Urinary Incontinence - Midterm Notes PDF

6 1 URINARY AND RENAL DISORDERS – Urinary Incon+nence Urinary Incon+nence (UI) Urinary incon+nence is defined as the involuntary leakage of urine, which can result from a variety of anatomical, neurological,...

6 1 URINARY AND RENAL DISORDERS – Urinary Incon+nence Urinary Incon+nence (UI) Urinary incon+nence is defined as the involuntary leakage of urine, which can result from a variety of anatomical, neurological, and func+onal disorders. The main types of urinary incon+nence include: 1. Stress Incon+nence 2. Urge Incon+nence 3. Overflow Incon+nence 4. Mixed Incon+nence (combina+on of stress and urge incon+nence) 5. Func+onal Incon+nence (due to physical or cogni+ve impairments). 1. Most Likely Cause The most likely cause of urinary incon+nence depends on the type of incon+nence. The causes for each type are as follows: Stress Incon+nence: o Weakness of the pelvic floor muscles (oFen due to childbirth, pregnancy, aging, or surgery). o Increased intra-abdominal pressure due to ac+vi+es like laughing, coughing, sneezing, or heavy liFing. Urge Incon+nence: o Detrusor overac+vity: Can be triggered by local irrita+on, bladder infec+ons (cys++s), or neurological disorders (e.g., Parkinson's disease, stroke, or spinal cord injury). o Loss of cerebral inhibi+on of detrusor muscle contrac+on. Overflow Incon+nence: o Bladder outlet obstruc+on (due to enlarged prostate, urinary stones, or tumors). o Detrusor underac+vity: Can be caused by spinal cord injury below S1, nerve damage, or medica+ons that impair bladder contrac+on. Func+onal Incon+nence: o Caused by physical or cogni+ve impairments, such as demen+a or limited mobility, which prevent +mely access to a toilet. Mixed Incon+nence: o A combina+on of stress incon+nence and urge incon+nence, oFen seen in older adults. 2. Pathophysiology The pathophysiology of urinary incon+nence varies by type: Stress Incon+nence Pathophysiology: o When intra-abdominal pressure rises suddenly (e.g., from laughing or sneezing), urine leaks because the urethral sphincter is unable to remain closed.  2 o Pelvic floor muscle weakness (caused by aging, childbirth, or surgery) results in reduced support for the bladder and urethra, impairing their ability to maintain con+nence. o Impaired sphincter control prevents proper closure of the urethra. Urge Incon+nence Pathophysiology: o Characterized by overac+vity of the detrusor muscle (involuntary bladder contrac+ons) that result in a sudden, strong urge to urinate. o May be triggered by sensory s+mula+on (local irrita+on, infec+on) or neurological dysfunc+on (e.g., Parkinson's disease, stroke). o Loss of cerebral inhibi+on of detrusor contrac+ons leads to involuntary bladder contrac+ons. Overflow Incon+nence Pathophysiology: o Occurs when bladder pressure exceeds urethral pressure due to a chronic overfilled bladder. o Bladder outlet obstruc+on (e.g., from an enlarged prostate) prevents complete bladder emptying, resul+ng in con+nuous, small-volume leakage (dribbling). o The bladder becomes distended, and con+nuous small dribbling occurs because the sphincter is unable to maintain con+nence against the pressure of the large volume of retained urine. Func+onal Incon+nence Pathophysiology: o There is no dysfunc+on of the urinary system, but the individual cannot physically or cogni+vely access a toilet. o This can be due to cogni+ve impairment (e.g., demen+a) or physical limita+ons (e.g., immobility, frailty). Mixed Incon+nence Pathophysiology: o Combina+on of stress and urge incon+nence: The individual may have a weakened pelvic floor (as in stress incon+nence) and detrusor overac+vity (as in urge incon+nence). 3. Disease Transmission Transmission: o Not transmissible. Urinary incon+nence is a non-infec+ous condi+on. o Some infec+ous condi+ons like urinary tract infec+ons (UTIs) or cys++s can lead to transient incon+nence, but they are not considered transmissible causes of incon+nence. 4. Risk Factors The risk factors for urinary incon+nence can be classified as modifiable and non-modifiable factors. Modifiable Risk Factors  3 Obesity: Increases intra-abdominal pressure, which can contribute to stress incon+nence. Smoking: Causes chronic coughing, which increases abdominal pressure, and may also weaken the pelvic floor muscles. High-impact physical ac+vi+es: Repeated ac+vi+es that increase abdominal pressure (like heavy liFing) may cause stress incon+nence. Diet: Excessive intake of caffeine or alcohol can irritate the bladder and worsen urge incon+nence. Medica+ons: Certain drugs (e.g., diure+cs, seda+ves) can affect the bladder's ability to store or release urine. Urinary Tract Infec+ons (UTIs): Can lead to temporary urge incon+nence. Non-Modifiable Risk Factors Age: Older age is linked to a reduc+on in detrusor muscle func+on, reduced bladder capacity, and an increased risk of stress and urge incon+nence. Gender: Women are more prone to stress incon+nence (due to pregnancy, childbirth, and menopause). Childbirth: Vaginal delivery causes stretching and weakening of the pelvic floor muscles, increasing the risk of stress incon+nence. Neurological Disorders: Condi+ons like stroke, mul+ple sclerosis (MS), Parkinson's disease, and spinal cord injuries can impair the brain's ability to control urina+on, leading to urge incon+nence. Spinal Cord Injury: Lesions below S1 or above the sacral area impair reflexes that control bladder filling and voiding, resul+ng in neurogenic bladder and incon+nence. Prostate Enlargement: Enlarged prostate in men can cause overflow incon+nence by blocking the bladder outlet. Summary Table Criteria Urinary Incon+nence Stress Incon+nence: Pelvic floor weakness, increased abdominal pressure. Most Likely Urge Incon+nence: Detrusor overac+vity, neurological changes. Overflow Cause Incon+nence: Bladder outlet obstruc+on, spinal cord injury. Func+onal Incon+nence: Physical or cogni+ve limita+ons. Stress: Weakened pelvic floor & increased abdominal pressure. Urge: Pathophysiology Overac+ve detrusor contrac+ons. Overflow: Overfilled bladder leaks. Func+onal: Physical or cogni+ve inability to access a toilet. Transmission Not transmissible. Urinary incon+nence is a non-infec+ous condi+on. Modifiable: Obesity, smoking, caffeine, alcohol, medica+ons, UTIs. Non- Risk Factors Modifiable: Age, gender (female), pregnancy, childbirth, spinal cord injury, neurological disorders (e.g., stroke).