Week 4: Normal Micturation and voiding dysfunction Flashcards Preview

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Flashcards in Week 4: Normal Micturation and voiding dysfunction Deck (12):

Frequency and impact of incontinence in the US

-10-35% of adults are affected by incontinence
-2x as many women as men, mostly nursing home residents


Neuroanatomy and function of normal voiding.

-continence is learned: cognitive control over a reflex bladder contraction
1. Sensory afferent nerves sends signals from bladder to T10-L2 then to brain that bladder is full via Pudendal nerve. Activates spinobulbospinal reflex pathway passing through pons
-pontine micturition center activated, cortical inhibitory tone released
2. parasymp stimulation of detrusor muscle activated via S2-S4 via pelvic nerves
3. signaling to bladder neck and urethra inhibits contraction via inhibition of symp and somatic nerves (sphincter tone) and allows voiding


Causes of abnormal bladder function in filling, storage, emptying

-poor compliance
-overactive bladder
-poor sphincter activity
-disruption in connection and communication between brain and bladder
-injury to cortex/brain
-overstretched detrusor: chronic obstruction or loss of sensation
-injury to spinal cord
-injury to pons
-non-relaxation of outlet
-obstructed outlet
-poor bladder contraction (areflexia)-easily stretched, can overfill and leak


Etiology of abnormal bladder function

1. Idiopathic (non-neurogenic)
-must rule out BPH, UTI, bladder tumor, stones, polyuria secondary to ...
2. Neurogenic: can be upper motor or lower motor neuron problem
-MS, spinal cord injury, transverse myelitis, CVA, parkinsons


Differentiate between lower and upper motor neuron

1. bladder: detrusor overactivity with
2. sphincter:
-supersacral spinal cord lesion-->sphincter dyssynergia. Usually have coordination of bladder contraction with sphincter relaxation, but can have sphincter contraction while bladder contraction with interruption in voiding
-at or above brains ten-->synergistic sphincter: doesn't affect pontine center of micurition which coordinates detrusor and sphincter activity
1. Bladder: areflexic
2. Sphincter: normal to decreased


Categorization of void dysfunction

1. Stress incontinence: underactive urethra
2. urgency incontinence: overactive bladder-mixed stress and urge
3. overflow: underactive bladder or overactive urethra or both
4. functional
5. iatrogenic
6. transient


Stress urinary incontinence

-due to poor outlet resistance: sphincter problem
-symptoms: cough, sneeze, exercise incontinence
-small amounts of urine loss
-no feelings of urgency or frequency


urge incontinence

-due to bladder overactivity
-may coexist with stress urinary incontinence
-origin: idiopathic or neurologic
-symptoms: urgency prior to leakage or leakage without awareness
-wet at night or nocturne, frequency, urgency, often large volume, no relationship to activity



-due to failure to empty
-outlet obstruction or poor contractility or both: neurologic, BPH, diabetes, radical pelvic surgery
-symptoms: straining to void, poor sensation, frequency


Functional incontinence

-normal lower urinary tract but unable to toilet due to physical or cognitive limitations
-s/p joint replacement, back surgery, dementia


Iatrogenic Incontinence

-Treatment related/physician neglect
-diuretics, bladder over distention after spinal anesthetic
-medications: antihistamines, anticholinergics, antidepressants


treatment for overactive bladder

-pads, behavior therapy, medications, neuromodulation, surgery