Urinary Incontinence 2

Posted by e-Medical PPT
Urinary incontinence is the inability to control urination which results in unintended urinary flow or leakage
Normal Bladder Function and Continence
Detrusor muscle:
under simultaneous sympathetic and parasympathetic control
Filling phase:
sympathetic tone predominates
allows relaxation of detrusor and tightening of internal sphincter

Voluntary voiding:
sensation of bladder fullness mediated by proprioceptive fibers in detrusor
reflex arc between detrusor and brainstem initiates bladder contraction via increase in parasympathetic and decrease in sympathetic stimulation
reflex under cortical inhibition
voiding occurs with release of inhibition and voluntary relaxation of external sphincter
urethrovesicular angle changes to allow full drainage of bladder

Classification of Urinary Incontinence
6 major subtypes of urinary incontinence:
Stress
Urge (“overactive bladder”)
Overflow
Mixed
Functional
Other (deformity/lack of continuity)

Stress incontinence
Causes:
urethral hypermobility due to pelvic floor laxity
aging
difficult or multiple vaginal deliveries
hysterectomy
other perineal injury (e.g. radiation)
intrinsic urethral sphincter deficiency
autonomic neuropathy
inadequate estrogen levels
partial denervation

Urge incontinence (overactive bladder, detrusor instability)
Cause:
Inappropriate contraction of detrusor muscle during bladder filling
idiopathic
related to aging (unclear mechanism)
decreased cortical inhibition (CVA, Parkinson’s disease, Alzheimer’s disease, brain tumor)
bladder irritation (UTI, bladder CA, stones)

Reflex incontinence (FYI)
variant of overactive bladder caused by SCI, MS, neurosyphilis, or cord compression
loss of central control leads to detrusor spasticity and functional outlet obstruction
symptoms:
frequent voiding without warning
moderate volumes
equal frequency day and night
decreased perineal sensation and sphincter control
sacral reflexes intact..

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