L6 Flashcards
(27 cards)
Normal function of urinary bladder
- Bladder filling:
Detrusor muscle relax, urethral sphincter contract, pelvic floor contract - First sensation to void (200-300mL)
Bladder half full, urination voluntarily inhibited until appropriate timing - Normal desire to void
- Micturition:
Detrusor muscle contracts, urethral sphincter relax, pelvic floor relax
Stress incontinence
Increase abdominal and detrusor pressure; incompetent urethra
Causes of stress incontinence
Weakened bladder neck;
Internal sphincter deficiency;
Vaginal prolapse下垂 due to vaginal brith or aging
Symptoms of stress incontinence
Urine loss through physical exertion (e.g. cough, sneeze, exercise);
Small volume of urine loss with each exertion;
Normal voiding;
Post-void residual: <=50mL
Treatment for stress incontinence
Pelvic floor exercise;
Lifestyle modification e.g. weight loss;
External condom catheter or penile clamps for men
Urge incontinence
Involuntary loss of urine associated with a strong desire to urinate
Cause of urge incontinence
Overreactive bladder or detrusor muscle; Brain and nerve disorders; Bladder cancer; Bladder inflammation or infection
Symptoms of urge incontinence
Abrupt突然 and strong urge to urinate;
May have loss of large amount of urine with each occurrence
Treatment for urge incontinence
Pelvic floor exercise; Bladder training and time voiding; Lifestyle modification e.g. prevent constipation; Anticholinergic drugs; Containment devices e.g. external condom catheter and absorbent products
Mixed incontinence
Combination of stress and urge incontinence
Overflow incontinence
Involuntary urine loss due to over distention of the bladder; Obstruction of the urethra; small but frequent urination
Causes of overflow incontinence
Anatomic obstruction (by enlarged prostate, large cystocele {bladder bulge into the vagina}, faecal impaction);
Detrusor muscle underactivity;
Detrusor muscle areflexia (unable to contract) due to diabetes neuropathy or low spinal cord injury
Symptoms of overflow incontinence
Bladder distention; Constant dribbling of urine; Small but frequent urination
Treatments for overflow incontinence
Urinary catheterisation or intermittent catheterisation for bladder decompression;
Alpha-adrenergic blockers/antagonists;
Surgery; Intravaginal devices e.g. pessary to support prolapse
Causes of functional incontinence
Cognitive disorder; Immobility; Physical restraints; Unavailability of toilet assistance; Depression
Alpha-adrenergic blocker
Relax the smooth muscle of bladder neck and prostatic urethra
Anticholinergic drug
Used in urge incontinence
Block the action of acetylcholine in muscarinic receptors
Relax bladder muscle and inhibit overactive detrusor contractors
Side effects: dry mouth and eyes, constipation, blurred vision, sleepiness
Botox
Used in urge incontinence (overreactive of detrusor muscle)
Injection to the bladder to relax it and increase storage capacity
Pelvic floor muscle exercise
Involve voluntary contraction and relaxation of levator ani muscle;
Prevent downward rotation of urethra and involuntary urine loss;
Increase urethral closure pressure;
Allow a stronger relax control following a quick rise in intra-abdominal pressure
Increase support to urethral sphincter and detrusor muscle
Acute retention of urine
Total inability to pass urine out through micturition
Medical emergency
Chronic retention of urine
Incomplete bladder emptying despite urination
Post void volume >= 300mL
Causes of urine retention
Bladder outlet obstruction;
Deficient detrusor muscle contraction strength
Assessment for urine retention
Bladder scanner use USG to scan estimate urine; over 400mL may need intermittent catheterization
Management of urine retention
Catheterizatioin (intermittent / indwelling);
Drug therapy; Surgery;
Scheduled toileting
