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Urinary incontinence

1 High Yield

1 High Yield

Urinary incontinence
Urinary incontinence: Pathology review
Neurogenic bladder
Elimination disorders: Clinical
Pediatric urological conditions: Clinical
Neonatal jaundice: Clinical
Jaundice
Preoperative evaluation: Clinical
Postoperative evaluation: Clinical
Protein synthesis inhibitors: Aminoglycosides
Miscellaneous cell wall synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
Laxatives and cathartics
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Glucocorticoids
Opioid agonists, mixed agonist-antagonists and partial agonists
Insulins
Abdominal pain: Clinical
Esophageal surgical conditions: Clinical
Gastrointestinal bleeding: Clinical
Peptic ulcers and stomach cancer: Clinical
Inflammatory bowel disease: Clinical
Appendicitis: Clinical
Diverticular disease: Clinical
Hernias: Clinical
Bowel obstruction: Clinical
Colorectal cancer: Clinical
Abdominal trauma: Clinical
Anal conditions: Clinical
Gallbladder disorders: Clinical
Pancreatitis: Clinical
Adrenal masses and tumors: Clinical
Breast cancer: Clinical
Benign breast conditions: Pathology review
Skin and soft tissue infections: Clinical
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Breast
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Other abdominal organs
Peripheral vascular disease: Clinical
Leg ulcers: Clinical
Aortic aneurysms and dissections: Clinical
Adrenergic antagonists: Beta blockers
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Thrombolytics
Estrogens and antiestrogens
Progestins and antiprogestins
Androgens and antiandrogens
Aromatase inhibitors
Uterine stimulants and relaxants
Puberty and Tanner staging
Amenorrhea: Clinical
Contraception: Clinical
Virilization: Clinical
Infertility: Clinical
Vulvovaginitis: Clinical
Sexually transmitted infections: Clinical
Menopause
Abnormal uterine bleeding: Clinical
Ovarian cysts, cancer, and other adnexal masses: Clinical
Endometrial hyperplasia and cancer: Clinical
Cervical cancer: Clinical
Vaginal cancer: Clinical
Vulvar cancer: Clinical
Pregnancy
Routine prenatal care: Clinical
Hypertensive disorders of pregnancy: Clinical
Antepartum hemorrhage: Clinical
Premature rupture of membranes: Clinical
Stages of labor
Abnormal labor: Clinical
Vaginal versus cesarean delivery: Clinical
Postpartum hemorrhage: Clinical
Gestational trophoblastic disease: Clinical
Breastfeeding
Asthma: Clinical
Pediatric lower airway conditions: Clinical
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Diabetes mellitus: Clinical
Hyperthyroidism: Clinical
Hypothyroidism and thyroiditis: Clinical
Parathyroid conditions and calcium imbalance: Clinical
Thyroid nodules and thyroid cancer: Clinical
Pituitary adenomas and pituitary hyperfunction: Clinical
Hypopituitarism: Clinical
Cushing syndrome: Clinical
Adrenal insufficiency: Clinical
MEN syndromes: Clinical
Newborn management: Clinical
Neonatal ICU conditions: Clinical
Congenital TORCH infections: Pathology review
Perinatal infections: Clinical
Congenital disorders: Clinical
Congenital heart defects: Clinical
Autosomal trisomies: Pathology review
Miscellaneous genetic disorders: Pathology review
Disorders of carbohydrate metabolism: Pathology review
Disorders of amino acid metabolism: Pathology review
Disorders of fatty acid metabolism: Pathology review
Glycogen storage disorders: Pathology review
Lysosomal storage disorders: Pathology review

Flashcards

Urinary incontinence

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Questions

USMLE® Step 1 style questions USMLE

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A 55 year-old female comes to her outpatient physician because of urinary incontinence. The patient reports a sense of fullness in the bladder and continuous dribbling of urine over the past two months. Past medical history is notable for type 2 diabetes mellitus and hypertension. However, the patient reports being inconsistent in taking her medications. Her temperature is 37.1°C (98.8°F), blood pressure is 158/91 mmHg, and pulse is 75/min. Physical exam reveals decreased sensation to soft touch and pinprick in the distal arms and legs. Laboratory results are as follows:  
 
 Laboratory value  Result 
 Glucose  167 mg/dL 
 HbA1c  8.1% 
 Postvoid residual volume   170 ml 

Which of the following best describes the pathophysiology of this patient’s symptoms?   

Transcript

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Content Reviewers

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.

Summary

Urinary incontinence is a common condition that occurs when urine involuntarily leaks from the bladder, often through the internal and external sphincter muscles. There are several types of urinary incontinence, including urge incontinence, stress incontinence, and overflow incontinence.

Urge incontinence is typically caused by an overactive bladder, which can lead to sudden and strong urges to urinate that are difficult to control. Stress incontinence, on the other hand, is often due to increased pressure on the bladder, which can happen during physical activity, sneezing, or coughing. Overflow incontinence is caused by incomplete emptying of the bladder, leading to urine leakage due to bladder overfilling.

The treatment for urinary incontinence depends on the underlying cause and severity of the condition. Some common interventions include strengthening the external sphincter muscle by doing things like Kegel exercises, and catheterization or medications like alpha-blockers, which relax the smooth muscle to assist with urination.