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Medicine Notes Gynaecology Notes

Urinary Incontinence Notes

Updated Urinary Incontinence Notes

Gynaecology Notes

Gynaecology

Approximately 26 pages

Complete set of notes covering gynaecology. Includes pathophysiology, presenting features, investigation and management. Uses colour coding for different topics and tables and diagrams. Ideal for written or clinical finals...

The following is a more accessible 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

    • S2-4 – contraction of detrusor muscle in voiding

  • Sympathetic

    • T12-L2 – contraction of sphincter in storage

  • Somatic

    • S2-4 – contraction + relaxation of pelvic floor (voluntary)

Muscles involved in continence

  • Detrusor muscle

    • 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 continence

  • Continence 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 intra-abdominal 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

    • Bladder pressure> urethral pressure = incontinence

Normal bladder function

2 main phases

  1. Storage phase

    1. Active relaxation of detrusor muscle as bladder fills to keep a low pressure

    2. Contraction of urethral sphincters

    3. Sensory efferents sense filling + communicate with brain

    4. Voluntary reinforcement of external sphincter tone at capacity

  2. Voiding phase

    1. Removal of higher centre suppression leads to coordinated relaxation of sphincters + detrusor contraction

Clinical features

  • Urgency = 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

  • Dysuria = discomfort (burning sensation) on voiding

In the history

  • Look for symptoms listed above

  • Ask about pattern of symptoms, severity, impact on QoL

  • Assess fluid intake

  • Search for associated symptoms e.g prolapse

  • Obstetric history, surgical history, drugs (diretics), PMHx (diabetes)

...

Buy the full version of these notes or essay plans and more in our Gynaecology Notes.