Urinary Incontinence in Women Flashcards
(35 cards)
What conditions can predispose to urinary incontence? Females?
Faecal impaction , decreased mobility, confusional states, drugs e.g. Diuretics & hypnotics.
What are the commonets types of urinary incontinence in women?
Stress urinary inconinece- SUI-
Overactive bladder
Retention w/ overflow
Fistula
Whats the commonets type of UI in women?
Stress UIs
60-70% of cases.
Can be a sign or symptom
Happens when there is a rise in intra- abdominal pressure without a detrussor contraction,
So notic leakege when coughing, sneezing, laughing
If severe: on walking or sitting up.
What happens in an overavrive bladder? Whats its %0 along UIs?
Detrussor hyperreflexia
When a. Woman is incontinent due to an involuntary detrussor contraction.
30% of cases in adult women.
She experiences urgency, if too slow pee on herslef. :(
Same day & night- complain of nocturia, ore severely, enuresis (bed wetting).
Whats commonest in eldelry patients?
Retention with overflow or thos with neurological problem.
Denervated bladder fills, until spills–> leakage.
Causes of a fistula im women?
Abnormal connection in UK usually surgical complication.
Affluent countries- obstructed labour.
1 in 1000
Any abnormal connection between Lower urinary tapract (ureter, bladder, urethra) and genital system (vagina, uterus)–> continuous dribbling of incontinence.
What should we consider!
That may have more than one type of ipcoexisting incontinence.
An over pactive bladder usualky coexists with both stress incontinence and voiding difficulty or tenetion.
Mechanism of incontinence
Maintained at bladder neck
Proximal urethra maintains continence. There is no flow of urine( radio opaque medium, Xray, woman standing) .
No sphincter muscles exists.
There is a smooth muscle in proximal urethra but runs longitudinally and not in a circular direction.
So could not maintain continence.
Whats the ‘proximal urethral sphincter mechanism’?
Water-tight seal which maintains the pressure in the urethra greater than that of the bladder.
Whats the water-tight seal made out if?
Arteriovenous anastomoses with the wall of the proximal,urethra,
passinung entirely around the urethraforming a hermetic seal
by keeping the urethra occluded.
Whats the distal urethral mechanism?
the greatest pressure however is in the mid-urethra.
Anatomical basis in muscle: The striated muscle innervated by spinal roots S2-4, is found within the wall of the mid-urethra.
Define urinary incontinence
Condition in which there is involuntary loss of urine, social and hygienic problem.
Urine vol lost not feature of dx
But that the person CAN confirm that there is urine loss.
Causes sign distress
F- 10-20% of adult female pop incontenent 1> times a month.
Age> 75- 25-50% of women.
Whats important about the intra-abdominal position of the urethra?
The supporting tissues– > if the proximal Urethravis intra-abdominal, then any pressure rise in the abdomen will be equally transmitted to the bladder & the prox urethra; the pressure difference will. Or change, and conintinence will be maintained.
What are the supporting tissues around the urethra and what happens when they are damaged?
Weakness/damage may predispose to stress incontinence.
Pubourethral ligaments, derived from facial of pelvic floor & levator ani.
What happens in vaginal delivery?
The pudental nerve might be compressed–> again, predisposing to stress UI.
Whats a bladder? What happens to overactive bladders in women?
Detrussor muscle should only contract during micturition and relax when filled. The detrussor relaxes durinh filling, but then contracts involuntarily.
How do the symptomes of overactive bladders come about?
If the contraction-modest, she will experience urinary urgency.
If severe- UI. Since the oressure in the bladder will be above the press of the urethra.
Whats the aetiology of stress(SUI?)
Requires some degree of weakness in both proximal & distal urethral sphnicter mechanisms.
No cause, but predisposing factors:
Pregnancy
Prolapse( e.g. Anterior vjj wall)
Menopause
Collagen disorder (constitute the pubourethral ligaments)
Obesity
How does pregnancy aid in SUI?
(denervation of pudental nerve–> damage to the supporting tissues round urethra)
The 1st vjj delivery more common to cause it.
Caesarean section can prevent it.
⬆️ intra abdo pressure, + smooth muscle- relaxant effect of progesterone.
Why does menopause cause SUI? What does that mean?
Oestrgen abscence reduces the maximal urethral closure pressure; hence urethral pressure not as great as it used to be :( oh noo.
A small rise in intra abdo pressure, will reult is SUI.
Whats the pathophysiology of an overactive bladder?
Idiopathic
Neurogenic
Psychogenic
Poss agentsinvolved:
Nerve growth Factor, glutamate, nitric oxide, ATP
Voiding difficulty
Opposite as that of men!
Women: due to underactive detrussor (hypotonia) 90% and 10% shows anatomical obstruction.
Usually simple ageing, natural reduction of muscle fibres and strength–> enough to present clinically.
Neuronprobs- inapropriate contraction of urethral sphincter.
Clinical presentations of UI in women-
Stand alone- uncommon.
Urge incontinence- overactive bladder.
Ask about voiding difficulties
Sx are same as men: prostatic enlargement:
Hesitancy, poor stream, intermettent stream, streining to void, feeling of incomplete emptying and post- micturition dribbling.
Haematuria❌ – upper & lower urinary tracts ecpxamined.
What else can coexist with UI?
Anal. Incontinence Full DHx +medical Hx Essential: what impact on her lifestyle Can prevent socialising Severe: personality changes + womans sex life.
