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Reproduction > Pelvic Floor Dysfunction and Treatment > Flashcards

Pelvic Floor Dysfunction and Treatment Flashcards

1
Q

what does POP stand for?

A

pelvic organ prolapse

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2
Q

give examples of urethral and extraurethral causes of incontinence?

A

urethral

  • stress (external urethral sphincter dysfunction)
  • overactive (detrusor instability)

extraurethral

  • congenital malformation
  • fistula
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3
Q

how many women over the age of 55 experience stress incontinence, and how many require surgical treatment for this?

A

1 in 3 women = stress incontinence

1 in 10 women require treatment

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4
Q

what are the risk factors for incontinence?

A

women (pregnancy, childbirth, menopause, short urethra)
age
overweight (increased BMI = increased pressure causing incontinence)
smoking (chronic cough)

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5
Q

how many times per day is normal to void a bladder?

A

between 4 and 8
>8 = increased frequency

*if >60 years old then 1 episode of nocturia = normal

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6
Q

how much fluid is normally held in a bladder before needing to go?

A

400-500mls

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7
Q

patients with an overactive bladder may not leak - true or false?

A

true

  • can be wet or dry
  • can have increased frequency and urgency but not leak
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8
Q

how can the urethra be straightened to fix prolapse?

A

pessary

surgery (prevent prolapse causing kink in urethra)

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9
Q

what risk is associated with re-straightening the urethra after fixing a prolapse?

A

may cause patients to not have prolapse, but have stress incontinence risk instead

*warn patients of this as they may deem minor prolapse more manageable than incontinence

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10
Q

what questions must you ask about a patient’s sexual contact in order to assess the severity of their incontinence or prolapse?

A

do you avoid sexual contact due to incontinence/prolapse?

do you leak during sexual contact?

is the leak urinary or faecal?

if faecal, is this solid / liquid or gas?

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11
Q

at what volume does an overactive bladder feel full?

A

150-200ml

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12
Q

how can you specifically ask about quantity of urine lost during incontinence?

A

number of pads patient uses per day

type of pads used

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13
Q

why should examination of a patient with incontinence start in the abdomen?

A

look for a mass which could be increasing the pressure in the abdomen or on the bladder

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14
Q

what does atrophic vaginitis indicate may be the cause of the incontinence?

A

AV = thinning, drying and inflammation of the vaginal walls
- caused by lack of oestrogen after menopause

thinning of the bladder and urethral linings can also occur and cause urinary symptoms

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15
Q

what should be looked for on DRE if a patient suffers from incontinence?

A

rectal tone

masses

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16
Q

how can a speculum be used to assess for prolapse during an examination?

A

speculum pulled against the anterior wall of vagina to see if posterior wall bulges (and vice versa)
- minimal prolapse

patient also asked to cough as speculum withdrawn to see if cervix follows

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17
Q

what is recorded in a bladder diary?

A

time of day
frequency
volume
fluid intake volume

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18
Q

why is restricting fluids a bad idea for patients with overactive bladders or incontinence?

A

urine becomes more concentrated

  • more irritant to bladder
  • want to void at small volumes
19
Q

what other substances are irritant to the bladder?

A

caffeine (this takes around 6hrs to exit the system)
alcohol
certain fruit juices

20
Q

if a patient does not fill out their bladder diary, what does this make you worry about?

A

they wont be committed to treatment

21
Q

describe the treatment pathways used for incontinence?

A 
lifestyle modification 
bladder drill training 
pelvic floor physio exercises
drugs (anticholinergics, mirabegron)
botox 
neuromodulation 
reconstructive surgery
22
Q

how do anticholinergics work to prevent incontinence, but what side effects does this cause?

A

stops muscles of bladder contracting

but also affects other muscle groups eg eyes and mouth (causing dryness)
also increased risk of dementia if on for long term

23
Q

what are the 1st, 2nd and 3rd line drugs used for incontinence?

A

1st - tolterodine 2mg BD (can use MR if side effects)

2nd - mirabegron

3rd - solifenacin

24
Q

describe how mirabegron works and what must be checked before and after starting this drug in patients?

A

beta agonist - relaxes bladder

check BP before and after starting to check it is not increasing

25
Q

how long should drugs for incontinence be trialled for before swapping?

A

6-8 weeks

26
Q

combination of drugs can be used to treat incontinence - true or false?

A

true

27
Q

if incontinence has improves after 6 months, can drugs be stopped?

A

yes - patient can be taken off the drugs and restarted if symptoms recur

28
Q

what type of neuromodulation is used to treat overactive bladder and symptoms of urge incontinence?

A

percutaneous posterior tibial nerve stimulation (PTNS)

  • least invasive form
  • almost like “acupuncture” at back of ankle
29
Q

if drugs make no difference in incontinence treatment, botox can be used - where is this injected and what does it do?

A

injected into detrusor muscle

  • temporary paralysis
  • prevents contraction
30
Q

what must patients be taught how to do first before having botox to paralyse the detrusor muscle?

A

intermittent self catheterisation

- incase bladder cannot contract at all to let urine out

31
Q

what are urodynamics used for?

A

investigate why bladder is leaking ie make link to stress or not stress incontinence

32
Q

what findings on urodynamics would indicate obstruction?

A 
high pressure (probe usually in rectum / vagina)
low flow rate
33
Q

what drugs should you check for in a patients drug hx if they present with overflow incontinence?

A

anticholinergics

34
Q

what non-pharmacological methods can be used to treat stress incontinence?

A

continence pessary (designed to sit under bladder neck)
physiotherapy
surgery

35
Q

why is surgical mesh no longer inserted transvaginally as a treatment for prolapse or incontinence?

A

risk of erosion

36
Q

even after having a hysterectomy, women can still present with vault prolapse - true or false?

A

true

37
Q

what is a procidentia?

A

uterus, bladder, bowel etc are all contained in prolapse

AND prolapse is outwith the body

38
Q

how are prolapses roughly scored using the POP-Q?

A

anything within vagina = negative score

anything outwith vagina = positive score

39
Q

how can prolapse be treated?

A 
avoid heavy lifting 
lose weight (BMI limit for surgery = 30)
stop smoking 
decrease constipation and straining 
vaginal oestrogens if atrophic vaginitis present
40
Q

when would a ring pessary potentially NOT work in prolapse, and what could be used instead?

A

posterior wall (or 3rd degree) prolapse

change to cube if sexually active (patient needs to be able to remove this themselves)

could also use shelf pessary which is now made of silicone rather than hard plastic

41
Q

what surgery can be used in prolapse to close the vagina?

A

colpocleisis

42
Q

why is sacrospinous fixation difficult if patients have had a hysterectomy?

A

no cervix present

usually top of vagina or cervix would be attached to the ligament with a stitch and this becomes more difficult

43
Q

what other surgical fixation procedures can be used to treat prolapse?

A

uteropexy = fixation of a displaced uterus
cervicoplexy
colpopexy

Reproduction (45 decks)

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