Glossary Of Useful Continence Care Terms

A

Acute urinary retention

Sudden inability to pass urine

Areflexia

Absence of neurological reflexes such as the knee jerk reaction.

Atonic

Lacking normal tone or strength.

B

Benign prostatic hyperplasia (BPH)

Most common disease of the prostate gland. About 50% of all men will have an enlarged prostate by the age of 60, rising to 80% in their eighties. BPH is rarely a life threatening condition, deterioration in urinary flow is slow. The incidence of acute retention increases with prostrate size and requires urgent treatment.

Bladder capacity

Healthy adult bladder has a total capacity of between 500-600mls. Normal healthy bladder takes between 3-4 hours to fill. First awareness of bladder filling  between 250-300mls, desire to pass urine between 400-500mls.

Bladder neck

The male bladder neck provides a powerful sphincter mechanism from muscle bundles arranged in a circular orientation.  This is of primary importance in preventing retrograde ejaculation into the bladder. The female bladder neck is a far weaker structure. There are no circular layers of muscle in the female neck of the bladder.

Bladder scanning

A non-invasive procedure to measure residual volume of urine in the bladder after micturition. Usually used when a voiding dysfunction is suspected.

Bladder training

Consists of a strict timetable of regular, voluntary voiding with specific instructions to avoid a premature response to the symptom of urgency.

C

Candidiasis

Usually a superficial infection of the moist cutaneous areas of the body caused by the fungus, Candida albicans. It most commonly affects the mouth (oral candidiasis) and vagina (thrush).

Cystometry

Method for measurement of the pressure/volume relationship of the bladder.

Cystoscopy

Method for direct visual examination of the urinary tract.  An instrument with a lighted scope (cytoscope) is introduced into the bladder via the urethra under general or local anaesthesia.

D

Detrusor instability

This term refers to urodynamic observation of involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. The term detrusor instability can only be diagnosed after urodynamic investigation. Patients with symptoms of an overactive bladder will have not necessarily have detrusor instability similarly not all patients with detrusor overactivity will have the symptoms of bladder overactivity.

Detrusor muscle

Muscular layer of the bladder, contraction of the detrusor muscle empties the bladder of urine.

Diarrhoea

Frequent discharge of semi-solid or liquid faecal matter from the bowel.

Dyssynergia

Muscular incoordination (e.g., detrusor-urethral dyssynergia – a disorder caused by the lack of coordination between contraction of the detrusor muscle and relaxation of the urethra).

Dysuria

Pain on passing urine.

E

Electromyography

The electrical recording of muscle activity used to aid diagnosis of neuromuscular problems in the lower urinary tract (pelvic floor and sphincter).

Enuresis

Uncontrolled or involuntary urination, most often used to mean urination occurring during sleep (bed wetting).

Erosion/Denuding

Removal of the top layer of skin.

Erythema

Superficial redness of the skin due to congestion of the capillaries.

External Sphincter

Striated muscle that controls voluntary urine release from the bladder.

F

Faecal Incontinence

Involuntary passage of gas, liquid and/or solid faecal matter.

Female urethra

Is straight and 3-5cm long, passing through the muscles of the pelvic floor.

Flow Rate

The volume of fluid expelled via the urethra per unit of time.

Frequency

Complaint of voiding too often during the day and can be defined as more than 8 voids / 24hours. Often less than 200mls/ void.

Functional assessment

Aspects of a functional assessment should include:-

Mental function
Mobility
Dexterity
Environment
Eyesight / lighting
Height of bed & or chair
Flooring
Type of shoes
Diet

Functional incontinence

 Describes the incontinence because the patient is unable to reach the toilet in time or adjust their clothing or makes no attempt to use the toilet appropriately.

G

GI

Gastrointestinal tract.

GU

Genitourinary.  Refers to both the reproductive organs and the urinary tract.

H

Haematuria

The presence of blood in the urine.

Hesitancy

A difficulty in initiating micturition resulting in a delay in the onset of voiding when an individual is ready to pass urine.

Hydronephrosis

The swelling of the kidneys caused by an obstruction of urine flow any of part of the urinary tract.

Hyperreflexia

Over activity of reflex responses, usually resulting from injury to the nervous system or metabolic disease.

