Week 4: Normal Micturation and voiding dysfunction Flashcards Preview

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Flashcards in Week 4: Normal Micturation and voiding dysfunction Deck (12):
1

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

2

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

3

Causes of abnormal bladder function in filling, storage, emptying

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

4

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

5

Differentiate between lower and upper motor neuron

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
LOWER MOTOR NEURON
1. Bladder: areflexic
2. Sphincter: normal to decreased

6

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

7

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

8

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

9

overflow

-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

10

Functional incontinence

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

11

Iatrogenic Incontinence

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

12

treatment for overactive bladder

-pads, behavior therapy, medications, neuromodulation, surgery
-anticholinergics