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.

Outlines

00:00

🚽 Understanding Urinary Incontinence and Its Impact

Urinary incontinence is the involuntary leakage of urine, which can significantly affect personal hygiene and social life. Normally, urine is stored in the bladder, which expands as it fills. The bladder's expansion is aided by the detrusor muscle and transitional epithelium with 'umbrella cells' that stretch to accommodate urine. The bladder can hold about 750 ml of urine, with slightly less in women due to the uterus taking up space. Urine is kept in the bladder by two sphincters: the internal (involuntary) and external (voluntary) sphincters. The process of urination involves signals from the bladder’s stretch receptors, which communicate with the spinal cord and brain to control urination, allowing voluntary delay through the pons region of the brain.

05:03

🔄 Types of Urinary Incontinence

There are several types of urinary incontinence, each with distinct causes and treatments. Urge incontinence results from an overactive bladder, where the detrusor muscle contracts unpredictably, leading to sudden urges and frequent urination. Treatment focuses on reducing detrusor muscle activity with techniques and medications. Stress incontinence occurs when physical exertion, such as sneezing or laughing, puts pressure on the bladder, overwhelming the sphincter muscles. Strengthening these muscles through Kegel exercises can help. Overflow incontinence is caused by issues with bladder emptying, such as blockages or a weak detrusor muscle, resulting in urine overflow. Treatments aim to clear urine flow, potentially through catheterization or medications.

💡 Additional Causes and Final Overview

Other conditions like diabetes, bladder cancer, or neurological diseases can damage the nerves involved in the micturition reflex, causing urinary incontinence. Surgeries like prostatectomy or hysterectomy can also lead to incontinence. Treatment depends on the underlying condition. In summary, urge incontinence is due to overactive bladder muscles, stress incontinence from excessive pressure on the bladder, and overflow incontinence from incomplete bladder emptying. Special thanks to Vanita Gaglani for contributing to the video, highlighting her expertise in physical therapy and urinary incontinence.

Keywords

💡Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine. It is a primary topic of the video and is described as a condition that affects personal hygiene and social life. The script discusses the mechanics of how urine is usually controlled and what happens when those mechanisms fail, leading to involuntary urination.

💡Micturition Reflex

The micturition reflex is a physiological process that controls the release of urine from the bladder. It involves communication between the bladder, spinal cord, and brain. The script explains how stretch receptors in the bladder trigger this reflex when the bladder is half full, leading to a series of nerve signals that cause urination unless overridden by the brain.

💡Detrusor Muscle

The detrusor muscle is the muscular layer surrounding the bladder that contracts to release urine. It plays a central role in the video, as its contraction is necessary for urination. Problems with the detrusor muscle, such as overactivity, are linked to urge incontinence, which is one of the types of urinary incontinence discussed.

💡Internal and External Sphincter Muscles

These are two muscles that control the flow of urine out of the bladder. The internal sphincter is under involuntary control, while the external sphincter is under voluntary control. The video describes how these 'doors' work together to hold in or release urine, and how their malfunction can contribute to different types of urinary incontinence.

💡Urge Incontinence

Urge incontinence is a type of urinary incontinence where a person feels a sudden, strong urge to urinate, followed by involuntary urination. The script explains that this is often due to an overactive bladder, where the detrusor muscle contracts unexpectedly, leading to frequent and sometimes nighttime urination.

💡Stress Incontinence

Stress incontinence occurs when physical exertion or pressure, such as sneezing, coughing, or pregnancy, causes urine leakage. This type of incontinence happens because the sphincter muscles are unable to hold back urine under the increased pressure. The script emphasizes this form of incontinence as common in women, particularly during pregnancy.

💡Overflow Incontinence

Overflow incontinence is caused by the bladder not emptying completely, often due to blockages like an enlarged prostate or weak detrusor muscle. The script describes how this results in a full bladder that overflows, causing urine to leak through the sphincters. Symptoms include a weak urine stream or difficulty starting urination.

💡Kegel Exercises

Kegel exercises are exercises that involve contracting and relaxing the pelvic floor muscles to strengthen them. In the video, these exercises are mentioned as a treatment option for stress incontinence, as they help strengthen the external sphincter muscle, improving control over urination.

💡Pontine Micturition Center

The pontine micturition center is a part of the brain responsible for controlling voluntary urination. The video explains how the brain, specifically this center in the pons, overrides the micturition reflex when we want to delay urination. It also plays a role in allowing urination to occur when we are ready.

💡Alpha-Blockers

Alpha-blockers are medications that help relax the muscles in the bladder neck and prostate, making it easier to urinate. The script mentions these drugs in the context of treating overflow incontinence, particularly in cases where an enlarged prostate obstructs urine flow.

Highlights

Urinary incontinence is when urination happens involuntarily, impacting personal hygiene and social life.

Urine is held in the bladder, which can expand to hold about 750ml in adults, slightly less in women due to the uterus taking up space.

Two sphincter muscles control urination: the internal sphincter is involuntary, and the external sphincter is voluntary.

The bladder is lined with transitional epithelium containing 'umbrella cells' that stretch as the bladder fills.

Urination is controlled by the micturition reflex involving the spinal cord, brain, and pons.

Urge incontinence is caused by an overactive bladder, where involuntary contractions lead to frequent urination.

Treatments for urge incontinence focus on reducing detrusor muscle activity using relaxation techniques and antimuscarinic medications.

Stress incontinence occurs due to increased abdominal pressure, causing urinary leakage, commonly seen in pregnancy.

Kegel exercises can strengthen the external sphincter muscle to manage stress incontinence.

Overflow incontinence is caused by incomplete bladder emptying, often due to a blockage or ineffective detrusor muscle.

Symptoms of overflow incontinence include a weak or intermittent urinary stream and hesitancy in starting urination.

