prolapse/incontinence Flashcards

1
Q

what is a prolapse

A

weakness of supporting structures allows the pelvic organs to sag within the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is prolapse due to

A

may be congenital but usually from stretching during childbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk factors during childbirth for prolapse

A

push before dilatation, long stage 2, great force in stage 3. poor perineal repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what can weakness be exacerbated by

A

menopausal atrophy, coughing/straining- increase intra abdominal pressure. may cause incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

degrees of uterine prolapse

A

1st- cervix stays inside the vagina, 2nd- protrudes from the introitus when standing and straining, 3rd- uterine fundus lies outside the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

symptoms uterine prolapse

A

‘dragging’ or ‘something coming down’- worse by day. cystitis, freq, stress incontinence, difficulty defacating.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how to examine in prolapse

A

examine vaginal walls in left lateral position with a sims speculum. ask patient to bear down to demonstrate the prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

additional studies in uterine prolapse

A

urodynamic studies to exclude detrusor overacitivity and assess voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

prevention uterine prolapse

A

lower parity, pelvic floor exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatment mild prolapse

A

decrease intra abdominal pressure- lose weight, stop smoking, stop straining. increase muscle tone by exercises or physio. if postmenopausal- topical oestrogen- estriol cream or estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment severe prolapse

A

surgery- excise redundant tissue and strengthen supports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

disadvantage of surgery for prolapse

A

reduce vaginal width- surgery must compromise between treating prolapse and maintain sexually active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

marked prolapse best treated by

A

hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a temporary measure for prolapse or for the frail

A

ring pessaries- insert into the posterior fornix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

problems with ring pessaries

A

discomfort, infection, ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how often to change ring pessaries

A

every 6-12m

17
Q

if the ring pessaries keep falling out what is an alternative

A

shelf pessary

18
Q

what wall is weak in cystocele

A

upper anterior wall

19
Q

what is involved in cystocele

A

bladder. residual urine within cystocele may cause freq and dysuria

20
Q

what wall is weak in urethrocele

A

lower anterior wall bulges

21
Q

what happens in urethrocele

A

lower anterior wall bulges and displaces the urethra, impairing sphincter mechanisms

22
Q

what type of prolapse leads to stress incontinence

A

urethrocele

23
Q

treatment cystocele

A

trans vaginal mesh repair

24
Q

what wall is weak in rectocele

A

middle posterior wall

25
what wall is weak in enterocele
upper posterior vaginal wall. may contain loops of bowel from pouch of douglas
26
how is continence maintained
external sphincter and pelvic floor muscles
27
micturition
external sphincter and pelvic floor muscles relax and bladder detrusor muscle contracts
28
what happens in urge incontinence
bladder may be overactive with high detrusor activity
29
management urge
bladder training, pelvic floor physio, antimuscarinics- oxybutyrin, desmopressin- for nocturia
30
what happens in stress incontinence
intra abdominal pressure rises. commoner in paroud women.
31
management stress
pelvic floor exercises, duloxetine, surgery- increase intraurethral pressure and reduce prolapse.
32
what is true incontinence
continuous leakage due to congenital eg ectopic ureters, or acquired eg vesicovaginal fistula from trauma, malignancy, radiotherapy
33
causes voiding difficulty
CNS, obstructive, bladder overdistension, after epidural, detrusor weakness, myopathy, drugs
34
treatment voiding difficulty
acute catheter, tamsulosin for detrusor weakness. alpha blockers