I

Intermittent self-catheterisation (ISC)

Is the act of passing a catheter into the bladder to drain urine via the urethra. Intermittent self-catheterisation is useful in any condition in which bladder emptying is impaired in association with adequate outlet resistance.  In other words for self-catheterisation to be successful the bladder must be able to store urine adequately without leaking. Clean intermittent self-catheterisation is the preferred option for bladder drainage for patients who can manage this technique as it provides greater independence and personal control over bladder function. The individual must be physically able and motivated to perform catheterisation or for a carer to do it for them. Patients and caregivers need access to health professionals who can teach them the correct technique and provide support and a choice of catheters.

Internal Sphincter

A continuation of the detrusor muscle that is made of smooth muscle and therefore under autonomic (involuntary) control.

Intravenous Pyelogram (IVP)

A radiological study in which IV injection of a radiopaque dye that is excreted by the kidneys allows visualisation of the renal pelvices and urinary tract.

Intravesical Pressure

The pressure exerted on the contents of the bladder.

L

Lower Urinary Tract

Includes the ureters, bladder and urethra.

M

Maceration

Softening of the skin due to extended exposure to moisture.

Male urethra

Is S-shaped and 18-22cm long and provides a common pathway for the flow of both urine and semen.

Micturition

Micturition consists of a spinal reflex facilitated and inhibited by higher brain centre (Pontine Micturition Centre) and is subject to voluntary control.  The process consists of the contraction of the detrusor muscle,  a reflex relaxation of the internal urethral sphincter  and a  voluntary relaxation of the external sphincter.  The ability to control the bladder’s emptying is a learned process.

Mixed urinary incontinence

Occurs when symptoms of overactive bladder and stress urinary incontinence co-exist.

Mucosa

Thin mucous membrane which forms the innermost lining of the GI tract and bladder.

N

Nocturia

Is the complaint that an individual has to wake one or more times at night to void: each void is preceded and followed by sleep. 

O

Oestrogen therapy

The use of oestrogen in post menopausal women continues to be controversial. It is thought that oestrogen may be beneficial in increasing urethral closure. A trial of oestrogen treatment is therefore worthwhile but it is not considered a first-line treatment.

Overactive bladder

Is defined as urgency with or without urge incontinence, usually with frequency and nocturia. Overactive bladder results in bladder (detrusor) contractions during the filling stage, normally the detrusor muscle is relaxed during bladder filling and only contracts when full and directed to do so by the cerebral cortex.

Overflow incontinence

Is characterised by a reduction in the force and quality of the urine stream with the sensation of incomplete bladder emptying.

P

Pelvic floor

This is a sling like support consisting of muscle, ligaments and fascia. The pelvic floor is pierced by the rectum posteriorly and by the urethra and vagina anteriorly. In addition to providing support to the organs of the lower pelvis the pelvic floor contributes to the action of the external sphincter in maintaining closure.

Pelvic floor assessment

A physical examination is an integral part of female continence assessment  and a digital assessment of pelvic floor muscles should be undertaken before the use of supervised pelvic floor muscle training for the treatment of urinary incontinence (NICE 2006).

Pelvic floor muscle training

Can be taught using pelvic floor exercises. Weighted vaginal cones may be used in training the pelvic floor. Transvaginal electro-stimulation with biofeedback is used widely where the pelvic floor is very weak. By electrically stimulating selected muscle fibres, muscle tone can be increased until voluntary contractions can then be achieved.

Perineum

Region between the opening of the bowel behind and the genital organs in front.

Pessary

A device inserted into the vagina to provide support or correct the position of the uterus or rectum.

Polyuria

An excessive volume of urine, which in an adult would be more than 2500ml/day.

Prostate gland

The prostate is a small gland the size of a walnut and is responsible for secreting a thin, milky fluid that makes up 30% of semen and gives seminal fluid its milky appearance.

Prostate

A gland surrounding the neck of the bladder and urethra in males.

Prostatectomy

Surgical removal of part or all of the prostate gland.

Pudendal Nerve

Nerve which innervates the external genitalia, especially of the female.

R

Reflux

Backward or return flow.

Residual Urine

Volume of urine that remains in the bladder immediately following the completion of micturition.

Retraction

The action or condition of being drawn back.