Overflow incontinence treatments involve catheterization or medications like alpha-blockers to clear the urinary pathway.

Various conditions such as diabetes, Parkinson’s, or surgeries like prostatectomy can damage nerves involved in urination.

Urge incontinence is treated by relaxing the detrusor muscle, stress incontinence is addressed by strengthening the sphincter, and overflow incontinence focuses on clearing urinary pathways.

Special thanks to Vanita Gaglani, a registered physical therapist and author of a book on urinary incontinence, for her contribution to the video.

Transcripts

Urinary incontinence is a problem where the process of urination, also called micturition,

happens involuntarily, meaning that a person might urinate without intending to.

Urinary incontinence is particularly problematic because it affects a person’s personal hygiene

as well as their social life in a way that can be very limiting.

Normally, urine is held in the bladder, which receives urine from two ureters coming down

from the kidneys and then that urine leaves the bladder through the urethra.

As urine flows from the kidney, through the ureters and into the bladder, the bladder

starts to expand into the abdomen.

The bladder is able to expand and contract because it’s wrapped in a muscular layer,

called the detrusor muscle, and within that, lining the bladder itself is a layer of transitional

epithelium containing “umbrella cells”.

These umbrella cells get their name because they physically stretch out as the bladder

fills, just like an umbrella opening up in slow-motion.

In a grown adult, the bladder can expand to hold about 750ml, slightly less in women than

men because the uterus takes up space which crowds out the bladder a little bit.

Alright, so when the urine is collecting in the bladder, there are basically two “doors”

that are shut, holding that urine in.

The first door is the internal sphincter muscle, which is made of smooth muscle and is under

involuntary control, meaning that it opens and closes automatically.

Typically, that internal sphincter muscle opens up when the bladder is about half full.

The second door is the external sphincter muscle, and it’s made of skeletal muscle

and is under voluntary control, meaning that it opens and closes when a person wants it

to.

This is the reason that it’s possible to stop urine mid-stream by tightening up that

muscle, which is called doing kegel exercises.

Once urine has passed through the external sphincter muscle, it exits the body—in women

the exit is immediate and in men the urine flows through the penis before it exits.

So when specialized nerves called stretch receptors in the bladder wall sense that the

bladder is about half full, they send impulses to the spinal cord, specifically the sacral

spinal cord at levels S2 and S3, known as the micturition center, and the brain, specifically

two locations in the pons—the pontine storage center and pontine micturition center.

The spinal cord response is part of the micturition reflex.

And it causes an increase in parasympathetic stimulation and decrease in sympathetic stimulation

which makes the detrusor muscle contract and the internal sphincter relax.

It also decreases motor nerve stimulation to the external sphincter allowing it to relax

as well.

At this point, urination would occur at this point, if not for the pons.

The pons is the region of the brain that we train to voluntarily control urination.

If we want to delay urination, or hold it in, the pontine storage center overrides the

micturition reflex,

and when we want to urinate, the pontine micturition center allows for the micturition reflex to

happen.

Now, there are a few types of urinary incontinence.

The first is urge incontinence, which is when someone has a sudden urge to urinate because

of an "overactive bladder", followed immediately by involuntary urination.

This is typically due to an uninhibited detrusor muscle that contracts randomly.

This usually results in frequent urination, especially at night.

To treat urge incontinence, the focus is on decreasing the detrusor muscle activity.

Relaxation techniques to relax the bladder as well as antimuscarinic medications can

decrease detrusor muscle contractions.

Next there’s stress incontinence which is usually due to increased abdominal pressure

that overwhelms the sphincter muscles and allows urine to leak out.

Think of things that cause exertion, like sneezing, coughing, laughing—anything that

puts pressure on the bladder.

This is also relevant during pregnancy when a growing baby puts tremendous pressure on

the bladder and causes stress incontinence in some women.

The classic finding is urinary leakage with pressure applied to the abdomen.

Stress incontinence treatments typically focus on strengthening the external sphincter muscle

by doing things like Kegel exercises.

Another type is overflow incontinence which is typically caused by some sort of problem

with emptying the bladder.

This could be due to a blockage in urine flow, like a hypertrophic prostate in men which

presses on the urethra or an ineffective detrusor muscle.

Either way, thebladder doesn’t empty properly, and as a result the bladder fills up and overflows

with urine which leaks through the sphincters.

Typically this results in a weak or intermittent urinary stream or hesitancy where it takes

a while for the urine to begin to flow because of a blockage in the path.

Overflow treatments are aimed at reestablishing a clear pathway for urine flow.

For example, that might be through catheterization or medications like alpha-blockers which can

limit prostate enlargement.

Finally, there are various conditions like diabetes, bladder cancer, Parkinson’s, and

multiple sclerosis, as well as procedures such as prostatectomy or hysterectomy that

can damage the nerves involved with the micturition reflex, ultimately leading to urinary incontinence.

The symptoms and treatment for these problems depend on the exact condition.

Alright, as a quick recap, urinary incontinence occurs when urine involuntarily leaves the

bladder—through the internal and external sphincter muscles.

Urge incontinence is due to an overactive bladder, stress incontinence is due to too

much pressure for the sphincter muscles to resist, and overflow incontinence is due to

incomplete emptying of the bladder.

What's up guys, thanks for watching, hope you liked that one,

Special thanks to Vanita Gaglani for both helping to edit

the script on that one as well as

sponsor the video vanitas got our own

website called Vanitas rehab and she's a

registered physical therapist who was

actually written a book on urinary

incontinence so it's really awesome a

bore help with that video other than

that you can check out our new subreddit

called our Osmos it we're going to be

posting videos two there and having

discussions as well and then you can

also obviously subscribe to our channel

like our videos or donate to us on

patreon thanks guys bye

you