Urinary incontinence - causes, symptoms, diagnosis, treatment, pathology

Summary

This video discusses urinary incontinence, a condition where involuntary urination occurs. It explains how the bladder stores urine, the role of sphincter muscles, and the micturition reflex controlled by the brain and spinal cord. The video covers different types of incontinence—urge, stress, and overflow—and their causes, such as overactive bladder or blocked urine flow. Treatment options, including relaxation techniques, Kegel exercises, and medications, are explored. Various conditions like diabetes and surgery that impact urinary control are also discussed. The video is supported by a physical therapist and invites further discussion on a subreddit.

Takeaways

• 💧 Urinary incontinence is the involuntary release of urine, affecting personal hygiene and social life.
• 🫧 The bladder stores urine, expanding as it fills, thanks to its muscular and epithelial layers.
• 🚪 Two sphincters control urine release: the involuntary internal sphincter and the voluntary external sphincter.
• 🧠 The micturition reflex involves stretch receptors sending signals to the spinal cord and brain, leading to urination.
• 🛑 The pontine storage and micturition centers in the brain control voluntary urination.
• 💥 Urge incontinence results from an overactive bladder, causing sudden, involuntary urination.
• 💪 Stress incontinence occurs due to increased abdominal pressure, often caused by sneezing or laughing.
• 🔄 Overflow incontinence happens when the bladder doesn't empty properly, often due to blockages like an enlarged prostate.
• ⚕️ Conditions like diabetes, bladder cancer, or multiple sclerosis can lead to incontinence by affecting the micturition reflex.
• 🏋️ Treatments vary: relaxation techniques, Kegel exercises, medications, and in some cases, catheterization or surgery.

Q & A

What is urinary incontinence?

Urinary incontinence is a condition where urination, or micturition, happens involuntarily, meaning a person may urinate without intending to. This can affect personal hygiene and limit social life.

How does the bladder expand and contract during the process of urination?

The bladder expands as it fills with urine, which it receives from the kidneys via the ureters. It is able to expand because of the detrusor muscle surrounding it and a layer of transitional epithelium with 'umbrella cells' that stretch out as the bladder fills.

What are the roles of the internal and external sphincter muscles in controlling urination?

The internal sphincter is made of smooth muscle and operates involuntarily, typically opening when the bladder is half full. The external sphincter is made of skeletal muscle and is under voluntary control, allowing a person to control when to urinate.

How does the micturition reflex work?

The micturition reflex involves stretch receptors in the bladder wall sending signals to the spinal cord and brain when the bladder is half full. This increases parasympathetic stimulation, causing the detrusor muscle to contract and the internal sphincter to relax, allowing urination. The pons helps us control when we urinate.

What is urge incontinence, and how is it treated?

Urge incontinence is when someone experiences a sudden urge to urinate due to an 'overactive bladder,' followed by involuntary urination. It is caused by an uninhibited detrusor muscle. Treatment involves reducing detrusor muscle activity through relaxation techniques and antimuscarinic medications.

What is stress incontinence, and what causes it?

Stress incontinence occurs when increased abdominal pressure, such as from sneezing or laughing, overwhelms the sphincter muscles, leading to urine leakage. It can also occur during pregnancy due to pressure from the growing baby.

How is stress incontinence treated?

Stress incontinence treatments focus on strengthening the external sphincter muscle through exercises like Kegel exercises.

What is overflow incontinence, and what are its causes?

Overflow incontinence is caused by problems emptying the bladder, either due to a blockage, like an enlarged prostate, or an ineffective detrusor muscle. This leads to the bladder overfilling and leaking urine.

What are the common treatments for overflow incontinence?

Treatments for overflow incontinence aim to reestablish clear urine flow, using catheterization or medications like alpha-blockers to reduce prostate enlargement.

How can nerve damage lead to urinary incontinence, and what conditions may cause it?

Nerve damage, such as from diabetes, multiple sclerosis, or surgeries like prostatectomy or hysterectomy, can impair the micturition reflex, leading to urinary incontinence. Treatment depends on the specific condition.