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Urinary Anatomy and Physiology
This is the very beginning of the Muchawaited obstetrics and gynaecology series, which I
hope to get these done timely
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we 're
going to talk about the anatomy and physiology of the urinary tract
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we'll also talk about pharmacologic
management as we touch on each of these respective urinary incontinence disorders
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These tend to
happen in developing countries because of hysterectomies, but they can happen due to
pelvic surgery, especially if the woman already has something inflammatory in that area
already like endometriosis or public inflammatory disease
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You have muscarinic receptors, which are part of your
parasympathetic nervous system and then you also have beta adrenergic receptors
which allow smooth muscle to contract
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Alpha adrenergic receptor is going to increase the entry urethral pressure because it
constricts
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going to
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the sympathetic nervous system favors urinary retention because you reduce
the pressure in the bladder near the beta receptors and you increase pressure in urethra
via Lfo receptors
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We 'll talk about that in a little bit
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the pudendal nerves that also does some of the genital stuff too but when this is
damaged
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Tonic
contraction
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She 's needed to urinate once
twice
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the normal bladder residual is around
50 mils, and it's usually takes up to about 400 milliliters to where you 're going to feel the
urge to void
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Anticholinergics are essentially sympathomimetic s ' and the sympathetic nervous
system favours urinary continence
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In many cases you will be able to make a presumptive diagnosis
even without this waiting diary
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The drug is useful for patients who after surgery have some difficulty in
urinating by giving them a colander jerk like pathetic
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Those all right so I will see you in the next section of this
section

Stress Urinary Incontinence
54-year-old woman presents to the clinic complaining of intermittent urinary leakage over
the past nine months
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She requires the use of pads to keep from wetting her clothes
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There
is no incontinence at night
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she is a G4P for all uncomplicated spontaneous spontaneous vaginal deliveries
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stress your area incontinence is the urinary incontinent
that you get when you sneeze or york off or you laugh and a little bit of urine comes up,
but it is not going to cause that feeling that you need to go at random times frequently
throughout the day
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will be postmenopausal
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The support structure of pelvic floor begins to
wane
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This is just a triangle between the two ureteral orifices and the outlet of the bladder
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There is a causal link
between smoking and stress urinary incontinence
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Coughing increases the intraabdominal pressure and can
exacerbate stress incontinent
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likely
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coughing
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the pressure and increases stress urinary loss
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Coughing sneezing, laughing clapping lifting
orgasms intercourse standing up from sitting down
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All this has to do with is you have an increase in intraabdominal pressure
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stress Urinary incontinence is associated with
hypo-estrogen ism
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However, if you wind up deciding that you want to go forth
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a lot of these women will go on to require surgery
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The most common cause is weakening of the pelvic floor anatomy commonly due to
hypo-africanism and that would be something like menopause
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some women only have symptoms
when their bladder fills to a certain volume
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many women only experience their symptoms when the bladder reaches a
certain volume, so keep yourself below that you can get rid of your symptoms
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This is called kegel exercises
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stress urinary incontinence is not
a neuromuscular problem and bypass urinary inconsinence is here and so that will be
noted
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with the exception that they can void voluntarily
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Urge Urinary Incontinence
Urinalysis is something that you will do for every patient who presents with a new
complaint of urinary incontinence
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For example,
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an elderly woman has increased urgency
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the average person feels the urge to urinate around
400 to 500 mils of bladder volume
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there's something going on in the bladder that's
causing the detrusor muscle to become overactive and so a lot of times they withdraw
themselves from their daily activities, such as going to
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the difference is
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These patients have increased frequency and urgency and when they do go to the
bathroom
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These patients do n't have any problem unless they're coughing or sneezing or lifting
something with urinary inconsinence
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Even with small amounts of urine in their bladder
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overactive
bladder is a common term that 's thrown out amongst medical lady and a lot of times it 's
referring to urge urinating kinds, but these two are n't exactly the same
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Risk losing urine involuntarily
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these patients really are n't incontinent of urine because of any kind of
urinary tract pathology or stress urinary
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When patients with urgent or incontinence are incontinent, It 's going to be a large
amount
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This really causes a problem not so much at home, but in public okay
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It might not necessarily be diagnostic, but if a patient empties her
bladder and she 's still losing urine
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the way we manage urge urinary incontinence in comparison to
stress urinary inconsinence is quite different
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The problem is that

detrusor muscle being hyperactive and so there 's really not a lot of conservative
management we can do for these patients
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Mirror begaren is a beta-3-adrenergic agonist, and so this relaxes the dome of the
bladder
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You will relax a smooth muscle
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Imipramine can be useful for stress urinary incontinence
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with stress
urinary incontinence
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with overflow and bypass urinary inconsinence
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but with overflow urinary inconinence
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These patients will have
to be more than twice a night

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