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Flashcards in Urinary incontinence Deck (11):

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


What happens at the onset of voiding

the sphincters relax - mediated by decreased sympathetic activity


when does stress incontinence occur

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


stress incontinence rx

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


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


rx urge incontinence

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


overflow incontinence

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


rx overflow incontinence

urethral or suprapubic catheterisation to relieve obstruction otherwise = renal damage


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


causes of incontinence in old people

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


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