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Urinary Incontinence Notes

Medicine Notes > Gynaecology Notes

This is an extract of our Urinary Incontinence document, which we sell as part of our Gynaecology Notes collection written by the top tier of University Of Leicester students.

The following is a more accessble plain text extract of the PDF sample above, taken from our Gynaecology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Urinary Incontinence Nerve supply to the bladder
- Parasympathetic o S2-4 - contraction of detrusor muscle in voiding
- Sympathetic o T12-L2 - contraction of sphincter in storage
- Somatic o S2-4 - contraction + relaxation of pelvic floor (voluntary)

Muscles involved in continenceDetrusor muscle o Active relaxation in filling + contraction in voiding Internal urethral sphincter: smooth autonomic muscle External urethral sphincter: striated voluntary muscle Pelvic floor (levator ani): supports bladder + compresses urethra

Maintaining continenceContinence relies on bladder pressure < urethral pressure Bladder pressure = detrusor pressure + abdominal pressure Urethral pressure = abdominal pressure + internal sphincter +
external sphincter + pelvic floor pressure As long as the bladder is held in the correct position, the intraabdominal pressure is spread equally over the bladder and urethra If the pelvic floor is damaged then the bladder sits lower in the pelvis - therefore abdominal pressure is transferred only to the bladder o Bladder pressure> urethral pressure = incontinence

Normal bladder function 2 main phases

1. Storage phase a. Active relaxation of detrusor muscle as bladder fills to keep a low pressure b. Contraction of urethral sphincters c. Sensory efferents sense filling + communicate with brain d. Voluntary reinforcement of external sphincter tone at capacity

2. Voiding phase a. Removal of higher centre suppression leads to coordinated relaxation of sphincters + detrusor contraction

Clinical featuresInUrgency = overwhelming desire to void Urge incontinence = urgency + leaking Stress incontinence = leak of urine when raised intra-abdominal pressire Frequency = voids > 8/day Nocturia = voids > 2/night Hesitancy = delay in commencing stream O/E look for Dysuria = discomfort (burning sensation) on voiding
- Obesity
- Adb/pelvic mass the history
- Prolapse Look for symptoms listed above
- Visible Ask about pattern of symptoms, severity, impact on QoL incontinence Assess fluid intake
- Surgical scares

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