Pelvic Floor Disorders

Question 1

What are the 3 main categories of pelvic floor disorders?

Answer 1

Urinary incontinence
Pelvic organ prolapse
Anal incontinence

Question 2

List the 4 main types of urinary incontinence

Answer 2

Stress
Urge
Overflow
Mixed

Question 3

List risk factors for urinary incontinence

Answer 3

Being female
Increasing age
Obesity
Smoking
Kidney disease
Diabetes

Question 4

What is urinary urgency?

Answer 4

Sudden compelling desire to pass urine that is difficult to resist

Question 5

Does involuntary urine leakage occur in urge incontinence?

Answer 5

Yes

Question 6

How is overactive bladder different from stress incontinence?

Answer 6

OAB involves involuntary detrusor contraction; stress can be caused by pressure or urethral hypermotility

Question 7

How can incontinence be tested for on physical examination?

Answer 7

Standing or supine stress test

Question 8

List the spectrum of treatments for overactive bladder, from least to most invasive

Answer 8

Lifestyle improvement
Bladder training
Pelvic floor exercise/physio
Drugs
Botox
Neuromodulation
Reconstructive surgery

Question 9

Which drug class is the most commonly used for overactive bladder? Name the most used agent

Answer 9

Antimuscarinics

Oxybutynin

Question 10

What drug class can help relax the bladder? Give an example

Answer 10

B3 agonist

Mirabegron

Question 11

What is classified as a normal amount of urine to void a day?

Answer 11

Less than 8 times a day

Less than 2800 ml a day

Question 12

What does cystometry measure?

Answer 12

Pressure-volume relationship of the bladder during filling, provocation and voiding

Question 13

When does stress incontinence occur?

Answer 13

Sudden movements or increases in intrabdominal pressure

Question 14

Which drug can be used for stress incontinence?

Answer 14

Duloxetine

Question 15

What surgical methods can be used for stress incontinence?

Answer 15

Low-tension vaginal tape
Colposuspension
Artificial sphincters

Question 16

When is overactive bladder dry and when is it wet?

Answer 16

Wet when urge incontinence is present, dry when it is not

Question 17

What is overflow incontinence?

Answer 17

Chronic urinary retention due to bladder outflow obstruction

Question 18

What specific symptom do patients often complain about with overflow incontinence?

Answer 18

Nocturia

Question 19

Stress incontinence does not involve urgency. True/False?

Answer 19

True

Question 20

List risk factors for pelvic organ prolapse

Answer 20

Pelvic surgery
Childbirth
Menopause
Obesity
Chronic constipation/coughing/heavy lifting
Uterine fibroids
Connective tissue disorders

Question 21

Which part of the vaginal wall does a cystocele come from?

Answer 21

Anterior

Question 22

Which part of the vaginal wall does a enterocele come from?

Answer 22

Middle

Question 23

Which part of the vaginal wall does a rectocele come from?

Answer 23

Posterior

Question 24

List some clinical features of pelvic prolapse

Answer 24

Bulging pressure
Difficulty voiding, incomplete emptying
Splinting of vaginal wall
Pain with intercourse

Question 25

How are pelvic prolapses classified?

Answer 25

1st degree: in vagina
2nd degree: at interiotus
3rd degree: outside vagina
Procidentia: completely outside vagina

Question 26

What is the POP-Q system?

Answer 26

Pelvic organ prolapse quantification system

Measure each site of prolapse in relation to hymenal ring: if above hymen, -ve, if below hymen, +ve

Question 27

What should be given if someone has pelvic prolapse with atrophic vaginitis?

Answer 27

Oestrogen

Question 28

What are the 2 main management options for pelvic prolapse?

Answer 28

Pessary

Surgery