Introduction to Gyno

Question 1

Stress vs. urge incontinence

Answer 1

Stress is when you have an anatomic loss of support, leading to leaking out urine when you cough, sneeze or laugh, in small amounts.

Urge incontinence is seen with Detrusor instability or overactive bladder where you cannot inhibit contractions of the bladder. We see sudden large volume losses, and patients complain of urgency, frequency, and nocturia.

Question 2

What is overflow?

Answer 2

Obstruction or loss of neurologic control. Constantly full with periodic dribbling

Question 3

How do we treat urge incontinence?

Answer 3

Gotta relax that bladder, we’ll give anticholinergic medications like oxytryol or ditropan, or Detrol.

Can also give:

• Muscarinic receptor antagonists like Flavoxate which calmc muscle spasms
• TCA like doxepin or imipramine to paralyze the smooth muscle of the bladder

Question 4

How would we treat stress urinary incontinence?

Answer 4

Anticholinergic meds like Oxytrol or Ditropan or Detrol like with urge incontinence, as well as TCAs like imipramine, also like urge incontinence.

Also could use

• Estrogen therapy
• Pessary (continence ring”)
• Surgery

Question 5

How do we deal with overflow incontinence?

Answer 5

• Behavior modification
• Surgery to relieve obstruction
• Muscarinic receptor agonist like Bethanechol (contraindicated in patients with asthma, CAD, ulcers, or hypothyroidism)

Question 6

PID can present in many different ways, all centered around general discomfort and pelvic pain.

How do we treat it?

Answer 6

Combination therapy:

• Ceftriaxone (250mg)
• Azithromycin 1g once or Doxy 100mg BID x 7 days