Urinary Incontinence and Prolapse Flashcards
Leakage of urine during raised intra-abdominal pressure
Stress urinary incontinence
Leakage associated with urgency, usually with detrusor activity
Overactive bladder
What could cause voiding difficulties?
Detrusor hypotonia
Overflow
Neurological conditions that could cause urinary incontinence?
Multiple sclerosis
Diabetes
Most common type of urinary incontinence?
Stress urine incontinence (48%)
This records voided volumes, frequencies and UI episodes
Bladder chart
This quantifies urine leakage over specified time
Pad test
Why would you study urodynamics?
Can differentiate between stress incontinence and overactive bladder (urge incontinence) in patients in whom surgey is considered
- includes uroflowmetry
- cystometry
Lifestyle measures to treat stress urinary incontinence
Lose weight
Stop smoking
Avoid caffeinated drinks
Avoid excessive fluid intake
Physiotherapy - pelvic floor muscles etc
Drugs for stress urinary incontinence
Duloxetine
SNRI
Drugs for OAB
Oxybutynin
B3 antagonists
How does duloxetine work?
SNRI (stops NA and 5HT uptake)
-increases intraurethral closure pressure
How does oxybutynin work?
Blocks detrusor muscarinic receptor
= decreases detrusor contractibility
1st degree prolapse
In vagina
2nd degree prolapse
At introitus
3rd degree prolapse
Outside vagina
Procidentia
Entirely outside vagina
What is an enterocele?
Type of prolapse involving pouch of douglas containing small bowel
Symptoms of rectocele?
constipation
dyschezia
Symptoms of cystourethrocele?
- stress urinary incontinence
- urinary retention,
- recurrent UTI
What investigations should you do if someone with prolapse has significant urinary symptoms?
MSSU
Bladder chart
Consider drug treatment/referral urodynamics
Conservative management for uterovaginal prolapse
VAGINAL OESTROGENS - only if symptomatic atrophic vaginitis
- avoid lifting heavy weights
- stop smoking
- lose weight
- reduce constipation
When can you give vaginal oestrogens for prolapse?
Only if atrophic vaginitis
When can you consider surgical management for prolapse?
ONLY after failed conservative management and if major impact on quality of life
Which ligament could you attach the vaginal vault to?
Sacrospinous ligament
sacrospinous ligament fixatiton
M1
Brain (cortex and hippocampus)
Salivary glands
Cognitive functioning and memory
Saliva secretion
M2
Heart, brain, smooth muscle
M3
Smooth muscles, glands, eye (control iris contraction)
M4
Brain
-modulation of several important dopamine-dependent behaviours
M5
Brain (substantia nigra)
-regulation of striatal dopamine release
What could lead to a woman developing a fistula
Cervical cancer
Obstructive labour
Why might you check bloods in someone with urinary incontinence?
Want to check renal function if you suspect renal impairment
This investigation allows you to measure peak flow, mean flow and voided volume
Uroflowmetry
This is a method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding
Cystometry
