Incontinence + Prolapse Flashcards

1
Q

Name the types of incontinence

A

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

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2
Q

What should be covered in an incontinence Hx?

A

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)

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3
Q

What should be covered in an incontinence exam?

A
  • Obesity (stress, detrusor overactivity)
  • Scar (?hysterectomy)
  • Abdo/pelvic masses (fibroid uterus, ovarian cyst)
  • Visible incontinence (cough)
  • Prolapse
  • Pelvic floor tone (DVE)
  • CNS (MS)
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4
Q

How should incontinence be investigated?

A
  • Urinalysis - infection
  • Diaries - 3-7 days, intake, frequency, voided amount
  • Pad tests - measure amount lost in 24h
  • US/IVP for renal tract abnormalities
  • Cystoscopy
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5
Q

Describe cystometry

A

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

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6
Q

What are the causes of incontinence?

A

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

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7
Q

How is urodynamic stress incontinence Tx?

A

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
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8
Q

How is detrusor overactivity Tx?

A

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

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9
Q

What gives uterine support?

A

Uterosacral lig (uterus to sacrum)

Cardinal (transverse cervical) lig (base of the broad lig that cover the uterus)

Pelvic floor

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10
Q

How can uterine decent be classified?

A

1 - into vagina but reach introitus

2 - reaches introitus

3 - partially or completely outside the vagina

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11
Q

What factors predispose a pt to uterine prolapse?

A

Age, menopause, parity, CT disease, obesity, smoking

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12
Q

What are the symptoms of uterine prolapse?

A

‘something is coming down’

Urinary/fecal incontinence

Diff micuration/defaecation

Bleeding/discharge

Painful sex

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13
Q

Outline the management of uterine prolapse

A

do nothing, pessaries, surgery (remove lump, restore organs, correct incontinence)

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14
Q

What is duloxetine?

A

= noradrenaline and serotonin reuptake inhibitor

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

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