PATHO EXAM 3
UNIT 6
CH 29: Disorders of the Lower Urinary Tract
Physiology of Micturition
Central autonomic, and peripheral nervous system are all involved in urinary elimination
Incontinence
What is it?
o Report of any involuntary urine loss
o HIGH in adults over 65
o Never normal under any circumstance
o Not a normal part of gaining
RISK FACTORS
o Immobility
o Impaired cognition
o Medication: diuretics
o Morbid obesity
o Smoking
o Fecal impaction
o Delirium
o Pregnancy
Types of Incontinence
1. Stress urinary incontinence (SUI)
What is it?
o Occurs when urine is involuntarily lost with increases in intra-abdominal pressure
o Precipitated by effort or exertion, such as cough, laugh, lifting heavy objects, sneezing, or
bending
o CAUSE: Because of weakening of pelvic muscles or intrinsic urethral sphincter deficiency
o May be because of degenerative neurologic disease that impair nerves that send messages
(down neurons) to the bladder, obesity, childbirth related trauma, pelvic surgery and
radiotherapy, diabetes
RISK FACTORS:
o Obesity
o Alcohol
o Child birth related trauma
o Pelvic surgery
o Aging
o Diuretics
o Radiotherapy
o Diabetes
o Recurrent bladder infection
2. Urgency urinary incontinence (UUI)
What is it?
o Involuntary sudden leakage or urine along with or immediately following the sensation of a need
to urinate (urgency)
o Underlying Issue: overactive detrusor muscle
, o May be idiopathic, because of aging, bladder infection, prostate enlargement, radiation
therapy, tumors, stones, or CNS damage, diuretics, and alcohol
3. Overflow urinary incontinence
Issue: The bladder becomes so full that it leaks urine
More common in men
Urethral obstruction such as enlarged prostate gland
4. Functional incontinence
Physical or environmental limitations resulting in an inability to access a toilet in time
Broken leg, stroke, medications
Inaccessible toilets, mobility disorders, cognitive dysfunction, or mental disabilities prevent normal
or timely toilet usage
5. Transient incontinence
Sudden onset and is due to potentially reversible conditions
UTI’s, constipation, or fecal impactions
Bladder Pain Syndrome/Interstitial Cystitis
BPS, “painful bladder syndrome” is a genitourinary pain syndrome in which suprapubic pain is
experienced w/ bladder filling along with other LUTs such as frequent, unaccompanied proven UTI
Also known as “interstitial cystitis (IC)
Pelvic pain MUST be of at least 6 months duration and be accompanied by at least one others LUTs
RECURRENT SYMPTOMS:
o Urgency, dysuria, and dyspareunia
o Worsens w/ consumption of certain foods and drinks such as alcohol and caffeine containing
beverages, citrus juice and fruits, and hot peppers
Pain is often relieved w/ voiding
Urethritis and Cystitis
Urethritis: STI inflammation of the Urethra
o Can be caused by infection, external irritants, and in women (insufficient estrogen levels)
o Most common sexual transmitted organisms: N. Gonorrhea and C. Trachmoaties
o Inflammation of urethra may lead to pain, dysuria, urethral discharge and abscess
o More common in men and can be caused by an STI or immunosuppression
Cystitis: UTI inflammation of the bladder lining
o Most common cause: bacterial infection
Escherichia coli responsible for 85% of community cases **inappropriate cleaning**
o Cystitis is LESS COMMON in men, MORE COMMON in women
o Etiology/Pathogenesis:
Bacteria is normally cleared from the bladder by flushing and dilutional effects of voiding
o S/S:
Acute onset if frequency, urgency, dysuria
Pain may be present in suprapubic area
Urine may appear pink (hematuria or cloudy)
Older adults: delirium or altered mental status
CH 27: Intrarenal Disorders
Cystic Kidney Disease
Genetically transmitted renal d/o exulting in fluid filled; may be localized to one area or affect both
kidneys
Can lead to renal failure, requiring dialysis or transplantation
UNIT 6
CH 29: Disorders of the Lower Urinary Tract
Physiology of Micturition
Central autonomic, and peripheral nervous system are all involved in urinary elimination
Incontinence
What is it?
