Incontinence + Prolapse Flashcards
Name the types of incontinence
Urgency = overwhelming desire to void
Urge incontinence = associated with leak
Stress incontinence = leak while coughing
Frequency = >8/d
Nocturia = >2/night
Hesitancy = delay in commencing stream
Dysuria = burning discomfort while/after
What should be covered in an incontinence Hx?
PC
Severity - amount, pad use (size, number), lifestyle mods
Fluid intake
Associated symp - prolapse, faecal symp, leak during intercourse
Obs Hx - birthweight, forceps, perineal trauma, duration of second stage
Prev surgery - hysterectomy, pelvic floor repair, incontinence op
Medical/FH - lung disease, CT, DM, HTN (doxasacin - alpha 1 antagonist)
What should be covered in an incontinence exam?
- Obesity (stress, detrusor overactivity)
- Scar (?hysterectomy)
- Abdo/pelvic masses (fibroid uterus, ovarian cyst)
- Visible incontinence (cough)
- Prolapse
- Pelvic floor tone (DVE)
- CNS (MS)
How should incontinence be investigated?
- Urinalysis - infection
- Diaries - 3-7 days, intake, frequency, voided amount
- Pad tests - measure amount lost in 24h
- US/IVP for renal tract abnormalities
- Cystoscopy
Describe cystometry
Bladder filled with room temp saline, 50ml/min
Pressure catheter in the bladder + abdo pressure via water filled balloon in rectum
Bladder pressure - abdo pressure = detrusor pressure
Bladder function - capacity, flow rate, voiding function, demonstrate leakage with intravesical pressure
What are the causes of incontinence?
Urodynamic stress incontinence
- Incompetent urethral sphincter = childbirth, menopause, prolapse, chronic cough
- Positional displacement = during cough bladder neck falls through urogenital hiatus
- Intrinsic weakness = not enough pressure generated
Detrusor overactivity
- More common in pts with hx of childhood UTIs
Mixed incontinence
How is urodynamic stress incontinence Tx?
Sensible fluid intake, no caffeine/alcohol, mobility aids/toilet placement, pads, bedpans/commodes
Physio
Medication
- Duloxetine
Surgery
- Tension free vaginal tape
- Burch colposuspension
- Transobturator tapes
- Single incision tapes
- Periurethral injection
How is detrusor overactivity Tx?
Sensible fluid intake, no caffeine/alcohol, mobility aids/toilet placement, pads, bedpans/commodes
Electrical stimulation applied to pudendal N, Posterior tibial N, Sacral N
Anticholinergic drugs (muscarinic receptor) = oxybutynin, tolterodine
Botulinum toxin
What gives uterine support?
Uterosacral lig (uterus to sacrum)
Cardinal (transverse cervical) lig (base of the broad lig that cover the uterus)
Pelvic floor
How can uterine decent be classified?
1 - into vagina but reach introitus
2 - reaches introitus
3 - partially or completely outside the vagina
What factors predispose a pt to uterine prolapse?
Age, menopause, parity, CT disease, obesity, smoking
What are the symptoms of uterine prolapse?
‘something is coming down’
Urinary/fecal incontinence
Diff micuration/defaecation
Bleeding/discharge
Painful sex
Outline the management of uterine prolapse
CONSERVATIVE = pessaries, reduce RF (smoking, weight loss, prevent constipation), Kegel exercises
SURGERY = obliterative (close off vagina) or reconstructive
What is duloxetine?
= SNRI
Mechanism = thought to work by interfering with certain chemicals (called serotonin and noradrenaline) that are used within the nerves that send messages to your pelvic floor muscles
SE = nausea, dry mouth, constipation, diarrhoea, fatigue
