Pelvic Floor Disorders Flashcards
what are the types of urinary incontinence
Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence
what are risk factors for urinary incontinence
sex [W > M]
age
obesity
smoking
what is urgency
complaint of a sudden compelling desire to pass urine which is difficult to defer
what is nocturia
having to wake up at night to go to the toilet
what is frequency
complaint of having to go to the toilet more often
what is urge incontinence
involuntary urine leakage accompanied by or immediately preceded by urgency
what is overactive bladder syndrome [OAB]
Urgency, with or without urge urinary incontinence, usually with frequency and nocturia in the absence of pathologic or metabolic conditions that might explain these symptoms
what is OAB wet
where urge incontinence is present
what is OAB dry
where incontinence is absent
what is the definition of urge incontinence
involuntary leakage accompanied by, or immediately preceded by urgency.
Urgency, with or without urge incontinence, usually with frequency and nocturia - what is this?
overactive bladder syndrome, or urge syndrome
what is mixed urinary incontinence
Involuntary leakage associated with urgency and also with exertion, sneezing, or coughing (SUI)
what is OAB associated with
detrusor contractions
what is the definition of stress incontinence
Urine leaks during increased intra abdominal pressure, without a detrusor contraction
what are lifestyle measure that can help make incontinence better
bladder retraining
caffeine reduction
weight reduction if BMI >30
what are physio Tx for incontinence
pelvic floor muscle exercises
[only useful for stress and mixed incontinence]
what medical Tx can be given for incontinence
1st line = Oxybutymin (anti-muscarinic)
2nd line = Mirabegron (beta3 agonist) [when anti-muscarinic contraindicated or ineffective]
what are anti Muscarinic side effects
dry mouth
constipation
blurred vision
somnolence
what does a uroflowmetry do
measure the volume of urine expelled from the bladder each second
what are indications of investigation by uroflowmetry
hesitance voiding difficulty neuropathy Hx of urine retention post-op follow up
what is cystometry used for
measure the pressure/volume relationship of the bladder during filling, provocation and during voiding
what causes overflow incontinence
Obstruction of urethra
Poor contractile bladder muscle
what is needed for a diagnosis of overflow incontinence
post-void residual (PVR)
- a urine test measures the amount of urine left in the bladder after urination
what drug must be stopped in overflow incontinence
anti-cholinergics
- atropine, Oxybutynin, TCA drugs
pelvic prolapse = what compartments that can prolapse
anterior
middle or apical
posterior
what is the classification of prolapse
1st degree (in vagina), 2nd degree (at vagina orifice), 3rd degree (outside vagina) Procidentia (entirely outside vagina)
what is an anterior pelvic prolapse called
cystocele
what are Sx of cystocele
bulging, pressure "mass" difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse.
what is a middle/apical prolapse also called
enterocele
Sx of enterocoele
same as cystocele
bulging, pressure "mass" difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse.
what is a posterior prolapse also called
rectocele
Sx of rectocele
bulging, pressure, “mass" difficulty defecation incomplete defecation splinting vaginal wall or perineum difficulty inserting tampon.
what is it called when all compartments prolapse
complete eversion
what are the types of complete eversion
Uterine Procidentia
Complete uterine prolapse
Mx of prolapse - conservative
reassure
avoid heavy lifting
lose weight
stop smoking
vaginal oestrogens = if sx atrophic vaginitis
Mx of prolapse
Physio
Pessary
Surgery
who is suitable to receive pessaries
Women unfit for surgery
Relief symptoms whilst awaiting surgery
Further pregnancies planned or pregnant
As diagnostic test for prolapse/ensure correction of large cystourethrocele not cause SUI
Patient request
surgical Tx for prolapse
vaginal hysterectomy
mesh repair
abdominal sacralcolpopexy
