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Flashcards in Incontinence And Malignancy Deck (78)
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1

Which nerve controls the detrusor muscle?

PNS pelvic nerves
S2-4
Involuntary

2

Which nerve controls the external urethral sphincter?

Somatic pudendal nerve
S2-4

3

Describe the positions of the external sphincter

Usually contracted
Relaxes when voiding

4

How does a lower motor neurone lesion affect the bladder and anus?

Low detrusor pressure
No action
Large volume of residual urine -> overflow incontinence
Can't feel the bladder filling
Reduced perianal sensation
Lax anal tone

5

How does an upper motor lesion affect the bladder?

Constantly contracting the detrusor muscle
Poor coordination with sphincters
(Detrusor-sphincter dyssynergia)
Urine can go up, dilate the ureters and cause damage to the kidneys

6

How do we classify lower urinary tract symptoms?

By phase:
Storage
Voiding
Post-micturition

7

Describe some LUT symptoms of the storage phase

Frequency
Urgency
Nocturia
Incontinence

8

Describe some LUT symptoms of the voiding phase

Slow stream
Spitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble

9

Describe some LUT symptoms of post-micturition

Dribble
Feeling of incomplete emptying

10

Define urinary incontinence

The complaint of any involuntary leakage of urine

11

How does incontinence affect quality of life?

Depression
Social exclusion - don't want to go out
Sense of shame

12

What are the different types of incontinence?

Stress
Urge
Mixed
Overflow

13

Describe stress urinary incontinence

Involuntary leakage on effort/exertion or on sneezing/coughing

14

Describe urge incontinence

Involuntary leakage accompanied by or immediately proceeded by urgency

15

Describe mixed urinary incontinence

Associated with urgency and also afford/exertion/coughing/sneezing

16

Describe overflow incontinence

Bladder accepts more and more urine without any action
Eventually it dribbles out due to the large volume

17

Describe the symptoms associated with overactive bladder syndrome

Urgency
Frequency
Nocturia

18

What is more common, overactive bladder or urge incontinence?

Overactive bladder syndrome

19

Why does the prevalence of urinary incontinence increase with age?

Bladder more sensitive
Smaller
Less able to hold urine

20

Describe how BPH affects urinary incontinence

Enlarged prostate blocks urine flow
Bladder gets larger and larger until cannot distend anymore
Starts to leak
Overflow incontinence

21

What is the most common type of urinary incontinence?

Stress
(Due to weak pelvic floor muscles)

22

Give some risk factors for urinary incontinence

Family predisposition
Anatomical abnormalities
Neurological abnormalities
Co-morbidities
Increased intraabdominal pressure
UTI
Menopause
Pregnancy/childbirth
Pelvic surgery
Pelvic prolapse
Obesity
Age
Cognitive impairment
Drugs
Race

23

What examinations would you do for someone with incontinence?

BMI
Abdominal exam (palpable bladder?)
DRE - check prostate
Females - external genitalia and vaginal exam

24

What is the mandatory investigation for urinary incontinence?

Urine dipstick
Check for UTI, haematuria, proteinuria, glycosuria etc

25

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
Pad tests
Cystoscopy

26

What different factors does the management of incontinence depend on?

Symptoms
Degree of nuisance
Effects of treatment
Previous/current treatments

27

What is the general advice for someone experiencing urinary incontinence?

Lose weight
Decreased caffeine intake
Stop smoking
Try to regulate bowel movements

28

What is contained incontinence?

For patients unsuitable for surgery who have failed conservative/medical management
Condom catheters
Urethral/suprapubic catheter
Incontinence pads

29

Describe pelvic floor muscle training

8 contractions
3 times a day
For at least 3 months
Patients are not usually very compliant with this

30

Describe how duloxetine works to treat stress incontinence

Combined adrenaline and serotonin uptake inhibitor
Increased activity in external sphincter during filling so more likely to remain closed
Has many side effects