Incontinence Flashcards
(48 cards)
What is urinary incontinence?
Unintentional passing of urine
What are the consequences of urinary incontinence?
Hygiene problems Skin damage Socially restricting Affects self-esteem Reduces quality of life
Why are women more often affected by urinary incontinence?
Because they are often affected weakening of pelvic floor and sphincter muscles due to childbirth
What are the risk factors of urinary incontinence?
Multiparity Hysterectomy Obesity Bowel dysfunction Menopause Dietary factors: caffeine, alcohol Drugs: diuretics
What is the muscle found in the wall of the bladder?
Detrusor muscle
Which type of muscle makes up the:
- internal urethral sphincter
- external urethral sphincter?
Internal: smooth
External: skeletal
Which branch of the nervous system controls micturition?
Autonomic: parasympathetic + sympathetic
What is the role of the parasympathetic nerves in micturition?
What neurotransmitters do they use?
Drive detrusor contraction
So drives urination
Cholinergic
What is the role of the sympathetic nerves in micturition?
What neurotransmitters do they use?
Inhibits contraction of detrusor
So prevents urination
Noradrenergic
What types of incontinence are there? Briefly say what they are.
Stress: sphincter weakness
Urge: overactive bladder
Mixed stress + urge
Overflow
Functional
What is stress incontinence?
Sphincter weakness that causes small leakages of urine when intra-abdominal pressure rises
This happens when laughing, coughing, exercising
The urethra becomes hypermobile
What causes stress incontinence?
Primary:
- neurogenic problems
- congenital (rare)
Secondary:
- pelvic floor damage to nerves + fascial support
What is meant by the urethra becoming ‘hypermobile’?
When the urethra sags and ends up below the pelvic floor, meaning the sphincters are unable to control urine outflow
Management of stress incontinence?
Reduce caffeine and alcohol intake
Pelvic floor re-education + physio
Duloxetine: a drug that is not great
Surgical methods
What type of drug is duloxetine?
A serotonin-noradrenaline reuptake inhibitor
Treats stress incontinence
Many side effects and not much benefit
What surgical methods can be used to treat stress incontinence?
A sling:
- a hammock underneath the urethra to provide support and prevent hypermobility
- TOT and TVT slings
Colposuspension:
- stitches to support bladder neck
Injectable drugs:
- to make bladder neck stronger
Artificial urinary sphincter
What are TOT and TVT slings?
What is meant by autologous in this context?
Used to treat stress incontinence
TOT: Trans-obturator tape sling
TVT: tension-free vaginal tape sling
Autologous = when the tape is made out of the person’s own tissue
Describe an artificial urinary sphincter?
A cuff fits around the urethra and can be inflated to close off the urethra
The cuff is inflated with fluid stored in a balloon placed under the abdominal muscles
The pump is placed in the scrotum for men and in the lower abdominal muscles for women
What is urge incontinence?
What are the features of it?
Urgent need to void and sometimes urine leakage or complete emptying of bladder before you can get to a toilet
Enuresis: bed wetting
Incontinence with the sound of running water
What causes urge incontinence?
Detrusor muscle over-activity due to:
- detrusor instability
- brain damage
Overactive bladder
Vaginitis, urethritis
UTI
What is detrusor instability and what causes it?
Detrusor muscle contracts when it shouldn’t
Local irritation of the bladder such as infection, trauma, inflammation
What types of brain damage causes detrusor instability?
Dementia
Stroke
Parkinson’s
Investigation of urge incontinence?
Ultrasound of bladder to exclude urinary retention
Management of urge incontinence?
Treat cause if able to: i.e. infection
Behavioural therapy:
- limit fluid intake
- mind over bladder
Pelvic floor exercises
Electrical stimulation
Drugs
Botox
Bladder augmentation
