Urinary incontinence and pelvic organ prolapse Flashcards
What are the different forms of urinary incontinence?
Stress
Mixed
Urge/ overactive bladder
Why should a dipstick be undertaken in all women with urinary incontinence?
Detect; Blood Glucose Protein Leukocytes Nitrites
How long should a bladder diary be taken for?
3 days covering variations in usual activities such as both working and leisure days
What are the lifestyle interventions for urinary incontinence?
Trial of caffeine reduction to women with overactive bladder
Modify fluid intake; ensure around 2L a day
If BMI over 30; advise weight loss
For how long should pelvic floor muscle training last?
At least 3 months as a 1st line for women with stress of mixed
At least 8 contractions 3 times a day
For what group of women should electrical stimulation +/- biofeedback be considered?
Women who cannot actively contract pelvic floor to aid motivation and adherence to therapy
Who should bladder training be offered to?
Minimum of 6 weeks as 1st line for women with urgency or mixed
When can percutaneous posterior tibial nerve stimulation be offered?
Local MDT review
Non-surgical management including overactive bladder medicine has not worked
Woman does not want botulinum toxin or percutaneous sacral nerve stimulation
When should bladder catheterisation be considered?
Persistent urinary retention is causing incontinence, symptomatic infections or renal dysfunction and in whom this cannot be otherwise correted
What should be taken into consideration when prescribing an anticholinergic medicine?
Coexisting conditions (poor bladder emptying, cognitive impairment, dementia)
Current use of other medicines that affect total anticholinergic load
Risk of adverse SE; cognitive impairment
When should desmopressin be considered?
In women to reduce nocturia
Use caution in women with CF and avoid in those over 65 with CV disease or hypertension
What medication can be offered for stress incontinence?
Duloxetine
What should be offered to treat women with overactive bladder with co-existing vaginal atrophy
Vaginal oestrogen
When can botulinum toxin be offered?
After local MDT to women with an overactive bladder caused by detrusor overactivity that has not responded to non-surgical management including pharma tx
What are the options for surgical management of stress urinary incontinence?
Colposuspension
Autologous rectus fascial sling
Retropubic mid-urethral mesh sling
Intramural bulking agents
How are vaginal prolapses graded?
POP-Q system; assess and record presence and degree of prolapse of anterior, central and posterior vaginal compartments of vaginal wall
What should be examined in women presenting with vaginal prolapse?
POP-Q
Activity of pelvic floor muscles
Vaginal atrophy
Rule out pelvic mass
What history should be taken from women presenting with prolapse?
Symptoms of prolapse
Urinary function
Bowel function
Sexual function
What are the lifestyle modifications for vaginal prolapse?
Losing weight if BMI over 30
Minimising heavy lifting
Preventing or treating constipation
When should topical oestrogen be utilised in vaginal prolapse?
If signs of vaginal atrophy
In what women can pelvic floor muscle training be helpful in vaginal prolapse?
At least 16 weeks in women with symptomatic POP-Q stage 1 or 2
When should pessaries be considered in vaginal prolapse?
Women with symptomatic pelvic organ prolapse
What should be discussed before pessary treatment?
Treat vaginal atrophy with oestrogen
More than 1 pessary fitting may be required to find a suitable one
Can affect sexual interocourse
Complications
What are the complications of a pessary?
Vaginal discharge
Bleeding
Difficulty removing pessary
Pessary expulsion
How often should a pessary be removed?
At least once every 6 months
What are the surgical options for women with uterine prolapse?
Hysterectomy
Vaginal sacrospinous fixation
Manchester repair
Sacrocolpopexy
