The Pathophysiology of Urinary Incontinence: A Comprehensive Insight
Instructions
A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the NP if this is just a sign of getting older.
- Discuss the pathophysiology associated with incontinence.
Solution
In the presented scenario, the patient experienced symptoms of urinary incontinence, especially, when he coughs or sneezes. According to Harris & Riggs (2022), urinary incontinence is the involuntary leakage of urine. Incontinence varies in severity and affects the quality of life of the patient. Urinary incontinence may lead to significant lifestyle changes and psychosocial well-being. Three major types of urinary incontinence include stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence (Harris & Riggs, 2022). The purpose of this paper is to discuss the pathophysiology associated with incontinence.
According to Wyndaele & Hashim (2017), different types of urinary incontinence have varied pathophysiology processes. Stress urinary incontinence is associated with a sudden increase in intra-abdominal pressure, due to physical extension, effort, sneezing, or coughing (Wyndaele & Hashim, 2017). This incident is often followed by a lack of sufficient increase in urethral pressure, resulting in a reversal of pressure gradient between the bladder and its outlet with leakage of urine as the result. Therefore, stress urinary incontinence is caused by a urethral deficiency (Wyndaele & Hashim, 2017).
Women are more at risk of stress urinary incontinence due to the urethral anatomy as well as due to their weak bladder neck. Two pathophysiological mechanisms have been identified in women, such as urethral hypermobility and intrinsic sphincter deficiency (Wyndaele & Hashim, 2017). Furthermore, the two processes are interrelated elements on a spectrum of change rather than being two entirely separate entities.
According to Harris & Riggs (2022), the pathophysiology of urgency incontinence is related to uninhibited bladder contractions because of irritation or loss of neurologic control of bladder contractions. Regarding bladder activity, the urothelium-based hypothesis and a myogenic hypothesis are two theories associated with bladder contraction problems (Wyndaele & Hashim, 2017).
The sensory molecules of the urothelium react to chemical and mechanical stimuli by producing neurotransmitters into the sub-urothelium, which in turn trigger afferent nerve activity. Changes in urothelial receptor function, such as upregulation, neurotransmitter release (increase), and sensitivity of the sub-urothelial cell network may increase afferent activity triggered by the bladder, hence, causing incontinence.
The myogenic hypothesis states that alterations in the excitability of the bladder smooth muscles and other intestinal cells or myocytes may result in the generation of uninhibited contractions. The normal detrusor has poorly coupled smooth muscles to prevent the spread of localized micro-motions or contractions during the storage phase (Wyndaele & Hashim, 2017).
The local contraction may also enhance different activities, hence, inducing a sensation of urgency incontinence. Neurological problems (abnormal handling of signals in the brain) are associated with damages to the central inhibitory sensitization or pathways of various signals, leading to the lack of control of primitive voiding reflexes, triggering detrusor over-activity (DO) (Wyndaele & Hashim, 2017). Mixed urinary incontinence is a combination of urgent urinary incontinence and stress urinary incontinence in a single patient. The pathophysiological processes of mixed urinary incontinence involve dysfunctions leading to either stress urinary incontinence or urgency urinary incontinence.
Conclusion
Urinary incontinence is an involuntary leakage of urine. The health condition can have significant changes in the individual changes psychological well-being. Three main types of incontinence include stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence. Stress urinary incontinence is caused by a sudden rise of intra-abdominal pressure due to sneezing or coughing. Pathophysiology of urinary incontinence varies based on the type of health condition. This paper has looked into the pathophysiology of urinary incontinence.
References
Harris, S., & Riggs, J. (2022). Mixed Urinary Incontinence. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534234/#:~:text=The%20pathophysiology%20of%20stress%20incontinence,neurologic%20control%20of%20bladder%20contractions.
Wyndaele, M., & Hashim, H. (2017). Pathophysiology of urinary incontinence. Surgery (Oxford), 35(6), 287-292. http://dx.doi.org/10.1016/ j.mpsur.2017.03.002