The urinary bladder
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Overall, urinary incontinence occurs in 5% of men and 20% of women. Up to 40% of women over the age of 60 years and 50% of institutionalised elderly patients experience regular episodes of urinary incontinence. Health problems include skin breakdown and depression, and loss of esteem and sexual activity. Continence is dependent on normal mobility and brain function allowing a perception of when it is socially acceptable to void, normal bladder sensation, normal voluntary detrusor contraction producing good bladder emptying, a normally competent sphincter mechanism, which relaxes appropriately during a voluntary detrusor contraction allowing good bladder emptying, and good bladder capacity with normally low pressures during filling. This is clearly a fine balance and several factors can cause incontinence. In children, non-neurogenic incontinence is often associated with other dysfunctional conditions such as infections, constipation, psychological factors, increased fluid intake, intentional misconduct or an overactive bladder. Several investigations are required for diagnosis of urinary incontinence.
General principles on caring for older adults
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The prevalence of urinary incontinence is higher than that of heart disease and diabetes, affecting almost 4 million older men and 10 million older women (100). It has negative effect on the quality of life and increases the risk of depression, functional limitations, falls, and nursing home placement (101). Despite the population burden and significant health impact, it remains underdiagnosed and undertreated; only a quarter of patients with incontinence seek medical care (102). The risk factors of urinary incontinence may differ by types of incontinence (stress, urgency, and mixed type). Common contributing causes include conditions affecting lower urinary tract (e.g., atrophic vaginal tissue, urinary tract infection, fecal impaction), increased urine volume (e.g., volume overload, diuretic use, caffeine intake, hyperglycemia), impaired mobility, dementia and delirium, depression, and external factors (e.g., restraint use, availability of restroom and toilet aids). Medications used to manage CVD can affect several of these factors. Cough, a common side effect from angiotensin-converting enzyme inhibitors, may cause stress incontinence. Increase urine volume from loop diuretics can lead to urgency incontinence. Calcium channel blockers may worsen urgency incontinence by causing urinary retention and constipation.
Continence
Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson in Health Care Needs Assessment, 2018
Evidence for the efficacy of lifestyle changes in the management of urinary incontinence is lacking. Much of current practice is based upon expert opinion and a ‘common sense’ approach. Such measures include advice relevant to the maintenance of general health and therefore should not be neglected. It appears that, when taken as a whole, the basket of interventions is effective in reducing the subjective severity of bladder problems as assessed by sufferers. The evidence for bladder retraining is a little more robust and data suggest that, in certain groups, bladder retraining can gain as much improvement as drug therapy. When employed as part of a package of measures, bladder retraining appears to be as effectively delivered on an outpatient as an in-patient basis,168,169 but remote delivery, by telephone, does not work.170 This suggests that the therapeutic relationship and direct contact with their clinician or therapist is important in achieving success. In many studies the technique is used as part of a package of other lifestyle measures (diet and fluid advice, caffeine restriction) with or without pelvic floor therapy and medication.171,172 Studies of bladder retraining alone indicate that among incontinent women successfully undertaking a bladder retraining programme 60–80% will be improved in terms of urine loss and urinary frequency.173–176
Lichen sclerosus of the vulva
Published in Climacteric, 2021
Architectural alteration is common with significant narrowing of the vaginal introitus. The cervix is not involved (in contrast to lichen planus on the cervix, which can be seen as a white plaque without acetic acid application), although rarely the vagina may be involved, especially if there is a significant vaginal prolapse, when the mucosa may become keratinized and develop the disease [17,18]. Perianal lesions occur in women in 30% of cases. Dyspareunia occurs in the presence of erosions, fissures or introital narrowing. Urinary symptoms and urinary incontinence may also be described. Anterior and/or posterior fusion of the vaginal labia can lead to a narrowing of the introitus. If this is significant and causes dyspareunia, surgery may need to be considered, using part of the posterior vaginal wall in the reconstruction to prevent further adhesions, stenosis or fissuring [19] (Figure 1).
Hip exercises improve intravaginal squeeze pressure in older women
Published in Physiotherapy Theory and Practice, 2020
Lori J. Tuttle, Taylor Autry, Caitlin Kemp, Monique Lassaga-Bishop, Michaela Mettenleiter, Haley Shetter, Janelle Zukowski
The pelvic floor muscles (PFM) are partly responsible for controlling urinary and bowel functions of both males and females. The PFM consist of pubovisceral, puborectalis, and iliococcygeus, which originate on the pubis and the tendinous arch of the levator ani and insert on the perineal body, vaginal wall, between the internal and external anal sphincter, behind the rectum and in the iliococcygeal raphe (Kearney, Sawhney, and Delancey, 2004). These muscles work together to support internal organs and assist in maintaining posture and urinary and fecal continence (Raizada and Mittal, 2008; Rocca Rossetti, 2016). Pelvic Floor Dysfunction (PFD) is most often seen in postmenopausal women but affects both sexes and people of all ages (Milsom et al., 2014; Pierce, Perry, Chiarelli, and Gallagher, 2016; Shamliyan, Kane, Wyman, and Wilt, 2008). Nearly 26–30% of women report experiencing symptoms of PFD at some point in their lifetime, demonstrating its high prevalence in society (Nygaard et al., 2008; Wu et al., 2014). Symptoms may include: urinary and/or fecal incontinence (e.g. stress, urge, or mixed incontinence); frequent urination; and pelvic pain during urination or intercourse. A myriad of factors has been implicated in the development of PFD including, but not limited to: vaginal childbirth; constipation; diabetes; aging; injury; pelvic trauma; and obesity (Delancey et al., 2008; Pierce, Perry, Chiarelli, and Gallagher, 2016; Tinelli et al., 2010).
Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers
Published in Clinical Toxicology, 2018
Scott E. Schaeffer, Carol DesLauriers, Henry A. Spiller, Alfred Aleguas, Salvador Baeza, Mark L. Ryan
Eight patients developed symptoms judged as related to exposure; six were adults with an average age of 56 years. One pediatric patient was 15 years old and had ingested 125 mg of empagliflozin in an attempt to harm himself. Urinary incontinence was the only symptom that developed in this case. The other pediatric patient was two years old and developed tachycardia and nausea. None of the adverse effects noted were serious in nature; two adults developed symptoms characterized as moderate in severity. One, a 65-year-old male, was taking canagliflozin 100 mg daily as prescribed (duration unknown) before presenting with metabolic acidosis (serum bicarbonate of 10 mEq/L), hypokalemia (serum potassium 3 mEq/L), nausea, and vomiting. Treatment consisted of administration of IV fluids, dextrose, and sodium bicarbonate; symptoms resolved within 24 h. The second adult patient, a 43-year-old female, developed tachycardia and mild hypertension after ingesting 6000 mg of canagliflozin in an attempt at self-harm. Her symptoms resolved without specific intervention, and she was subsequently transferred after four hours’ observation in the ED for inpatient psychiatric care. No further follow-up was possible in this case.
Related Knowledge Centers
- Bladder Training
- Enuresis
- Geriatrics
- Kegel Exercise
- Nocturnal Enuresis
- Overactive Bladder
- Overflow Incontinence
- Quality of Life
- Urination
- Quality of Life
- Stress Incontinence