Pelvic floor disorders Flashcards
causes of urethral incontinence
urethral sphincter incompetence
detrusor instability
retention with overflow
function
types of extraurethral urinary incontinence
congenital
fistula
types of urinary incontinence
stress
urge - over reactive bladder
mixed
overflow
incidence of USI
1/3 women over 55
1/10 will need surgery for it
risk factors for USI
women>men age obesity smoking - chronic cough kidney disease/DM
what is over reactive bladder syndrome
urgency with or without urge urinary incontinence usually with frequency and nocturne in the absence of pathological or metabolic conditions that might explain these symptoms
difference between OAB wet and OAB dry
wet is where urge incontinence is present
dry is where incontinence is absent
what is urge incontinence
proceeded by an urge to void - triggers such as running water, opening a door
what is mixed urinary incontinence
involuntary leak associated with urgency and also with exertion such as sneezing, coughing
what is happening to the bladder in OAB and UUI
and the what happens in SUI
bladder experiencing frequent involuntary contractions
bladder muscle experiences stress related contraction and support muscles unable to remain completely shut
examination
abdomen - masses, bladder
external genitalia
vaginal - prolapse, malignancy, fistula
rectal - tone, masses
what exam can be done for incontinence
standing or supine stress test - cough standing up
post void residual
urine analysis
bladder diary
treatment in OAB
lifestyle advice bladder drill pelvic floor physio drugs botulinum toxin neuromodulation reconstructive surgery
lifestyle advice in OAB
bladder retraining to increase bladder capacity and decrease frequency anti muscarinic if frequency a problem sensible fluid intake caffeine reduction weight reduction if BMI >30
physical treatments in OAB
pelvic floor muscle exercises - not as useful in urge incontinence
anti muscarinic agents when should they be given
what do they do
after lifestyle changes for OAB syndrome
reduce intra vesical pressure
increase compliance
raise volume threshold for micturition
reduce uninhibited
types of anti muscarinics
oxybutynin
tolterodine
solifenacin
propiverine
anti muscarinic SE
dry mouth
constipation
blurred vision
somnolence
B3 agonists example
what does this drug do
mirabegron
relaxes smooth muscle through activation of the b3 adenoreceptor
increases the voiding interval and inhibit spontaneous bladder contractions during filling
when is mirabegron given to px
given in overreactive bladder syndrome when antimuscarinic agents are contraindicated, clinically ineffective or have unacceptable side effects
what nerve thing can be done for OBS and what does it lead to
percutaneous posterior tibial nerve stimulation - can reduce symptoms in the short and medium term
what should be offered to women with OAB or mixed UI
oxybutanin
tolterdodine
peopiverine
what is the second line treatment for OAB
tropsium
oxybutynin - extended release
darifenacin
what is uroflowmetry
what are the indications for it
measurement of volume of urine in mls expelled from the bladder each second. can measure peak flow, mean flow and voided volume
hesitancy voiding difficulties neuropathy history of urinary retention post op follow up
indications for multi channel urodynamics
uncertain dx
fail to respond to treatment
prior surgery
what is cystometry
pressure/volume relationship of the bladder is measures during filling, porvocation and during voiding
post ovoidal residue and urine dipstick findings
normal - age dependent 10-80cc
abnormal >100-150cc
causes of overflow incontinence
what should be stopped
obstruction of urethra
poor contractile bladder muscle
anticholinergics
treatment of stress urinary incontinence
lifestyle - lose weight, stop smoking, stop caffeine
physio - pelvic floor muscle exercise
drugs - duloexetine
surgery
treatment for overactive bladder
lifestyle - avoid caffeine
physio - bladde training
drugs - oxyb
surgery
types of prolapse
anterior
middle or apical
posterior
who does pelvic prolapse occur in
risk of surgery
why is it increasing
almost 50% of parous women
11% lifetime risk
women LE increasing
classification of uterovaginal prolapse
1st degree- in vagina
2ng - at interiottus
3rd degree - outside vagina
prociedentia - entirely outside vagina
anterior cystocele symptoms
bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse
middle/apical
vaginal vault prolapse symptoms
and retrocede (posterior
bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse
pelvic organ prolapse quantification system
with the px straining 6 sites are evaluated and at rest 3 sites are measured
measure each site in relation to the hymenal ring which is fixed
if its above the hymen -ve
if its below +ve
risk factors for vaginal apical prolapse
raging pelvic surgery menopause loss of muscle tone multiple vaginal births obesity chronic constipation, coughing, heavy lifting uterine fibroids FH
management of uterovaginal prolapse conservative
reassure avoid heavy lifting lose weight stop smoking vaginal oestrogen IF SYMP ATROPHIC VAGINITIS
prolapse treatment options
physio
pessary
surgery - abd, vaginal, lapro, mesh kits
indications for pessaries
women unfit for surgery
relief of symptoms while waiting for surgery
further pregnancies planned or preg
as a dx test for prolapse/ensure correction of large cystourethrocele
px request
