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ER Week 4 > Incontinence and Pelvic Organ Prolapse > Flashcards

Incontinence and Pelvic Organ Prolapse Flashcards

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1
Q

What percentage of americam n women can be affected by icnotinence?

A

as many as 30-40%

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2
Q

What are some factors that influence developing incontinence?

A 
gender
age
hormonal status
previous vaginal delivery and birthin trauma
CT differences
neurologic conditions
medications
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3
Q

What’s the most important muscle in the pelvus floor?

A

levator ani

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4
Q

Where are the beta adrenergic receptors in the bladder?

A

bladder dome

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5
Q

Where are the alpha-1 receptors?

A

trigone

urethral smooth muscle

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6
Q

Where are the muscarinic receptors?

A

in the deep layer throughout.

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7
Q

THe internal sphincter is smooth muscle under involuntary control of what receptors?

A

alpha 1

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8
Q

The external sphincter is skeletal muscle supplied by what nerve?

A

somatic pudendal nerve - under voluntary control

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9
Q

The function of the urethra is affected by estrogen because….

A

the blood vessels assist the layer sin coming together to close the urethra and vasculature decreases with decreasing estrogen levels

this is why menopause is a factor

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10
Q

Sympathetics are involved with hwat bladder function in general terms?

A

storage of urine - bladder dome relaxation

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11
Q

WHere do these sympathetics come from?

A

T10-L2 to inferior mesenteric ganglion and palvic plexus. then hypogastric and pelvic nerves to the bladder

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12
Q

Parasympathetics are involved with what bladder funcion?

A

actually peeing

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13
Q

Detrussor muscle will do what when exposed to cholinergic muscuarinic receptor agonists?

A

contract - make you pee

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14
Q

What are the muscarinic receptor subtypes in bladder smooth muscl

A

mainly M2 and M3

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15
Q

Activating M2 receptors does what?

A

inhibits bladder relaxation

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16
Q

Activating M3 receptors does what?

A

promotes bladder contraction (so M2 and M3 promote the same result by different means)

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17
Q

What are the beta adrenergic receptors in the detrusor?

A

B2 and B3 (again, promote relaxation)

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18
Q

Where is the micturition center?

A

pons

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19
Q

What are some major drgus taht influence bladder fucntion?

A

antidepressants/antipsychotics
sedatives
diuretics - increase
caffeine - increase
anticholinergics - urinary retention or used to treat incontinence
alcohol - sedation and bladder irritating
narcotis

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20
Q

What are the three main type sof incontinence?

A

stress
urge
mixed

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21
Q

What is stress incontinence?

A

leakage of small amoutns of urine when itnraabdominal pressure is increased (with walking, running, lifting, coughing, etc.)

very common

22
Q

What is urge incontinence?

A

overactive bladder - irritation and overativity of the bladder musculature itself. they’ll have the urge to urinate and then leak large amounts of urine shortly after they have that urge - can’t get to the bathroom in time sometimes

23
Q

What are the typical causes of stress I?

A

pelvic floor weakness
loss of elasticity
hormoneal or connective tissue effects

24
Q

What are the typical causes of urge?

A

inappropriate bladder contractions - PVC of the bladder, abnormal nerve signals

25
Q

What is overflow incontinence?

A

caused by either a blockage of the outlet (like BPH) or weak bladder muscle function resultin gin frequent or constnat dribbling

26
Q

What is functional incont?

A

untimely urination due toinability to get to a bathroom either from mobility issues, obstacles, communication or cognitive problems

27
Q

What are the common causes of transient incontinence?

A 
DIAPPERS
Delirium
Infection
Atropic vaginitis
Pharmaceuticals
Pysychological disorder (esp depression)
Excessive urine output
Reduced mobility (functional) or reversible urinary retention
Stool impaction
28
Q

What are the risks for stress incontinence?

