POP and Urinary Incontinence Flashcards
What causes pelvic organ prolapse?
Pelvic floor muscle weakness, aggravated by anything that raises the intra-abdominal pressure:
- obesity
- chronic cough
- constipation
Give five factors which predispose to pelvic organ prolapse
Childbirth Menopause (low oestrogen) Congenital Gynae surgery Genetic factors
Give two types of anterior prolapse
Urethrocele
Cystocele
Give three grades of central prolapse
Uterine/cervical prolapse:
- first degree
- second degree
- third degree
Give two types of posterior prolapse
Enterocele
Rectocele
Describe the conservative management options for prolapse
Weight loss Smoking cessation Normalise fluid intake Supervised pelvic floor physiotherapy Pessary (e.g. ring pessary)
When is surgery indicated to treat pelvic organ prolapse? What procedures might be used?
For severe prolapse, if impacting QOL and conservative management has no effect.
Anterior/posterior colporrhaphy
Vaginal hysterectomy or Manchester repair
Give the two types of urinary incontinence
Stress urinary incontinence (SUI) Overactive bladder (OAB)
Describe the aetiology o stress urinary incontinence
Weakness of both sphincters;
- pregnancy
- prolapse
- menopause
- collagen disorder
- obesity
Which dermatomes would be assessed when investigating stress urinary incontinence?
S2 - S4
Describe the management options for urinary incontinence
Conservative; lifestyle, bladder retraining
Physiotherapy (supervised)
Drug therapy
Surgery
What are the main drugs used to treat urinary incontinence??
OAB: antimuscarinics
SUI: oestrogens or Duloxetine
What lifestyle interventions can help reduce urinary incontinence?
Normalise fluid intake Restrict alcohol and caffeine Weight loss Smoking cessation Avoid carbonated drinks Treat constipation, chronic cough etc
