Abdallah Rimawi, MD Geriatrics Fellow SVCMC. Urinary Incontinence. Definition. Involuntary loss of urine in a sufficient amount or frequency to be a social/health problem. . Epidemiology. UI has a prevalence 15-30% in community-residing elderly patients
Involuntary loss of urine in a sufficient amount or frequency to be a social/health problem.
UI has a prevalence
15-30% in community-residing elderly patients
50-84% among older adults in long-term care institutions
33% in older persons in acute care settings.
Urge incontinence constitutes over 50% of overall incontinence in men, 10-15% in younger women, and 30-40% in older women. Stress incontinence tends to be more common in women younger than 65 years.
Distribution of different types of incontinence in the general population. Diagnoses other than stress, urge, and mixed are excluded.
Dr. Hogne Sandvik: 1996 nobel award in biology
1) The filling and storage phase
2) The emptying phase
The PMC functions as a relay switch in the voiding pathway. Stimulation of the PMC causes the urethral sphincters to open while facilitating the detrusor to contract and expel the urine.
When Bladder becomes full, the stretch receptors of the detrusor muscle send a signal to the pons (via the spinal cord), which in turn notifies the brain. Patients perceive this signal (bladder fullness) as a sudden desire to go to the bathroom. Under normal situations, the brain sends an inhibitory signal to the pons to inhibit the bladder from contracting until a bathroom is found.
Sympathetic system (Epinepherine & Norepinepherine):
Normally controls the bladder and internal urethral sphincter
Accommodation: an increase the bladder capacity without raising bladder pressure
Keeps the internal urinary sphincter tightly closed.
relaxes bladder dome
inhibits parasympathetic system
The sympathetic activity also inhibits the micturition reflex is inhibited.
The somatic nervous system regulates the actions of the muscles under voluntary control. Such as muscles of the external urinary sphincter and the pelvic diaphragm. .
suprasacral-infrapontine spinal cord trauma can cause overstimulation of the pudendal nerve that results in urinary retention.
Population: May occur in anyone at any age, but it is more common in women and elderly. Second only to stress incontinence as the most common cause of urinary incontinence (involuntary loss of urine). Approximately 1% to 2% of adult females are affected by urge incontinence.
PVC: "Premature Vesicular Contraction"
Overly sensitive bladder Urge to void is perceived
Inhibition of detrussor contraction is ineffective
Etiologies:Urge incontinence may result from neurological injuries (such as spinal cord injury or stroke), neurological diseases (such as multiple sclerosis), infection, bladder cancer, bladder stones, bladder inflammation, or bladder outlet obstruction.
The majority of cases are classified as idiopathic -- a specific cause cannot be identified
Signs and Symptoms
Irresistable urge to void
Urge preceeded by various stimulation : Posture change, Hear or feel water ,Laugh or cough
Urine volume lost :Few drops to entire bladder contents
Urine loss timing:Begins seconds after trigger
Rule out neurological or infectious etiology
Sterile in-out catheterization or
Ultrasound measurement of post-void residual
Signs and Symptoms
Palpable distended bladder post voiding
Post-void residual >200 cc
Have patient void
Insert Urinary Catheter and record urine volume
Normally less than 50 cc
Diagnosis :Ultrasound assess bladder volume
1) Betanachol (Urecholine)
Cholinergic agonist with Parasympathetic stimulation contracts detrussor
Indications: Non-obstructive bladder atony
Contraindications : Hyperthyroidism , Peptic Ulcer Disease , Asthma
2) Alpha-Adrenergic blockade
Prazosin (Minipress) ,Terazosin (Hytrin)
Decreases bladder neck and urethral tone
Indications :Benign Prostatic Hypertrophy ,Sphincter Hyperspasticity