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Endo/Repro: Week 4 > Nordin: Urge Incontinence and Pelvic Organ Prolapse > Flashcards

Nordin: Urge Incontinence and Pelvic Organ Prolapse Flashcards

1
Q

What is incontinence?

A

involuntary loss of urine

may affect 30-40% of women

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2
Q

leakage of small amounts of urine when intraabdominal pressure is increased

A

Stress incontinence

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3
Q

receptors in bladder dome

A

beta adrenergic

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4
Q

receptors in trigone and urethral smooth muscle

A

alpha 1

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5
Q

receptors in deep layers of bladder

A

muscarinic

parasympathetics are involved w/ emptying

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6
Q

internal sphincter

A

involuntary alpha 1 receptors

smooth muscle

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7
Q

external sphincter

A

skeletal muscle supplied by pudendal nerve
voluntary control
somatic receptors

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8
Q

urethral sphincter smooth muscle

A

contains alpha 1 recetpors

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9
Q

how does estrogen affect urethral function?

A

less vascular/thinned w/ decreased levels

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10
Q

Sympathetics (T10-L2)

A

STORAGE
IUS- CLOSE
Bladder dome- RELAX

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11
Q

Somatics

A

alpha motor neurons in ventral horn

EUS- OPEN (voluntary)

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12
Q

Parasympathetics

A

bladder musculature

EMPTY

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13
Q

How do you empty the bladder?

A

Cholinergic muscarinic receptor agonists stimulate receptors on the detrusor muscle> contraction

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14
Q

M2/M3

A

bladder smooth muscle

Salivary glands–dry mouth

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15
Q

Activating M3 receptors

A

smooth muscle contraction

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16
Q

activating M2 receptors

A

inhibits bladder relaxation

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17
Q

B2/B3 adrenergic stimulation

A

relaxation of detrusor muscles

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18
Q

increase urethral resistance

A

Alpha adrenergic agonists

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19
Q

block urethral contraction

A

alpha antagonists

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20
Q

What is the mechanism of urine storage?

A

distension of bladder>
sympathetics>
B3 relax detrusor muscle>
A1 closure of urethral outlet smooth muscle

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21
Q

How can a cough or sneeze make you pee a bit?

A

Sudden increase in bladder pressure (cough/sneeze)>
activate somatics>
open external urethral sphincter

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22
Q

Somatic micturition reflex

A

fluid flow in urethra> initiates bladder contraction>

by way of pudendal nerve and sacral spinal cord

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23
Q

spinal vesicovesical micturition reflex

A

triggered by noxious stimuli>

bladder contraction

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24
Q

What causes reflex urination/incontinence problems?

A

damage to micturition loops

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25
Q

Meds that affect continence…

A
  1. diuretics
  2. caffeine
  3. Anticholinergics–> retention/overflow
  4. alcohol> irritates bladder
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26
Q

leakage of small amounts of urine when intraabdominal pressure is increased (coughing, laughing, exercise)

A

Stress incontinence

27
Q

leakage of large amounts of urine occurring shortly after a sudden urge to urinate mediated by bladder muscle contraction

A

Urge incontinence

28
Q

Stress incontinence

A

Muscles that normally keep urethra closed are prevented from squeezing as tightly as they should d/t :
pelvic floor weakness
loss of elasticity
CT/hormones affecting urethral sphincter

29
Q

Urge

A

Inappropriate bladder contractions:
PVC of bladder (hypersensitive and always contraction)
anormal nerve signals

30
Q

blockage of outlet or weak bladder muscle fxn> frequent/constant dribbing

A

overflow

common in men with prostate enlargement

31
Q

urination due to inability to get to a bathroom either from mobility issues, obstacles, communication/cognitive problem

A

Functional

bladder normal but person can’t get to bathroom!

32
Q

Temporary condition causing incontinence such as medication, infection, illness

A 
DIAPERS
delerium
infection
atrophic vaginitis (lack of estrogen)
drugs
psychological disorders
excessive urine output
reduced mobility
stool impaction
33
Q

Cough, laugh, sneeze, lift, exercise >
intrabdominal pressure exceeds urethral closing pressure>
SMALL AMOUNTS

A

stress urinary incontinence

34
Q

What are RF for stress urinary incontinence?

