Urinary incontinence Flashcards Preview

Year 2 > Urinary incontinence > Flashcards

Flashcards in Urinary incontinence Deck (38):
1

What is urinary incontinence?

Involuntary leakage of urine

2

Urinary incontinence is common. T/F

True

3

Which sex experiences urinary incontinence more commonly?

Female

4

List the types of urinary incontinence

Overflow
Urge
Stress
Mixed

5

By which two means might urine leak extra-urethrally?

Extopic ureter
Fistula

6

Explain the normal micturition cycle

Storage phase - intravesical pressure lower than intraurethral pressure so urine stays in bladder

Voiding phase - detrusor contracts increasing intravesical pressure above intraurethral pressure causing relaxation of sphincters and micturition

7

What affects intravesical pressure?

Urine volume
Detrusor muscle
Abdominal pressure (coughing, sneezing, etc)

8

What is urodynamics?

An invasive test measuring pressure within the bladder and abdominal cavity and detrusor muscle pressure

9

How is a urodynamic test carried out?

Pressure sensor in bladder
Pressure sensor in rectum
Ask patient to cough three times - each time with more force

10

What are the components of the micturition reflex?

Bladder
Sphincters
Brain
Spinal bladder centre (S2-3)

11

Which nerves are involved in the micturition reflex?

Pelvic parasympathetics (bladder & internal sphincter)
Pudendal (external sphincter)

12

The micturition reflex is inhibited and facilitated by descending controls from the brain. T/F

True

13

What causes overflow incontinence?

Outflow obstruction

14

How does overflow incontinence present?

Huge palpable bladder
Chronic retention
Enuresis
Insensible incontinence (only aware after feeling wetness)
Renal impairment (due to back pressure of urine)

15

What causes urge incontinence?

Detrusor overactivity

16

How does urge syndrome present?

Increased frequency
Small volumes of urine
Urgency (provoked by sounds, standing, coughing, laughing, sneezing)
Enuresis
Urge incontinence

17

What is detrusor overactivity?

Contraction of detrusor during inhibition of micturition

18

How is detrusor overactivity diagnosed?

Urodynamics

19

What causes detrusor overactivity?

Afferent overstimulation (stone, tumour)
Excess central facilitation (anxiety)
Paraplegia (loss of central inhibition)
Destruction of bladder centre (S2-3) - inert bag bladder
Pelvic surgery/fracture --> parasympathetic nerve damage
Idiopathic

20

What is damage to parasympathetic nerves associated with?

Higher risk of infection

21

What nerve is not affected when parasympathetic nerves are damaged?

Pudendal!

22

How does idiopathic detrusor overactivity usually present?

Older woman
Urgency
Frequency
Urge incontinence

23

What is (urodynamic) stress incontinence?

Leakage of urine during increased intra abdominal pressure WITHOUT detrusor contraction

24

What causes stress incontinence?

Damage to pelvic floor
Damage to urethral function

i.e child birth

25

How is stress incontinence diagnosed?

Urodynamics

26

When might frequency occur with stress incontinence? Which symptom should not be present?

As a learned behaviour to try and prevent/reduce incontinence
Urgency

27

How should the bladder feel on examination (if it is full)?

Painless mass arising from pelvis
Cannot "get below it"
Dull to percussion

Nb - in female patients it could be pregnancy

28

How is overflow urinary incontinence treated?

Assessment of renal function
Catheterisation to treat obstruction
Rehabilitation of bladder (teach how to self catheterise)

29

How is urge urinary incontinence treated?

Avoid caffeine
Bladder retraining
Timing of bladder emptying
Pharmacotherapy
Neuromodulin (pacemaker)
Enterocystoplasty

30

Which pharmacological options are available in the treatment of urge incontinence? What are the side effects?

Anti-muscarinics e.g oxybutinin, tolterodine (dry mouth)
Beta 3 adrenergic i.e mirabegron

31

How is stress incontinence treated?

Weight loss
Smoking cessation
Physiotherapy (pelvic floor exercises)
Pharmacotherapy (not useful)
Surgery (open vs tape)

32

How is mixed incontinence treated?

Combination urge and stress treatment approach

33

What are risk factors for urinary incontinence in the elderly?

Dementia
Immobility
Drugs (diuretics, sedatives)
Obstruction --> overflow
Neuropathy
Weak pelvic floor

34

Ectopic ureters are congenital. T/F

True

35

What is the cause of most vesico-vaginal fistula?

Prolonged obstructed labour

36

What is urgency?

Sudden, compelling desire to pass urine

37

List some voiding symptoms

Slow stream
Abnormal stream (splitting)
Hesitancy
Straining

38

What is a frequency volume chart?

Used to measure urine output (& at which time of day) for at least 24 hours

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