A

age
pregnancy with childborth
menipause
hysterectomy/pelvic surgery
obestiy
chronically increased intraabodminal rpessure from chronic cough,smoking, constipation or occupational lifting
neurological conditions affecting urethral tone.

29
Q

What is the rterm for poor urethral sphincter function?

A

instrinsic sphincter deficiency

30
Q

What are the factors that can lead to problems with urethra not closing adequately?

A

nerve damage
scarring
decreased vascularity

31
Q

What is the most common cause of urge incont. others?

A

most frequently caused by detrusor overactivity or inacbility to suppress detrusor contractions

also UTI, bladder stones, bladder cancer, etc

32
Q

Wht pertinent things on the PMH should be considered?

A 
Obstetric and gynecologic history
Deliveries, surgeries, estrogen status
Diabetes
Stroke
Lumbar disc disease
Neurologic disease
Chronic lung disease (coughing)
Fecal impaction or constipation
Cognitive impairment 
Medications!
33
Q

What can you do for diagnosis?

A

general inspection for atrophy, neurologic function (bulbocavernosus reflex), anal wink, levator ani testing

have then cough and look for leakage
bimanual to assess for pelvic masses or stool impaction

34
Q

How can we tell if there is residual volume post void?

A

urinarlysis with catheter

35
Q

What are the options fo rstress icintoinence?

A 
weight loss
fluid reduction
caffeine reduction
smoking cessation
control of constipation
pelvic floor muscle exercises (kegels)
occlusive devices like pessaries or urethral inserts
Estrogen intravaginally
surgery
36
Q

What are two other medications that can be used for stree incotninences?

A

Duloxetine

alpha adrenergic drugs

37
Q

What are the treatments for urge incont?

A 
bladder retraining with scheduled voiding
fluid restriciton
eliminate meds that make it worse
pelvic floor muscle exercises
meds
tibial nerve stimulation
implantable sacral nerve stimulator
38
Q

What meds can be used for urge incont

A

anticholinergics
beta-agonists
estrogen
botulinum toxin injections

39
Q

What muscle is exercised by the kegel exercises?

A

levator ani

40
Q

What are extracorporeal magnetic innervation

A

stimulates the pelvic floor muscle sin people whoa re unable to sense whethe they are contracting the muscles or not

41
Q

How doe s apessary work?

A

it’s a disc with a round ball and you put it up into the vagina so that the ball pushes against the bladder anteriorly to help hold it all up

42
Q

Meds are only technically approved for what?

A

urge incotninence

43
Q

But what are the drugs you can try for stress incontinence?

A

estrogen

alpha agonists like pseudoephedrine

44
Q

For urge incontinence, you can do anticholienrgic agents. What are some examples?

A

oxybutinin, detrol, trospium

45
Q

What are the contraindications for these anticholinergic agents?

A

narrow angle glaucoma
dementia (make them worse)
GI obstruciton
urinary retention

46
Q

What is the main bet agonists used for urge incontinence?

A

mirabegron

B3 agonist

47
Q

What are the side effects of beta agonists here?

A

urinary retention, icnreased blood pressure, nausea and vomiting, headache, dizziness

48
Q

What is bladder training?

A

teach them to ignore bladder urgency and re-establish control over the bladder - do scheduled voiding only

49
Q

When should you refer someone on?

A 
Recurrent Urinary Tract Infections
New onset neurologic symptoms
Markedly enlarged prostate
Pelvic organ prolapse past the introitus
Pelvic pain and incontinence
Persistent hematuria or proteinuria
Large post void residual (200 ml)
Previous pelvic surgery or radiation
Uncertain diagnosis
50
Q

WHat ar ethe main symptoms with prolapse?

A

bulge symtpms - sense of a bulge, protrusion, heaviness or pressure

and urinary symptoms - incontinence, frequency, weak stream, etc

bowel symptoms

sexual symptoms - dyspareunia, decreased sensation

pain in the vagina, bladder, rectum, pelvis, or low back pain

ER Week 4 (15 decks)

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