Urinary Incontinence Flashcards
(56 cards)
Risks that come alongside urinary incontinence?
Increase risk of falls and fractures
Social isolation and toilet mapping
Skin irritation and pressure sores
Increased risk of catheterization
How does the bladder act to store urine and how much is stored?
can store maximum of 500mls but usually empty at 250mls
Smooth muscle detrusor muscle allows expansion of bladder without increased pressure
What is the urethra made from?
Fibromuscular tube lined with mucosa
Where can the urethral opening and internal ureteral orifice be found?
Trigone
What are the 3 layers of muscle that surround the proximal urethra as it leaves the bladder?
Outer striated
Middle circular smoother muscle
Inner longitudinal smooth muscle
What is the outer striated muscle layer of the urethra also known as?
Rhabdosphincter
What is the difference between the internal and the external sphincters of the urethra?
Internal sphincter is detrusor continuation that extends nearly the whole length of the urethra
External sphincter has an intramural and extramural component that extends into the pelvic floor muscles
What 2 areas of the brain delay voiding by inhibiting the pontine micturition centre?
Hypothalamus and prefrontal cortex
Where is the pontine micturition centre found?
Brainstem
Motor innervation is sent via pudendal nerve which is involved in continenece?
Innervation to levator ani muscle
Contraction of external urethral sphincter
What nerve provides sympathetic innervation to the bladder and urethra? What nerve roots does this come from?
Hypogastric nerve from T10-L2
What kind of innervation does the hypogastric nerve provide and what does it cause?
Sympathetic innervation
Provides SM contraction of the urethra and bladder base
Detrusor muscle relaxation
What receptors on the detrusor muscle are activated by sympathetic innervation causing relaxation?
Beta 3
What spinal roots does parasympathetic innervation of ht bladder come from? What receptors are stimulated? Where? what happens?
S2-S4
Stimulates M3 muscarinic receptors on detrusor
Causes detrusor contraction
Where is the spinal micturition centre?
S2-S4 = effectively the parasympathetic supply
How does the bladder change as we age?
Less contractility - leaves greater residual volume
Less capacity
Detrusor overactivity
Bacteraemia more common
Increased volume excreted later in the day or at night
How do the pelvic floor muscles change as we age?
Pelvic floor muscle atrophy
Pelvic organ prolapse especially when they can’t compensate for changes in intra-abdominal pressure
Difference in urinary leakage types caused by atrophic vaginitis vs prostate enlargement?
Atrophic vaginitis = incontinence
enlarged prostate = overflow
Two classifications of duration in terms of urinary incontinence?
Transient
Established
DIAPPERS pneumonic for transient incontinence?
Delirium Infection Atrophic urethritis/vaginitis Pharmacological Psychological Excessive UO Reduced mobility Stool impaction
6 different types of incontinence?
Urge incontinence Stress incontinence Mixed incontinence Overflow incontinence Neurological or reflex incontinence Functional incontinence
What is the usual demographic for individuals suffering stress incontinence?
Female
After surgery or childbirth
Pathophysiology of stress incontinence?
Weakened external sphincter and prolapse bladder neck
Causes no prevention to the stop of urine when there is an increase in intraabdominal pressure - coughing, standing, exercise, obesity
What is the non-pharmacological management of stress incontinence?
Lose weight
Pelvic floor exercises
Treat any chronic cough
