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Reproductive - Post-Menopause > Incontinence and Prolapse > Flashcards

Incontinence and Prolapse Flashcards

1
Q

What is incontinence?

A

Involuntary leakage of urine

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2
Q

What type of incontinence is a) provoked? b) unprovoked?

A

a) Stress b) Urge (OAB)

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3
Q

What is the most common type of incontinence? What is it due to?

A

Stress: poor closure of the bladder

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4
Q

When does stress incontinence occur?

A

On exertion or effort (e.g. sneezing, coughing, laughing)

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5
Q

Describe what happens in urge incontinence?

A

There is a sudden, compelling desire to urinate that is difficult to delay, and can cause urgency which can lead to incontinence

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6
Q

Mixed incontinence is a combination of which types?

A

Urge and stress

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7
Q

Women who have an overactive bladder often do what?

A

Drink an excessive amount of fluid, and have a high caffeine intake

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8
Q

What defines an overactive bladder? What are some symptoms which are commonly associated?

A

Urgency which occurs with or without incontinence / frequency and nocturia

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9
Q

What is overactive bladder known as if it occurs a) with incontinence? b) without incontinence?

A

a) wet OAB b) dry OAB

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10
Q

What happens to the detrusor muscle to cause OAB?

A

Hyperactivity, there are involuntary contractions

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11
Q

Which type of incontinence is more likely to be idiopathic? What are some common risk factors for the other type?

A

OAB (urge) / stress - childbirth and pregnancy, obesity, chronic cough

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12
Q

What effect does caffeine have on the bladder muscle? This of more importance in which type of incontinence?

A

It is a bladder muscle irritant, more relevant in urge incontinence

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13
Q

Which type of medications are especially bad for causing incontinence?

A

Psychoactive medications (acting on the CNS)

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14
Q

What are some examples of storage symptoms?

A

Frequency, nocturia, urgency, constant leakage

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15
Q

What are some examples of voiding symptoms?

A

Hesitancy, straining, poor flow

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16
Q

What are some important aspects of examination when somebody presents with incontinence?

A

BMI, abdominal exam, vaginal exam, PR exam

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17
Q

The total urine passed in one day should be less than what?

A

< 1800ml

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18
Q

Patients with incontinence are often asked to keep a bladder diary, what should be recorded in this? How long is it done for?

A

How often they go to the toilet and how much is passed, any leakage, how much they are drinking / 3 days

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19
Q

What two investigations should be done on every woman presenting with incontinence?

A

Urinalysis and post-void residual

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20
Q

What is the purpose of doing urinalysis when people present with incontinence?

A

To rule out a UTI (nitrates/WCC), bladder cancer/stones (blood) and diabetes (glucose)

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21
Q

What are some further investigations which could be done for incontinence but are not done routinely?

A

Urodynamics, cystoscopy, imaging

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22
Q

When are urodynamics used as an investigation for incontinence?

A

If the woman is undergoing surgery, if medical treatment has failed or if outflow obstruction is suspected

23
Q

What happens in overflow incontinence?

A

There is a bladder outflow obstruction where the voiding sensation is inadequate, leading to dribbling incontinence

24
Q

Overflow incontinence can arise as a result of what?

A

Previous surgery for incontinence or prolapse

25
Q

How can overflow incontinence be treated?

A

Treat the underlying cause, alpha blockers or intermittent self-catheterisation

26
Q

What is the first step in the management of stress incontinence?

A

Conservative management: weight loss, physiotherapy for pelvic floor exercises, smoking cessation, cut down alcohol/caffeine

27
Q

If conservative management for stress incontinence has failed, what are some other options?

A

Incontinence pessary, duloxetine (not usually 1st line), surgery (mid-urethral tape surgery)

28
Q

What will a bladder diary of someone with OAB show?

A

Frequent, small volume voids through the day and night

29
Q

What are the main lifestyle interventions that can be used as treatment options for an overactive bladder?

A

Reduce caffeine/alcohol/chocolate, keep fluid intake between 1.5-2.5L/day, weight loss aiming for BMI < 30

30
Q

Apart from lifestyle interventions, what are some other conservative treatment options for OAB?

A

Pelvic floor exercises for 3 months, bladder retraining for 6 weeks

31
Q

What is the first line pharmacological management for OAB? How do these work?

A

Anti-muscarinic agents / they relax bladder smooth muscle and hence increase bladder capacity

32
Q

Which specific anti-muscarinic agent is used first for OAB? It often has poor tolerance due to what? If oral methods are intolerant, what can be tried instead?

A

Oxybutynin / side effects e.g. dry eyes and blurred vision, dry mouth, sedation / transdermal

33
Q

When should you review a patient after starting anti-muscarinic agents for OAB? If they haven’t worked, what is the next line management?

A

4-6 weeks / consider surgical options

34
Q

Anti-muscarinic are generally not prescribed to who? Why?

A

Those aged > 85, they can cause confusion/dementia

35
Q

Mirabegron is another pharmacological agent which can be used for OAB. What group of drugs does this belong to? How does it work?

A

Beta 3 agonists / relaxes bladder smooth muscle

36
Q

What happens in an a) anterior b) middle/apical and c) posterior prolapse?

A

a) bladder drops into the vagina b) uterus drops into the vagina c) bowel drops into the vagina

37
Q

How common in pelvic organ prolapse?

A

Occurs in 50% of parous women, with 10-20% being symptomatic

38
Q

A cystocele is another name for an anterior prolapse, what can prolapse here? What is a more specific symptom of this type of prolapse?

A

Bladder or anterior vaginal wall / incontinence

39
Q

Middle/apical organ prolapses (enteroceles) can cause what specific symptom?

A

Back pain

40
Q

A rectocele is another name for a posterior prolapse, what can prolapse here? What is a more specific symptom of this type of prolapse?

A

Rectum or posterior vaginal wall / incomplete defaecation

41
Q

What are the most significant contributors to the aetiology of prolapse?

A

Age, childbirth and family history, as well as increased intra abdominal pressure (e.g. obesity, chronic cough)

42
Q

What is the most common presenting complaint of a prolapse?

A

A dragging sensation down below, which gets worse as the day progresses

43
Q

What are some groups of symptoms you would want to ask about if a woman presented with a prolapse?

A

Urinary symptoms, bowel symptoms, sexual dysfunction

44
Q

What position would you want to examine a woman in for suspected prolapse to assess the full extent? How will the prolapse be demonstrated?

A

While standing or squatting/ Valsalva manoeuvre or coughing

45
Q

Is prolapse routinely investigated for?

A

No, only if it is of sudden onset as this may be due to pressure from a pelvic mass

46
Q

In the quantification system for prolapse, all sites are measured in relation to which structure?

A

Hymenal ring

47
Q

What are some conservative management options for prolapse?

A

Weight loss, smoking cessation, pelvic floor exercises for 3 months, pessaries

48
Q

When would pessaries be used instead of surgery in the management of prolapse?

A

If that was the preference, not completed family, only mild-moderate, for frail patients

49
Q

What are some complications of using a pessary?

A

Discharge, ulcerations which may lead to fistula

50
Q

How often should a pessary be changed? What is used alongside it?

A

Every 6 months / topical oestrogen

51
Q

Sex is only possible with what kind of pessary?

A

Ring

52
Q

What is the surgical management of uterine prolapse?

A

Vaginal hysterectomy with vault support

53
Q

What is the surgical management of anterior or posterior prolapses?

A

Vaginal repair

54
Q

What is the surgical management for uterine prolapse if the woman doesn’t want a hysterectomy?

A

Sacrohysteroplexy

Reproductive - Post-Menopause (7 decks)

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