Pelvic Floor Disorders Flashcards
what are the types of urinary incontinence
Stress Incontinence
Urge Incontinence
Mixed incontinence
Overflow incontinence
Describe stress incontinence
Urine leakage on effort or exertion
Can be brought on by sneezing/coughing/laughing
(anything that increases intra abdominal pressure)
Describe urge incontinence
Urine leakage accompanied/preceded by urgency
Describe mixed incontinence
urine leakage associated with urgency and exertion
Risk factors for incontinence
Female Age Obesity Parity smoking
what is overactive bladder syndrome (OAB)
Urgency, with or without incontinence, usually associated with frequency + nocturia in the absence of pathological or metabolic conditions that might explain the symptoms
what is OAB wet
where urge incontinence is present
what is OAB dry
where incontinence is absent
what is OAB associated with
detrusor contractions
what are some lifestyle measures that can improve incontinence
bladder retraining
caffeine reduction
weight reduction if BMI >30
investigations for incontinence
Urodynamics
Urinalysis
Cystoscopy
physio treatment for incontinence
pelvic floor muscle exercises
which types of incontinence are pelvic floor exercises useful in
stress and mixed
1st line medical treatment for OAB
Oxybutynin (anti-muscarinic)
2nd line medical treatment for OAB
mirabegron (beta 3 agonist)
used when anti-muscarinic is contraindicated/ineffective
anti-muscarinic side effects
dry mouth
constipation
blurred vision
somnolence
mode of action of mirabegron
relaxes bladder smooth muscle through activation of B3 receptor
what drug is given if there is nocturia
desmopressin
What drug is used in treating stress incontinence
duloxetine
what class of drug is duloxetine
combined noradrenaline + serotonin reuptake inhibitor
what does uroflowmetry do
measure the volume of urine expelled from the bladder each second
indications for investigation with uroflowmetry
hesitance voiding difficulty neuropathy History of urine retention Post operation follow up
what is cystometry used for
measure the pressure/volume relationship of the bladder during filling, provocation and 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 that measures the amount of urine left in the bladder after urination
what drugs must be stopped in overflow incontinence
Anticholinergics- atropine, oxybutynin
TCA’s
what are the 3 compartments that can prolapse
anterior
middle/apical
posterior
Classifications of prolapse
1st degree- in the vagina
2nd degree- at vaginal orriface
3rd degree- outside vagina
what does procidentia mean
entirely outside vagina
what is an anterior pelvic prolapse called
cystocele
symptoms of a cystocele
bulging, pressure, “mass”, difficulty voiding/inserting tampon, pain on intercourse
what is a middle vaginal prolapse called
enterocoele
symptoms of enterocoele
bulging, pressure, “mass”, difficulty voiding/inserting tampon, pain during sex
what is a posterior vaginal prolapse called
rectocele
symptoms of rectocele
bulging, pressure, “mass”, difficulty defecting, incomplete defecation, 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
risk factors for prolapse
Parity + vaginal delivery
Post menopausal oestrogen deficiency
Obestiy
Neurological condition e.g. spina bifida/muscular dystrophy
conservative management of prolapse
reassure
avoid heavy lifting
lose weight
stop smoking
Non conservative management of prolapse
pessary
surgery
who might receive a pessary
woman unfit for surgery
relief of symptoms whilst waiting for surgery
pregnant ladies
patient request
how often do pessaries need changed
6 monthly
surgical treatment for prolapse
vaginal hysterectomy
mesh repair
abdominal sacralcolpopexy
