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Flashcards in Voiding Dysfunction Deck (20):

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

micturition; urine storage


how does the sympathetic nervous system facilitate urine storage?

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


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

CNS and the somatic division of PNS


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

parasympathetic division of autonomous PNS


role of pontine micturition center

coordination of detrusor and sphincters


describe the micturition reflex

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


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


detrusor contraction: ______ innervation
internal sphincter relaxation: ______ innervation

parasympathetic; sympathetic


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)


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


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


functional incontinence: what is it

urine loss due to cognitive or physical impairments or environmental barriers


stress incontinence: risk factors

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


urge incontinence: risk factors

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


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

sympathetic nervous system


______ controls the external sphincter (voluntary control)

somatic nervous system


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


what types of medications can cause urinary retention?

anticholinergics, alpha-agonists, and narcotics


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

lack of inhibition of micturition reflex by the brain


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

hyperactive bladder, destrusor-sphincter dyssynergia