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
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