
activation of the pudendal nerve results in:
causes contraction of pelvic floor -> prevents release of urine
what system promotes urination from happening during relaxing situations......?
parasympathetic excitatory input to the detrusor muscle via the pelvic nerves and plexuses causes
- contraction of the detrusor muscle to allow for voiding
- relaxation of the bladder neck and external sphincter
two types of Bladder dysfunction?
what is urge incontinence? when does it occur?
occurs when the bladder pressure >> sphincter mechanisms; occurs w/o warning
what tends to open the bladder neck and urethra?
elevated bladder or detrusor pressure
what causes elevated bladder or detrusor pressure?
• increased detrusor overactivity due to a non-neurogenic or neurologic etiology that results in uninhibited detrusor contractions
• poor bladder compliance - loss of viscoeleastic features of the bladder or change in neural-regulatory activity
increased detrusor pressure is common in?
common in the elderly and may be associated with bladder outlet obstruction
causes of poor bladder compliance?
fibrotic scarred bladder, radiotherapy, increased outlet resistance
symptoms of Urge Incontinence? what happens in severe cases?
symptoms: sudden sensations to void but is then unable to suppress it fully; often have frequency and nocturia in addition to urgency and urge incontinence
severe cases: patients may have no sense of urge (or sense of needing to void) but will leak without warning; usually triggered by water sounds, full bladder
Test to diagnose urge Incontinence??
urodynamic exam – must see that bladder is overactive in order to diagnose
behavioral therapy for Urge Incontinence??
- “timed voiding” have patients void every 1-2 hrs to help them stay dry
- restrict fluid intake
- avoid bladder irritants
- bladder retraining – consciously delay voiding and increase interval btwn voids
- Pelvic muscle exercises
Rx for Urge Incontinence?
anticholinergics +/- alpha agonist
Rx for Urge Incontinence in patients with intractable detrusor muscle activity (not responsive to Rx)
- peripheral nerve stimulation
- sacral nerve stimulation
- surgical intervention
- botox injection into the detrusor muscle
treatment for Urge Incontinence when all else fails?
“augmentation cystoplasty” - bladder augmentation – patch of bowel is used to increase bladder capacity
What is overflow incontinence? When does it occur?
occurs Excess fluid overwhelms the bladder capacity or when the volume exceeds the bladder viscoelastic properties.
when is overflow incontinence often seen? 3 scenarios
- obstruction (urethral stricture disease or prostatic obstruction)
- poor bladder contractility that results in incomplete bladder emptying (lots of reasons)
- pelvic floor prolapse
what are sx of overflow incontinence?
extreme frequency or constant dribbling, leakage w/ activity, nocturia and urgency
Treatment of overflow incontinence?
Relieve obstruction (many ways..)
Treatment of overflow incontinence caused by urethral stricture?
urethral dilation, internal urethrotomy or urethroplasty
Treatment of overflow incontinence caused by prostatic obstruction?
TRUS (transurethral resection)
Treatment of overflow incontinence caused by previous surgeries or pelvic prolapse?
sling incision or excision, urethrolysis, surgical correction of prolapse, or clean intermittent catherization for those who cannot tolerate surgery
Treatment of overflow incontinence caused by poor detrusor contractility?
clean intermittent catherization
why don't you want to use indwelling catheters for long-term treatment of overflow incontinence?
predisposes them to bladder calculi and ultimately to squamous cell carcinoma of the bladder
What is stress incontinence?
when does it occur?
urine is leaked with any increase in abdominal pressure (coughing, laughing, sneezing, walking, getting out of a chair, bending over)
in severe cases, urine is leaked even with minimal activity.
etiologies of stress incontinence? 2
intrinsic sphincter deficiency (ISD, bladder neck dysfunction)