Medicine Notes Gynaecology Notes
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...
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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
Storage phase
Active relaxation of detrusor muscle as bladder fills to keep a low pressure
Contraction of urethral sphincters
Sensory efferents sense filling + communicate with brain
Voluntary reinforcement of external sphincter tone at capacity
Voiding phase
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)
...
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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...
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