Pelvic Floor Disorders Flashcards
What are the 3 main categories of pelvic floor disorders?
Urinary incontinence
Pelvic organ prolapse
Anal incontinence
List the 4 main types of urinary incontinence
Stress
Urge
Overflow
Mixed
List risk factors for urinary incontinence
Being female Increasing age Obesity Smoking Kidney disease Diabetes
What is urinary urgency?
Sudden compelling desire to pass urine that is difficult to resist
Does involuntary urine leakage occur in urge incontinence?
Yes
How is overactive bladder different from stress incontinence?
OAB involves involuntary detrusor contraction; stress can be caused by pressure or urethral hypermotility
How can incontinence be tested for on physical examination?
Standing or supine stress test
List the spectrum of treatments for overactive bladder, from least to most invasive
Lifestyle improvement Bladder training Pelvic floor exercise/physio Drugs Botox Neuromodulation Reconstructive surgery
Which drug class is the most commonly used for overactive bladder? Name the most used agent
Antimuscarinics
Oxybutynin
What drug class can help relax the bladder? Give an example
B3 agonist
Mirabegron
What is classified as a normal amount of urine to void a day?
Less than 8 times a day
Less than 2800 ml a day
What does cystometry measure?
Pressure-volume relationship of the bladder during filling, provocation and voiding
When does stress incontinence occur?
Sudden movements or increases in intrabdominal pressure
Which drug can be used for stress incontinence?
Duloxetine
What surgical methods can be used for stress incontinence?
Low-tension vaginal tape
Colposuspension
Artificial sphincters
When is overactive bladder dry and when is it wet?
Wet when urge incontinence is present, dry when it is not
What is overflow incontinence?
Chronic urinary retention due to bladder outflow obstruction
What specific symptom do patients often complain about with overflow incontinence?
Nocturia
Stress incontinence does not involve urgency. True/False?
True
List risk factors for pelvic organ prolapse
Pelvic surgery Childbirth Menopause Obesity Chronic constipation/coughing/heavy lifting Uterine fibroids Connective tissue disorders
Which part of the vaginal wall does a cystocele come from?
Anterior
Which part of the vaginal wall does a enterocele come from?
Middle
Which part of the vaginal wall does a rectocele come from?
Posterior
List some clinical features of pelvic prolapse
Bulging pressure
Difficulty voiding, incomplete emptying
Splinting of vaginal wall
Pain with intercourse
How are pelvic prolapses classified?
1st degree: in vagina
2nd degree: at interiotus
3rd degree: outside vagina
Procidentia: completely outside vagina
What is the POP-Q system?
Pelvic organ prolapse quantification system
Measure each site of prolapse in relation to hymenal ring: if above hymen, -ve, if below hymen, +ve
What should be given if someone has pelvic prolapse with atrophic vaginitis?
Oestrogen
What are the 2 main management options for pelvic prolapse?
Pessary
Surgery
