Flashcards in Incontinence And Malignancy Deck (78)
Which nerve controls the detrusor muscle?
PNS pelvic nerves
Which nerve controls the external urethral sphincter?
Somatic pudendal nerve
Describe the positions of the external sphincter
Relaxes when voiding
How does a lower motor neurone lesion affect the bladder and anus?
Low detrusor pressure
Large volume of residual urine -> overflow incontinence
Can't feel the bladder filling
Reduced perianal sensation
Lax anal tone
How does an upper motor lesion affect the bladder?
Constantly contracting the detrusor muscle
Poor coordination with sphincters
Urine can go up, dilate the ureters and cause damage to the kidneys
How do we classify lower urinary tract symptoms?
Describe some LUT symptoms of the storage phase
Describe some LUT symptoms of the voiding phase
Describe some LUT symptoms of post-micturition
Feeling of incomplete emptying
Define urinary incontinence
The complaint of any involuntary leakage of urine
How does incontinence affect quality of life?
Social exclusion - don't want to go out
Sense of shame
What are the different types of incontinence?
Describe stress urinary incontinence
Involuntary leakage on effort/exertion or on sneezing/coughing
Describe urge incontinence
Involuntary leakage accompanied by or immediately proceeded by urgency
Describe mixed urinary incontinence
Associated with urgency and also afford/exertion/coughing/sneezing
Describe overflow incontinence
Bladder accepts more and more urine without any action
Eventually it dribbles out due to the large volume
Describe the symptoms associated with overactive bladder syndrome
What is more common, overactive bladder or urge incontinence?
Overactive bladder syndrome
Why does the prevalence of urinary incontinence increase with age?
Bladder more sensitive
Less able to hold urine
Describe how BPH affects urinary incontinence
Enlarged prostate blocks urine flow
Bladder gets larger and larger until cannot distend anymore
Starts to leak
What is the most common type of urinary incontinence?
(Due to weak pelvic floor muscles)
Give some risk factors for urinary incontinence
Increased intraabdominal pressure
What examinations would you do for someone with incontinence?
Abdominal exam (palpable bladder?)
DRE - check prostate
Females - external genitalia and vaginal exam
What is the mandatory investigation for urinary incontinence?
Check for UTI, haematuria, proteinuria, glycosuria etc
After a urine dipstick, what other investigations could you do for incontinence?
Urodynamics: frequency-volume chart, bladder diary, post-micturition residual volume (USS)
Pressure flow studies
What different factors does the management of incontinence depend on?
Degree of nuisance
Effects of treatment
What is the general advice for someone experiencing urinary incontinence?
Decreased caffeine intake
Try to regulate bowel movements
What is contained incontinence?
For patients unsuitable for surgery who have failed conservative/medical management
Describe pelvic floor muscle training
3 times a day
For at least 3 months
Patients are not usually very compliant with this