S

Sheaths

Urinary sheaths can be used for men. Sheaths have evolved and provide a reliable form of management of urinary incontinence. There is a variety of different sheaths available from different manufacturers. These offer a wide range of choice in different sizes, styles and materials (latex or silicone).  Silicone sheaths have the advantage that they are transparent, allowing the patient’s skin to be observed. The choice of sheath should be based on reliability, comfort and ease of application. When assessing a patient for a sheath the penile length needs to be taken into consideration. There should be at least 1.5 inches  (4cm) of penile length available; some manufacturers make sheaths of a shorter length. Penile retraction is where the penis disappears inside the pelvic cavity and is more common as men get older. The penile shaft circumference should also be measured to ensure the correct size of sheath – one size does not fit all men.  Measurement tools, either a tape measure or a card with cut-out sections in various sizes, are provided by all manufacturers of sheaths.  A sheath that is too small will not fit correctly and may simply fall off or stop urinary flow because of urethral pressure.  A sheath that is too large will leak and the urine will then loosen the adhesive causing the sheath to fall off. Sheaths should be changed every 24 hours as, if they are left on longer, the security of the sheath may become compromised.

Skin Sealant

Aids the removal of adhesives from the skin by providing a clear copolymer protective layer to the skin.

Stable

Term used to describe normal detrusor function.

Stenosis

Abnormal narrowing or contraction of a duct or canal.

Stress urinary incontinence

An involuntary loss of urine when the bladder pressure exceeds the maximum urethral pressure, but in the absence of detrusor activity.

Stricture

(see stenosis).

Suprapubic indwelling catheter

This is an indwelling catheter inserted through the abdominal wall into the bladder to drain urine. Benefits of suprapubic route:-
- No risk of urethral trauma, necrosis or catheter induced urethritis
- Greater comfort, particularly for individuals who are chair bound
- Access to entry site is easy for cleansing and catheter changes
- Greater freedom for expression of sexuality

T

Transurethral Resection of the Prostate (TUR, TURP)

A method of treating the symptoms of an enlarged prostate by surgical removal of a portion of the prostate through the urethra.

Trigone

Triangular landmark at the base of the bladder, between the two openings of the ureters and the urethra.

U

Ureter

The tube through which urine passes from the kidney to the bladder. Urethral Incompetence: An incompetent urethral closure mechanism allowing for leakage of urine.

- Passive: Associated with genuine stress incontinence; includes low urethral closure pressure, shortened profile length, negative urethral closing pressure with increased intra abdominal pressures.
- Active: Inappropriate relaxation commonly associated with an unstable detrusor contraction.
Urethra - The urethra is the canal extending from the bladder to the exterior.

Urethral indwelling catheter

Drains urine from the bladder. A catheter should never be inserted for the convenience of healthcare workers and therefore a healthcare professional should never prejudicially influence a patient’s decision in this matter. The decision to insert an indwelling catheter needs to be made by a competent practitioner who is prepared to explore alternatives and who will consider which method of containment is in the patient’s best interest, especially if the patient is unable to give consent. Catheterisation is an invasive procedure and it is therefore important to explore all possible alternatives. Indications for catheterisation are patients with:-

- Bladder outlet obstruction (for example an enlarged prostate) who are unsuitable for surgery.
Chronic retention due to neurological disease or spinal cord injury where clean intermittent self-catheterisation is not possible.
- Condition resulting in profound disability and catheterised to prevent skin breakdown 
Intractable incontinence where catheterisation enhances quality of life but only when alternative methods have been found to be inappropriate or unsuccessful.
- Care of any person with a catheter should adhere to the Epic 2 guidelines http://www.epic.tvu.ac.uk/

Urgency

Complaint of a sudden compelling urge to pass urine, which is difficult to ignore. Urgency may occur with frequency.

Urge incontinence

Complaint of involuntary leakage accompanied by or immediately preceded by urgency.

Urinalysis

Has three main applications:-

- Screening for disease both systemic and renal
- Diagnosis to confirm or eliminate a suspected condition
- Management to monitor progress of an established disease

Urinary Meatus

External opening of the urethra.

Urinary Tract

The passage from the pelvis of the kidney through the ureters, bladder, and urethra to the external urinary opening.

Urinary tract infection

Is defined as the presence of micro-organisms such as bacteria within any part of the urinary tract (urethra, bladder, ureters and kidneys).

Urodynamics

Urodynamic investigations study the dynamics of the bladder and urethra. The purpose of urodynamic studies is to provide information relevant to the events in the bladder and bladder outlet during filling / storage and voiding phases of micturition. Urodynamic investigation is safe, with many urodynamic centres throughout the UK.

Video-Cystourethrogram (VCUG)

Method of visualising the filling and emptying of the bladder by introducing a contrast medium via a catheter.  This is a valuable assessment of lower urinary tract structure.

Voiding

The passage of urine from the urethra.