Bladder Problems Flashcards
Basic anatomy of the bladder
Found in the pelvic cavity when empty - expands into abdominal cavity when it becomes full
Made up of 4 parts - apex, base, superior surface and inferolateral surfaces
trigone = smooth triangular area between the openings of the ureters and urethra on inside of bladder
urethra = shorter in F so more likely to get infected
3 efferent nerve supplies to bladder and role of efferent supply
- Sympathetic (hypogastric nerve)
- Parasympathetic (pelvic nerve)
- Somatic (pudendal nerve)
= regulation of continence and micturition
Role of sympathetic (hypogastric) nerve
Perception of pain sensation from urethra and bladder
Role of parasympathetic (pelvic) nerve
Reflex micturition and sensation of bladder fullness
Role of somatic (pudendal) nerve
Sensation of passage of urine through urethra
Maintains tonic contractions of skeletal muscle fibres of the external sphincter Sensation of distention of urethra
Favourable conditions in neurogenic control of micturition
- contraction of anterior abdominal muscle and diaphragm to increase intra-abdominal pressure
- stimulation of sacral micturition centre
- voiding under parasympathetic (pelvic nerve) regulation
- inhibition of somatic (pudendal) nerves = relaxation of external urethral sphincter
Unfavourable conditions in neurogenic control of micturition
- inhibition of micturition reflux
- inhibition of sacral micturition centre
- holding of urine under sympathetic (hypogastric nerve) regulation
- stimulation of somatic (pudendal) nerves = contraction of external urethral sphincter
Cystometrogram
= plot of intravesical pressure (pressure in bladder) against volume
atonic/hypotonic bladder
Destruction of sensory nerve fibres from bladder.
Bladder loses tone and becomes flaccid
treatment of atonic/hypotonic bladder
Anticholinesterases - treats neurogenic problems to increase detrusor contraction
Antimuscarinics - enhance contraction of bladder smooth muscle
Bladder catheterisation
Automatic bladder
bladder loses tone and becomes flaccid and unresponsive
whenever bladder filled with some amount of urine = automatic evacuation of bladder
caused by spinal shock - 2-6 weeks for shock to pass
Uninhibited neurogenic bladder
= uncontrollable micturition
caused by lesions in some parts of brain stem = continuous excitation of spinal micturition centres by higher centres
Nocturnal micturition (bed wetting)
caused by incomplete myelination of motor nerve fibres of bladder
= loss of voluntary control of micturition
Symptoms and causes of overactive bladder
Symptoms: frequency and urge incontinence, urinary urgency and nocturia
Causes: stroke, spinal injury, MS, detrusor instability and meds (ACEi, opioids, diuretics, antipsychotics)
Treatment of overactive bladder
ADH synthetic analogue
change in lifestyle (more fluids in morn and avoid alcohol/caffeine)
muscarinic receptor antagonist
beta3-adrenoreceptor antagonist
topical vaginal oestrogen-replacement therapy
Urethral sphincter incompetence (inc. causes and consequences)
= dribbling and/or continuous leakage from incomplete bladder emptying
caused by impaired detrusor contractility and/or bladder outlet obstruction
produces: sphincter weakness in men and stress incontinence in women
treatment for urethral sphincter incompetence
anti-incontinence devices
alpha1-adrenoreceptor antagonists (SE may make it worse)
physical therapy (pelvic floor muscle training)
Painful bladder syndrome (PBS)/ Interstitial cystitis (IC) and causes
= bladder pain of variable sensitivity
caused by: urothelial abnormalities, altered bladder epithelial expression of HLA class I and II antigens, altered integrity of glucosaminoglycon (GAG) layer
types of over-active bladder (OAB)
Urinary frequency - perceived urination too often during the day (>8)
Urgency - sudden compelling desire to urinate w/ difficulty to delay
Enuresis - involuntary urination at night
Nocturia - woken at least once during sleep to pee
when to refer women with urinary incontinence
previous continence surgery suspected urogenital fistulae persisting pain benign pelvic mass palpable bladder symptoms of voiding difficulty
Risk factors for urinary incontinence in women
number of children age poor obstetric care co-morbidities (T2D, chronic UTIs) overweight post-menopausal changes
Causes of LUTS in men
drugs injury to urethral area infection cancer neurological conditions BPH = common cause
treatment options for OAB
anticholinergics, selective beta3 agonist (Mirabegron), desmopressin (nocturia in women), duloxetine (antidepressant)
drugs that can induce acute urinary retention
Drugs with significant antimuscarinic action:
atropine, tricyclic antidepressants, sedative antihistamines, some antipsychotics
