AM Tract
DISORDER OF LOWER URINARY TRACT – MEN
Voiding Dysfunction
- Pathologies affects nervous system
o Continence is both cognitive and physiologic
- Factors that affect process of peeing
o Medications
o Access to toilet
- Incontinence
o More common in women
o Risk factors: obesity, pregnancy, meds, smoking, impaired cognition, IMMOBILITY
o Urge incontinence: sudden involuntary leakage of urine
▪ Overactive detrusor muscle that suddenly contracts
o Stress incontinence: urine involuntarily lost with increase in intraabdominal
pressure, precipitated by exertion like a sneeze
▪ Result of weak pelvic floor muscle – a sphincter problem
o Mixed incontinence: combination of stress and urge
o Overflow incontinence: bladder so full it overflows
o Functional incontinence: related to physical or environmental limitations, like no
access to a toilet
o Transient incontinence: happens for various reasons
o Neurogenic bladder – can cause incontinence
▪ Spinal cord genital problem where you can’t feel as much towards the
bottom half of body
▪ Release when it wants to or doesn’t release at all, at that point will have
to straight cath
▪ Caused by spinal cord injury
▪ Or baby born with spina bifida
o Incontinence diagnosis – rule out and treat other causes
o Incontinence treatment
▪ Lifestyle changes – decrease caffeine, weight loss
▪ Behavioral, pharmaceutical and surgical options
▪ Train muscles – pelvic floor and bladder
▪ Meds – anticholinergic agents, vaginal or oral estrogen, alpha adrenergic
blockers
o Enuresis: intermittent incontinence while asleep
▪ Wetting of clothing or bed
▪ Typical in children
▪ Pathogenesis – deficiency in vasopressin
• Nocturnal overactivity of detrusor muscle
▪ Treatment – behavior modifications, avoid drinking a lot before bedtime,
manage constipation, medications such as vasopressin and
anticholinergics
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