Incontinence

Question 1

Define incontinence

Answer 1

Involuntary leakage of urine

Question 2

When does incontinence occur?

Answer 2

When bladder pressure > urethral pressure

Question 3

Who is most likely to suffer from incontinence?

Answer 3

<2 years old

Unable to suppress reflex bladder emptying

Question 4

What are the types of incontinence?

Answer 4

• stress incontinence
• urge incontinence
• overflow incontinence

Question 5

What is stress incontinence due to?

Answer 5

• intrinsic sphincter deficiency
• damage to external sphincters and/or pelvic floor
• increased abdominal pressure = lifting/sneezing/coughing

Question 6

What is urge incontinence due to?

Answer 6

• overactive bladder

- instability of bladder reflexes = sudden bladder contractions

Question 7

What is overflow incontinence due to?

Answer 7

• bladder doesn’t contract as amount of urine exceeds capacity
• frequent voiding of small volumes
• after dribble
• caused by poor bladder emptying
• due to obstruction or detrusor muscle/nerve damage

Question 8

What are some causes of urinary incontinence?

Answer 8

• trauma to pelvic floor
• spinal cord injury
• stroke/brain injury
• MS
• prostate enlargement
• bladder cancer
• urethral strictures

Question 9

How can trauma to the pelvic floor occur?

Answer 9

• child birth & post-prostectomy
• stress incontinence
• pelvic floor exercises

Question 10

Treatment for pelvic floor trauma incontinence

Answer 10

• AUS (artificial urinary sphincter)
• bulking materials
• slings
• mesh implants

Question 11

What are the sections of the spinal cord?

Answer 11

8 paired cervical
12 paired thoracic nerves
5 paired lumbar nerves
5 paired sacral nerves
1 pair of coccygeal nerves

Question 12

What is the role of the cerebral cortex?

Answer 12

• interprets messages as full or empty bladder

Question 13

What is the role of the pontine micturition centre?

Answer 13

Switches between filling/storage and voiding

Question 14

What is the role of the hypogastric nerve?

Answer 14

Sympathetic

Inhibits detrusor contraction during filling mode and contract muscles in urethra and bladder neck

Question 15

What is the role of the pelvic nerve?

Answer 15

Parasympathetic

Unopposed impulses result in detrusor contraction

Question 16

What is the role of the pudendal nerve?

Answer 16

Somatic

Under voluntary control

Question 17

What are the roots of the hypogastric nerve?

Answer 17

T10-L2

Question 18

What are the roots of the sacral micturition centre?

Answer 18

S2-S4

Question 19

How does a spinal cord injury above T10 present?

Answer 19

• reflexes are intact but no suppression = abberant reflexes

- no co-ordination of bladder and external sphincter contraction

Question 20

What are the result of abberrant reflexes?

Answer 20

• bladder reflex contractions at low volumes

- hyper-reflexia, urge incontinence

Question 21

What are the result of no co-ordination of bladder & external sphincter contraction?

Answer 21

• DSD
• high bladder pressure
• reflux, damage to ureters + kidneys
• kidney failure

Question 22

What is DSD?

Answer 22

Detrusor sphincter dyssynergia

Question 23

What is the treatment for incontinence due to spinal cord injury above T10?

Answer 23

• anticholinergic drugs (botox)
• intermittent catheters
• electrical stimulator implants (neuromodulation)

Question 24

How does incontinence due to spinal cord injury below T10 present?

Answer 24

• areflexic
• no contraction of detrusor or sphincter
• overflow incontinence
• little chance of reflux or kidney damage
• some patients can void by raising abdominal pressure -> incomplete emptying + UTI risk

Question 25

What is the treatment for incontinence due to spinal cord injury below T10?

Answer 25

• catheters

- electrical stimulator implants (voiding)

Question 26

How does incontinence due to stroke/brain injury occur?

Answer 26

• damage to part of the brain which inhibits pontine micturition centre
• urge incontinence

Question 27

How does MS incontinence occur?

Answer 27

• 80% of MS lesions disrupt control of bladder and sphincters
• overactive bladder = urge incontinence
• inability to empty = overflow incontinence
• sphincter muscle impairment = stress incontinence

Question 28

What are some other symptoms of MS?

Answer 28

• frequency and/or urgency
• hesitancy in starting voiding
• nocturia
• inability to empty completely

Question 29

What are some causes of prostate enlargment?

Answer 29

BPH

Prostate Cancer

Question 30

How many people have BPH?

Answer 30

30% of men over 60

Question 31

How significant is prostate cancer?

Answer 31

3rd highest cause of death in USA

Question 32

What are the symptoms of enlargement -> obstruction?

Answer 32

• poor flow rate <10ml/s, time to empty
• overflow incontinence/after dribble
• UTI
• frequency/nocturia
• retention -> pain
• changes to detrusor & kidney

Question 33

Treatment of prostate enlargement incontinence?

Answer 33

Drugs
Prostacteomy (open or TURP)
Endoprostatic stent

Question 34

What is the treatment for bladder cancer?

Answer 34

Chemo/radiotherapy
Cystectomy = removal of part/all of bladder (trigone sparing)
Artificial bladder (neo-bladder (bowel segment) or tissue engineering))

Question 35

How do urethral strictures present?

Answer 35

• scar tissue forms around urethra -> contraction

- obstruction

Question 36

What are the causes of urethral strictures?

Answer 36

Trauma
Infection
Malignancy
Congenital

Question 37

What are the symptoms of urethral strictures?

Answer 37

SAME AS BPH

• poor flow rate <10ml/s, time to empty
• overflow incontinence/after dribble
• UTI
• frequency/nocturia
• retention -> pain
• changes to detrusor & kidney

Question 38

What is the treatment for urethral strictures?

Answer 38

• internal urethrotomy
• urethral stent
• catheters
• tissue engineering/reconstruction