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Flashcards in Urinary incontinence Deck (11):
1

which 2 factors ensure the bladder maintains continence as it fills

- Intravesical pressure remains low as a result of stretching of the bladder muscle (detrusor) which does not contract involuntarily
- the sphincter mechanisms of the bladder neck urethral muscles

2

What happens at the onset of voiding

the sphincters relax - mediated by decreased sympathetic activity

3

when does stress incontinence occur

as a result of sphincter weakness
small leak of urine when intra abdo pressure rises eg with coughing

4

stress incontinence rx

young women - pelvic floor exercises
post menopausal women - oestrogen creams
surgery - artificial sphincter

5

what happens in urge incontinence

strong desire to void and the pt may be unable to hold his or her urine - caused by detrusor overactivity or overactive bladder

6

rx urge incontinence

mild cases - bladder retraining, reduction of alcohol / caffeine, hypnotherapy & electrical stimulation
severe - botulinum toxin (botox)

7

overflow incontinence

men w prostatic hypertrophy causing outflow obstruction
leakage of small amounts of urine
distended bladder on abdo exam

8

rx overflow incontinence

urethral or suprapubic catheterisation to relieve obstruction otherwise = renal damage

9

neurological causes of incontinence

brainstem damage - incoordination of detrusor muscle activity and sphincter relaxation = they contract together
rx - a-adrenergic blockers
autonomic neuropathy eg in diabetes - decreases detrusor excitability = distended bladder and large residual urine = infec

10

causes of incontinence in old people

diuretic rx, dementia and difficulty in getting to the toilet because of immobility

11

neuronal control of the lower urine tract

PS (cholinergic) S3-5 drive detrusor contraction = pee
S (noradrenergic) T10-L2 urethral contraction (smooth muscle component but the main part of the sphincter muscle is skeletal muscle), and inhibits detrusor contraction