Urinary Incontinence and Pelvic Organ Prolapse Flashcards
what is the main cause of stress incontinence?
weak external urethral sphincter/pelvic floor muscles
what is the main cause of urge incontinence?
overactive bladder
what are the risk factors for urinary incontinence in women?
age parity (+mode of delivery) being overweight smoking pelvic trauma previous surgery lifestyle factors (caffeine, fizzy drinks)
what are some of the symptoms women with stress incontinence present with?
urinary leakage during activities that cause a rise in intra-abdominal pressure
what are the three main investigations carried out for women with urinary incontinence?
- urine dipstick
- bladder scanning (ultrasound)
- urodynamics
- bladder diary
what is the main treatment option for stress incontinence in women?
pelvic floor exercises lifestyle changes (reduce coffee/fizzy drinks/weight loss)
how can stress incontinence be managed medically?
with duloxetine
how can stress incontinence be managed surgically?
tension-free vaginal tape (TVT)
transobturator tape (TOT)
colposuspension
what are the main features of an overactive bladder?
increased frequency
increased urgency
urge incontinence
nocturia
how long are women asked to complete a bladder diary for if they present with urinary incontinence?
3 days
what is the main reason for treating urinary incontinence?
improving QoL for women who want treatment
how can urge incontinence be managed conservatively?
lifestyle changes (weight loss, no caffeine/fizzy drinks) bladder retraining (timed voiding)
how can urge incontinence be managed medically?
antimuscarinics and anticholinergics
betmiga (mirabegron)
tricyclic antidepressants
botox injections
what is the reason for treating urge incontinence with antimuscarinics and anticholinergics?
the aim is to block the parasympathetic input to the bladder, which causes it to contract and void
what is the sympathetic input to the bladder?
hypogastric nerve (T10-L2)
what is the parasympathetic input to the bladder?
S2-S4
what are the risk factors for urge incontinence?
age
diabetes
smoking
recurrent UTIs
name the three layers of the pelvic floor
- endopelvic fascia
- pelvic diaphragm
- urogenital diaphragm
what ligaments make up the endopelvic fascia?
uterosacral/cardinal ligament
pubocervical ligament
rectovaginal ligament
what are the major risk factors for developing pelvic organ prolapse (POP)?
pregnancy/vaginal delivery/large baby
advancing age
obesity
previous pelvic surgery
what are the main symptoms of pelvic organ prolapse?
vaginal symptoms: feeling of dragging, fullness, visible lump, inability to have intercourse, difficulty with tampons
urinary symptoms: frequency/urgency, incomplete voiding
bladder symptoms: flatus, diarrhoea/constipation, straining, splinting during bowel movement, incomplete evacuation
what is the best assessment of the severity/extent of pelvic organ prolapse?
POPQ
what investigations are done to diagnose and assess severity of pelvic organ prolapse?
ultrasound/MRI
urodynamics (for concurrent UI/SI)
IVU if suspicion of ureter compression
what is the conservative treatment for pelvic organ prolapse?
pelvic floor exercises, only in mild cases
what are the interventional therapies for pelvic organ prolapse?
pessary
surgery
