9: Urinary incontinence and prolapse Flashcards
What is stress incontinence?
Leakage on increased intra-abdominal pressure
What is urge incontinence?
Urinary leakage preceded by a strong urge to go
An overactive bladder causes urgency (with / without) incontinence.
either
‘wet’ or ‘dry’ overactive bladder
Incontinence becomes (more / less) common as you have more children.
more common
multiparity is a risk factor
Which body state increases your risk of incontinence?
Obesity
What happens in the menopause to cause incontinence?
Relaxation of pelvic muscles, endopelvic fascia and pelvic ligaments
Which type of infection can cause urinary incontinence?
UTI
Which structure should be felt for in any abdominal/pelvic examination of a woman?
Bladder
What examinations should you do in a woman complaining of urinary incontinence?
Abdominal exam
Pelvic exam
PR exam
What test should you do in any woman complaining of urinary symptoms?
Urinalysis
What is the conservative management of an overactive bladder?
Lifestyle modifications:
drink less alcohol and caffeine
drink less fluid in general
lose weight
pelvic floor exercises and/or bladder training
Which muscle do antimuscarinics act on?
How?
Detrusor smooth muscle
Inhibit parasympathetics, reducing contraction
What are some examples of antimuscarinic drugs used for urge incontinence?
Oxybutynin
Tolterodine
What are some side effects of antimuscarinics like oxybutynin and tolterodine?
Dry mouth
Blurred vision
Constipation
Fatigue
Which new drug will soon be used instead of antimuscarinics to manage overactive bladder?
Mirabegron
B3 adrenoceptor agonist
RELAXES detrusor smooth muscle, reducing urge to void
What agents can be injected into the bladder to paralyse the smooth muscle, reducing incontinence but requiring catheterisation?
Botox
Botulinum toxin
How is stress incontinence managed?
Weight loss
Pelvic floor exercises
Incontinence pessaries - like pads, kind of
Anticholinergics e.g duloxetine
Injection of botulinum toxin
How do anticholinergics e.g duloxetine treat stress incontinence?
Constrict urethral smooth muscle
Maintain tone of internal urethral sphincter
If all else fails, urinary incontinence can be treated using ___.
surgery
What is a common gynae problem caused by increasing age and obesity?
Pelvic organ prolapse
What are some risk factors for pelvic organ prolapse?
Increasing age
Multiparity
Menopause
Obesity
Chronic constipation
Which three closely related organs, found in the pelvis, can prolapse into one another?
Bladder
Vagina/Uterus
Rectum
Which conditions, causing hypermobility, predispose women to pelvic organ prolapse?
Marfan’s syndrome
Ehlers-Danlos syndrome
What sort of symptoms are caused by pelvic organ prolapse?
Sensation of pressure, dragging in the pelvis
Urinary symptoms
Lower GI symptoms
Pain or discomfort during sex
What is an anterior pelvic prolapse also known as?
Cystocele
Cystocele causes ___ symptoms.
urinary symptoms
incomplete emptying, incontinence
What has prolapsed inferiorly in a woman with dragging sensation, back pain and dyspareunia?
Uterus
What is a posterior pelvic prolapse also known as?
Rectocele
What has prolapsed in a woman with dragging sensation and difficulty defaecating?
Rectum
What system is used to figure out what exactly has prolapsed in a woman with pelvic organ prolapse?
POP-Q
What structure is used as a reference point in the POP-Q quantification of pelvic prolapse?
Hymen
negative numbers - above hymen, good
positive numbers - below hymen, bad
How is pelvic prolapse investigated?
Ultrasound
MRI scan
How is pelvic prolapse managed conservatively?
Lose weight
Pelvic floor exercises
+/- Insert a vaginal pessary to keep things in place
What is a vaginal pessary?
Plate which is inserted to keep the pelvic organs in place
can be permanent (replaced every 6 months) or self-inserted depending on needs of patient
If conservative management and vaginal pessaries aren’t appropriate, how is vaginal prolapse managed?
Surgery
