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Flashcards in Urinary: Incontinence Deck (19):

What is the neurological supply of the bladder?

S234 which some from higher centres


What nerves innervate the detrusor and sphincter muscles?

The detrusor muscle is under involuntary control via the parasympathetic NS - supplied by the pelvic nerves (S234)
The external sphincter is under voluntary control via the somatic NS - supplied by the pudendal nerve (S234)


What is the maximum capacity of the bladder?



What is the consequence of a lower motor neurone lesion on the bladder?

The bladder is disconnected from higher centres so the detrusor muscle is always relaxed - therefore there is residual urine left over
The sphincter is always relaxed and there is no sensation of filling


What is the consequence of an upper motor neurone lesion on the bladder?

The bladder loses control and is purely under reflex
The detrusor and sphincter are always contracting to urine flows back up the ureters which become dilated


What are the 3 classifications of lower urinary tract symptoms?

Storage: frequency, urgency, nocturia, incontinence
Voiding (indicates obstruction): slow stream, straining, splitting, stop and start
Post micturation: feeling of incomplete emptying, post micturation dribble


What are the different types of incontinence?

Stress urinary incontinence: involuntary leakage on exertion eg sneezing or coughing (problem with sphincter)
Urge urinary incontinence: leakage accompanied by urgency (sensitive bladder or problem with detrusor)
Mixed urinary incontinence: both stress and urge urinary continence at the same time
Overflow incontinence: the bladder is accepting more urine


How prevalent is urinary incontinence?

Most common in men over 70 due to hypertrophic prostate
Stress urinary incontinence most common
Increases with age


What are some risk factors for urinary incontinence?

Pregnancy and childbirth, pelvic prolapse, anatomical abnormalities, increased intra abdominal pressure eg obesity, UTI, menopause, drugs, age


What examinations would you do?

- abdo exam to exclude palpable bladder (rule out urinary retention)
- digital rectal examination in males
- external genitalia stress test for women (ask them to cough)


What investigations can you do?

Mandatory: urine dipstick to test for infection, glucose to indicate uncontrolled diabetes, heamaturia and proteinuria
Non invasive: frequency volume chart, bladder diary, USS to measure residual volume
Invasive: pressure flow studies, cystoscopy to look inside bladder if theres any red flags


What are some lifestyle modifications that can help manage urinary incontinence?

Modify fluid intake, lose weight, stop smoking, decrease caffeine intake, avoid constipation, retrain bladder


What are the management options for pts unsuitable for surgery who have failed medical management?

Urethral or suprapubic catheter
Condom catheter
Incontinence pads


What is the initial management of stress urinary incontinence?

Pelvic floor muscle training - 8 contractions 3x daily for 3 months
Usually pts not very compliant but good results if they are


What is the pharmacological management of stress urinary incontinence?

Duloxetine - a combined noradrenaline and serotonin uptake inhibitor
Increased activity of the sphincter during the filling phase


What are the surgical options for stress urinary incontinence?

Females: most common is vaginal tapes which are a mesh to support the pelvic floor and sphincter, 90% success rate
Males: artificial urinary sphincter which has a closed band around the urethra which is opened by a button in the scrotum. 92% success rate


What is the initial management of urgency urinary incontinence?

Bladder training (scheduled voiding)
Void every hour then gradual increase intervals until 2-3 hours can be reached. At least 6 weeks duration


What are the pharmacological managements of urgency urinary incontinence?

Anticholinergics that act on M2 and M3 receptors (but have lots of side effects due to M receptors at other sites)
B3 agonists which help bladder to relax more and therefore fill more
Botulinum toxin injected into bladder to paralyse muscles - needs repeating every 3-6 months


What are the surgical options for urgency urinary incontinence?

Sacral nerve neuromodulation: alter signals from spinal chord using a probe, very effective
Divert urine from kidneys straight to outside

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