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Flashcards in Voiding Dysfunction Deck (20):
1

role of nervous system in micturition:
parasympathetic: facilitates _____
sympathetic: facilitates _____

micturition; urine storage

2

how does the sympathetic nervous system facilitate urine storage?

inhibition of detrusor (beta2 adrenergic receptors), contraction of "internal sphincter" (alpha adrenergic receptors)

3

what divisions of the nervous system are responsible for voluntary control over micturition?

CNS and the somatic division of PNS

4

what division of the nervous system is responsible for motor activation of detrusor contraction?

parasympathetic division of autonomous PNS

5

role of pontine micturition center

coordination of detrusor and sphincters

6

describe the micturition reflex

autonomic reflex; bladder fills with urine causing stretching of bladder wall --> send signals to spinal cord that promote detrusor contraction

7

how is micturition reflex modulated?

CNS (cortex) sends inhibitory signals to "turn off" micturition reflex; when decision to urinate is made, CNS removes inhibitory signals and external sphincter relaxes

8

detrusor contraction: ______ innervation
internal sphincter relaxation: ______ innervation

parasympathetic; sympathetic

9

urge incontinence: what is it and how is it treated?

uncontrolled urine leakage that occurs immediately after an urgent, irrepressible need to void (micturition reflex is not being inhibited by the brain); treated with pelvic floor exercises, anticholinergic medications (inhibit overactive detrusor contractions) and beta-3 agonist (relaxes detrusor)

10

stress incontinence: what is it and how is it treated?

urine leakage caused by abrupt increases in intra-abdominal pressure (e.g., with coughing, sneezing, laughing, bending, or lifting) due to weakness of the urethral and bladder neck support structures or weakness of the urethral/periurethral/bladder neck musculature (caused by childbirth, surgery, pelvic trauma); treated with pelvic floor exercises, duloxetine, surgery to lift/support urethra and bladder neck

11

overflow incontinence: what is it and how is it treated?

dribbling of urine from an overly full bladder (chronic urinary retention), mostly due to BPH in men; treated with catheter drainage of bladder and trying to reverse any outlet obstruction present

12

functional incontinence: what is it

urine loss due to cognitive or physical impairments or environmental barriers

13

stress incontinence: risk factors

vaginal/pelvic trauma, lack of estrogen (menopause), neurologic (spina bifida), radiation therapy, obesity

14

urge incontinence: risk factors

lack of estrogen (menopause), obesity, pelvic organ prolapse, pelvic floor dysfunction

15

_______ inhibits the detrusor and activates the bladder neck/internal sphincter for urine storage

sympathetic nervous system

16

______ controls the external sphincter (voluntary control)

somatic nervous system

17

give short descriptions of urge, overflow, and stress incontinence

urge: due to hyperactive/overactive bladder
overflow: due to weak overdistended bladder
stress: due to weak/damaged sphincter

18

what types of medications can cause urinary retention?

anticholinergics, alpha-agonists, and narcotics

19

lesion in brain (tumor, stroke) --> what kind of urinary problems?

lack of inhibition of micturition reflex by the brain

20

lesion in spinal cord between pons and sacral spinal cord --> what kind of urinary problems?

hyperactive bladder, destrusor-sphincter dyssynergia