o Report of any involuntary urine loss
o HIGH in adults over 65
o Never normal under any circumstance
o Not a normal part of gaining
RISK FACTORS
o Immobility
o Impaired cognition
o Medication: diuretics
o Morbid obesity
o Smoking
o Fecal impaction
o Delirium
o Pregnancy
Types of Incontinence
1. Stress urinary incontinence (SUI)
What is it?
o Occurs when urine is involuntarily lost with increases in intra-abdominal pressure
o Precipitated by effort or exertion, such as cough, laugh, lifting heavy objects, sneezing, or
bending
o CAUSE: Because of weakening of pelvic muscles or intrinsic urethral sphincter deficiency
o May be because of degenerative neurologic disease that impair nerves that send messages
(down neurons) to the bladder, obesity, childbirth related trauma, pelvic surgery and
radiotherapy, diabetes
RISK FACTORS:
o Obesity
o Alcohol
o Child birth related trauma
o Pelvic surgery
o Aging
o Diuretics
o Radiotherapy
o Diabetes
o Recurrent bladder infection
2. Urgency urinary incontinence (UUI)
What is it?
o Involuntary sudden leakage or urine along with or immediately following the sensation of a need
to urinate (urgency)
o Underlying Issue: overactive detrusor muscle
, o May be idiopathic, because of aging, bladder infection, prostate enlargement, radiation
therapy, tumors, stones, or CNS damage, diuretics, and alcohol
3. Overflow urinary incontinence
Issue: The bladder becomes so full that it leaks urine
More common in men
Urethral obstruction such as enlarged prostate gland
4. Functional incontinence
Physical or environmental limitations resulting in an inability to access a toilet in time
Broken leg, stroke, medications
Inaccessible toilets, mobility disorders, cognitive dysfunction, or mental disabilities prevent normal
or timely toilet usage
5. Transient incontinence
Sudden onset and is due to potentially reversible conditions
UTI’s, constipation, or fecal impactions
Bladder Pain Syndrome/Interstitial Cystitis
BPS, “painful bladder syndrome” is a genitourinary pain syndrome in which suprapubic pain is
experienced w/ bladder filling along with other LUTs such as frequent, unaccompanied proven UTI
Also known as “interstitial cystitis (IC)
Pelvic pain MUST be of at least 6 months duration and be accompanied by at least one others LUTs
RECURRENT SYMPTOMS:
o Urgency, dysuria, and dyspareunia
o Worsens w/ consumption of certain foods and drinks such as alcohol and caffeine containing
beverages, citrus juice and fruits, and hot peppers
Pain is often relieved w/ voiding
Urethritis and Cystitis
Urethritis: STI inflammation of the Urethra
o Can be caused by infection, external irritants, and in women (insufficient estrogen levels)
o Most common sexual transmitted organisms: N. Gonorrhea and C. Trachmoaties
o Inflammation of urethra may lead to pain, dysuria, urethral discharge and abscess
o More common in men and can be caused by an STI or immunosuppression
Cystitis: UTI inflammation of the bladder lining
o Most common cause: bacterial infection
Escherichia coli responsible for 85% of community cases **inappropriate cleaning**
o Cystitis is LESS COMMON in men, MORE COMMON in women
o Etiology/Pathogenesis:
Bacteria is normally cleared from the bladder by flushing and dilutional effects of voiding
o S/S:
Acute onset if frequency, urgency, dysuria
Pain may be present in suprapubic area
Urine may appear pink (hematuria or cloudy)
Older adults: delirium or altered mental status
CH 27: Intrarenal Disorders
Cystic Kidney Disease
Genetically transmitted renal d/o exulting in fluid filled; may be localized to one area or affect both
kidneys
Can lead to renal failure, requiring dialysis or transplantation
