3 types of Stress Incontinence
Type 1: Urine loss occurring in the ABSENCE of urethral hypermobility
Type 2: urine loss due to urethral hypermobility
- most common
Type 3: Urine loss due to intrinsic sphincter deficiency
Urge incontinence
- what is it?
- what is it most commonly caused by?
Involuntary leakage accompanied by or immediately preceded by urgency
- most commonly caused by overactive bladder syndrome
*stress incont is mostly caused by urethral hypermobility
Mixed incontinence
involuntary leakage associated with urgency and ALSO with exertion, effort, sneezing or coughing
*stress incontinence + urge incontinence
Most common cause of stress incontinence
urethral hypermobility
- results from poor urethral support
*urge incont. is most commonly caused by overactive bladder synd.
Intrinsic sphincter deficiency (stress incontinence) is usually result of?
deterioration of urethral musculature (external urethral sphincter) and/or neurologic injury
- urethra fails to close in response to increases in intra-abdominal pressure
Type of female incontinence: Cough Sneeze Laugh Exercise Position change
Stress Inc
Type of female incontinence: Urgency Frequency Nocturia Dysuria
Urgency Inc.
Type of female incontinence:
Stress + urge
Mixed
Cystometry
Detects rise in bladder P and the sensations that occur when the bladder fills
- Pt is standing –>
insert catheter –>
empty bladder –>
500 cc of water –>
Ask pt to report bladder initial sensation, initial urge to void, and maximum bladder capacity.
- Not very sensitive. Miss 40%.
3 muscles that make up Levator ani
PPI
Puborectalis
Pubococcygeus
Iliococcygeus
What indicates detrusor muscle overactivity in cystometry
Any rise in the meniscus of the fluid in the barrel of the syringe is considered a detrusor contraction and indicates detrusor overactivity.1
Multichannel urodynamics
Measures physiologic fxns of lower urinary tract
- P catheter in bladder and vagina or rectum
- Pdet calculated
4 fxns of levator Ani muscles
- Maintains constant tone
- Rapid contraction w/ cough
- Relaxation w/ defecation/urination
- Massive expansion/stretching during labor with quick recovery to “nl”
Type I fibers vs Type II
Type I fibers:
- slow twitch
- maintain tone
- 70% of muscle
Type II fibers:
- fast twitch
- rapid response to sudden increases in P
- 30% of muscle
Sensations of bladder fullness begin when the bladder is at half its physiologic capacity which is _____ mL. Max cystometric capacity is achieved at _____ mL.
First sensation: 100 mL
First desire to void:
250 mL
Max capacity:
500 mL
Muscle action when a person chooses to void. What about when it is complete?
the
urethral sphincter is voluntarily relaxed, the pelvic floor relaxes,
the detrusor contracts, and micturition occurs.
Once complete, the cycle resumes with bladder filling. The urethral sphincter and pelvic floor contract while the detrusor relaxes.
Urinary incontinence affects what % of women?
15-50%
*increases in prevalence with age
Parasympathetic nerve stimulation and administration of cholinergic drugs cause the detrusor muscles to ____
contract
Anticholinergic drugs cause the detrusor muscle to:
relax
- reduce bladder P and increase bladder capacity
Parasympathetic fibers originate in ____.
Sympathetic fibers originate from ____.
PS:
sacral spinal chord seg S2-S4
S:
Thoracolumbar segments (T10-L2)
- has alpha and beta adrenergic components
Alpha and beta fibers of the sympathetic system terminate where?
What does stimulation to each do?
B: terminate in detrusor muscle
- stimulation relaxes urethra and detrusor muscle
- let bladder fill up
a: terminate in urethra
- stimulation contracts the bladder neck and urethra
- relaxes detrusor
* not let anything out
Pudendal nerve (S2-4) provides motor innervation to ____
Striated urethral sphincter
Secondary defense against incontinence
Striated muscular urethral sphincter, which surrounds the distal 2/3s of the urethra
- contributes 50% of total urethral resistance
- also responsible 4 interruption of urinary flow at end of micturition
Most common vaginal prolapse
cystocele
- anterior vagina
