Continence Glossary

A

• Acute urinary retention – Sudden inability to pass urine.
• Areflexia – Absence of neurological reflexes such as the knee jerk reaction.
• Arelle – Arelle supplies high quality incontinence care products with service and advice based on many years experience. We provide incontinence briefs, incontinence pads and other incontinence products to help 1 in 3 women and 1 in 10 men continue with a normal life.
• 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.
• Disposable Pads – These disposable pads are convenient to use and have been put into 3 categories to help you. Pads for light to moderate incontinence, moderate to servere incontinence and all in one pads. Disposable Pads/Briefs are made from absorbent material that is thrown away when soiled.
• 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 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 – 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.

J

K

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.

Q

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.
• Reusable Pads / Briefs – are made from absorbent textile materials that can be washed when soiled and reused.

S

• 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.
• Suprapubic indwelling catheter – This is an indwelling catheter inserted through the abdominal wall into the bladder to drain urine.

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.
• 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.

V

• 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.

W

X

Y

Z