A 
age
pregnancy
childbirth
menopause (estrogen)
obesity (increased pressure)
chronic coughing (increased abdominal pressure, cough, smoking, constipation, occupation w/ lifting)
urethral tone
35
Q

Involuntary leakage preceded by sudden urge to urinate d/t involuntary bladder contractions (Bladder can be full or not)>
Typically leak LARGER amounts of urine than with stress incontinence, but varies

Also called detrusor instability, “overactive bladder”

A

Urge urinary incontinence

36
Q

Specific conditions that can cause urge urinary incontinence?

A

Urinary tract infection
Bladder stones
Bladder cancer

37
Q

MC cause of urge urinary incontinence

A

DETRUSOR OVERACTIVITY OR INABILITY TO SUPPRESS DETRUSOR CONTRACTIONS

38
Q

In pts w/ mixed incontinence, how do you treat them?

A

rule out most bothersome sx

39
Q

Weak bladder muscle (detrusor) or outlet obstruction>
overdistension of bladder>
dribbling/stress incontinence

A

Overflow

40
Q

What medications may cause overflow incontinence?

A

anticholinergics
beta agonists
alpha agonists

41
Q

How do you tx stress incontinence?

A

Weight loss if obese, fluid reduction, caffeine reduction, smoking cessation (to decrease chronic cough), control of constipation

pelvic floor exercises

occlusive devices (pessaries)

42
Q

What medications can be used to tx incontinence?

A

Estrogen (intravaginal for urethra affect)
Duloxetine (more side effects)
Alpha adrenergic drugs (contract urethral sphincter) (rarely used)

*not used as much

43
Q

What is a common tx for incontinence?

A

surgery

sling procedure
bulking agent into urethra

44
Q

How do you tx urge/overactive bladder?

A

Bladder retraining/scheduled voiding
Fluid restriction
If possible, eliminate medications and agents (caffeine) that patient is taking that may worsen incontinence
Pelvic Floor Muscle Exercises

45
Q

What is the key tx for urge/overactive bladder?

A

Anticholinergics
Beta-agonists (mirabegron)
Estrogen (intravaginal, NOT systemic)
Botulinum toxin injections

46
Q

What is a kegal?

A

contraction of levator ani muscles

47
Q

Pessary

A

holds things up and in place when there isn’t enough support

48
Q

Thickens periurethral tissue by increasing vascular engorgement

A

estrogen (vaginal cream or ring)

systemic worsens incontinence

49
Q

Medications for SUI?

A

estrogen
Alpha agonists (not really used)
Duloxetine ( could work for those w/ depression)

50
Q

Meds for urge incontinence?

A

Anticholinergic agents (nonselective and selective)

Selective have fewer side effects (dry mouth)

Long acting/extended release also have fewer side effects

Caution with use in frail elderly b/c can cause dementia and narrow angle glaucoma, dementia, GI obstruction, urinary retention

51
Q

M3 selective drug

A

tolterodine

52
Q

M2/M3 less selective drug

A

oxybutynin

53
Q

Anticholinergics

A

Competitive antagonist of acetylcholine at muscarinic receptors>
Relaxes bladder smooth muscle (detrusor muscle) (decreases overactivity and contraction)

54
Q

Mirabegron

A

beta agonist>
relaxes bladder dome and detrusor

*risk of urinary retention, esp if combined w/ anticholinergics

55
Q

botulinum toxin

A

used for urge incontinence

56
Q

Bladder training

A

helps pt establish control over bladder may take 1-3 mos to improve

57
Q

pelvic organ prolapse

A

Movement of pelvic organs (uterus, bladder) from normal position downward toward or through the vaginal opening

58
Q

cystocele

A

bladder through opening

59
Q

rectocele

A

bladder through opening

60
Q

enterocele

A

intestines coming out

61
Q

What are sxs of POP?

A

Many patients asymptomatic!

Bulge symptoms: bulge/protrusion, heaviness or pressure

Urinary symptoms: Incontinence, frequency, urgency, weak stream, incomplete emptying, need to change position to void

Bowel sxs

Sexual sxs

Pain

62
Q

What are general RF for POP?

A 
age
menopause 
obseity
anything that increases intra abdominal pressure (chronic cough, constipation, repeated heavy lifting)
Pregnancy
previous hysterectomy
63
Q

What is treatment for POP?

A

Observation
Pelvic Floor Muscle Exercises
Pessary use (especially in elderly)
Surgery

Endo/Repro: Week 4 (14 decks)

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