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Urinary Incontinence (Definitions (Mixed Incontinence = Combination of…
Urinary Incontinence
Definitions
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Overreactive Bladder = Urgency with frequency, when appearing in the absence of local pathology
Neurology
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Reflexes
Onuf's nucleus controls the guarding reflex. This allows voluntary control of micturition when it is is inappropriate to void
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Storage
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As the volume in the bladder increases, the pressure remains low due to receptive relaxation and detrusor muscle compliance
Bladder fills continuously as urine is produced by the kidney and is passed through ureters into bladder
Filling
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At lower volumes, the afferent pelvic nerve sends slow firing signals to the pons via the spinal cord
Voiding
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Positive feedback loop of coordinated detrusor contraction + external sphincter relaxation expel urine from bladder
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High volumes stimulate the afferent pelvic nerve to send fast signals to the sacral micturition centre in the sacral spinal cord
Stress Incontinence
After giving birth, there is denervation of the pelvic floor and urethral sphincter. Weakening of fascial support of bladder + urethra
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Urgency Incontinence
Urgency is precipitated by cold, arriving home, coffee/tea, obesity, sound of running water
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Urge to urinate is quickly followed by uncontrollable emptying of the bladder as detrusor muscle contracts
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Spinal Cord Injury
Paraplegia
Paralysed from the waist down, normal upper body function
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Flaccid
Caused by spina bifida, sacral fracture + cauda equina
There is loss of reflex bladder contraction, guarding reflex + receptive relaxation
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