Female genital prolapse + urinary incontinence Flashcards
Aetiology of pelvic organ prolapse
parity
hormonal factors - reduction of oestrogen
smoking - chronic cough increases intra-abdominal pressure and greater strain on pelvic floor
constipation
heavy lifting
surgery - continence procedures
What is an urethrocoele?
prolapse of lower abdominal wall involving urethra only
What is a cystocoele?
prolapse of upper anterior vaginal wall involving bladder (usually urethra too - cystourethrocoele)
What is a uterovaginal prolapse?
prolapse of uterus, cervix and upper vagina
What is an eneterocoele?
prolapse of upper posterior vaginal wall - containing loops of ileum
What is a rectocoele?
prolapse of lower posterior wall of the vagina involving anterior wall of rectum
What does the pelvic floor consist of?
levator ani
urogenital diaphragm
endopelvic fascia
perineal body
Describe the urogenital diaphragm
perineal membrane
triangular dense sheet of fibrous tissue
spans anterior half of pelvic outlet
forms pelvic diaphragm with levator ani
Clinical symptoms of female genital prolapse
feeling of discomfort or heaviness
lump coming down
symptoms worse with prolonged standing or at end of day
dyspareunia
chronic lower back ache
Management of prolapse
prevention
physiotherapy
intravaginal devices
surgery
How can prolapses be prevented?
avoid chronic increases in intra-abdominal pressure
avoid constipation
antenatal and postnatal pelvic floor exercises can be protective
What types of pessaries can be used to manage prolapse?
support - for minor prolapse, ring most common
space-occupying - advanced prolapse, shelf or Gellhorn
Contraindications to vaginal hysterectomy
uterine size greater than 14/40
2+ caesarean sections
endometriosis
previous PID
suspected malignancy
What symptoms should be asked about when assessing pelvic floor disorders?
lower urinary tract
vaginal
bowel
sexual dysfunction
Urge incontinence presentation
(overactive bladder)
frequency
nocturia
nocturnal enuresis
intercourse
Stress incontinence presentation
involuntary leakage:
- cough
- laugh
- lifting
- exercise
- movement
What assessments should be done for female incontinence in clinic?
patient reported outcome measure (ePAQ-PF)
frequency volume chart
urinalysis (dipstick + MSU)
uroflow
residual urine measurement
Lifestyle adaptations for incontinence
weight loss
smoking cessation
reduced caffeine intake
avoidance of straining and constipation
Management of urge incontinence
vaginal oestrogen
anticholinergics - oxybutynin, tolterodine, solifenacin
mirabegron - beta 3 agonist
Management of stress incontinence
physiotherapy
surgery
