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3 reproduction and sexual health > Urinary Incontinence and Prolapse > Flashcards

Urinary Incontinence and Prolapse Flashcards

1
Q

leakage on exertion…

A

stress incontinence

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2
Q

leakage accompanied or immediately preceded by urgency…

A

urge incontience

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3
Q

urgency with or without incontinence often with frequency and nocturia

A

overactive bladder (dont need incontinence to have this)

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4
Q

what frequency of urination per night is abnormal?

A

6-7 times a night

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5
Q

causes of incontinence

A 
BMI >35
age
parity - vaginal delivery
menopause
UTI
FH
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6
Q

name storage symptoms?

A 
FUN
frequency
urgency
nocturia
inconience
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7
Q

what should you ask about the incontinence?

A

exacerbating factors
timing
VOLUME!

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8
Q

name voiding symptoms?

A

hesitancy
straining
stream

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9
Q

what postmicturition symptoms should you ask about?

A

dribble?

incomplete emptying?

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10
Q

how should you ask about prolapse?

A

can you see anything coming out?

do you ever feel something has come loose inside?

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11
Q

important diet questions to ask about?

A

how much are they DRINKING?

coffee? alcohol? diet?

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12
Q

method of finding out the patient’s bladder activity?

A

bladder diary for 3 days

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13
Q

what examinations are done in a patient with incontinence?

A

general first
abdo exam
vaginal exam
PR

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14
Q

what are you looking for on abdo exam of someone with incontinence?

A

masses pain

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15
Q

what are you looking for on vaginal exam of someone with incontinence?

A

atrophy
prolapse
incontinence - ask to cough

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16
Q

Ix incontinence in women

A

urinalysis
post-voidal residual volume - emptying bladder properly

+/-
urodynamics
cystoscopy - bladder tumour/stones
imaging - haematuria?

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17
Q

conservative Tx of OAB

A 
lifestyle advice eg remove caffeine/alcohol
fluid intake 1.5-2.5l
weight loss
pelvic floor physio for 3 months
bladder retraining 6 weeks
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18
Q

pharm Tx of OAB

A
  1. anticholinergics (be wary in elderly)
  2. B3 agonist eg mirabegron
    - desmopressin if nocturia
    - topical oestrogen if atrophy
    - botox only in those who can self-catheterise
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19
Q

MoA of antimuscarinics in OAB

A

reduce intravesical pressure
raises volume threshold for micturition
reduce uninhibited contractions

20
Q

when should you review someone on anti-muscarinics for OAB

A

review after 4-6 weeks

21
Q

side effects of antimuscarinics

A 
dry mouth
constipation
blurred vision
confusion
dementia
22
Q

what is mirabegron?

A

B3 agonist

23
Q

what do B3 agonists do?

A

relaxes bladder
increases voiding interval
inhibits spontaneous bladder contractions

24
Q

what drug is recommended if nocturia is a specific complaint along with OAB?

A

desmopressin

25
Q

what drug is recommended if vaginal atrophy is a problem along with OAB?

A

topical oestrogen

26
Q

Tx of stress incontinence?

A 
weight loss
physio
incontinence pessary
bladder neck bulking via injection
surgery
medication - duloxetine
27
Q

pharm Tx of stress incontinence?

A

duloxetine NB not used much now

28
Q

surgical Tx of stress incontinence

A

TVT (tension free vaginal tape) - outpatient
autologous sling - inpatient
colpo suspension to stitch urethra

29
Q

what do incontinence pessaries do?

A

go under urethra to support it

30
Q

how common is pelvic organ prolapse?

A

up to 50% of parous women

31
Q

causes of prolapse?

A 
age 
parity 
MoD
menopause status
obesity
neuro disease
marfans/ehler dahlos
32
Q

what should you ask about prolapse?

A

pressure?
dragging sensation?
do you have to push something in to go to the toilet?

33
Q

storage symptoms of prolapse?

A

frequency

urgency

34
Q

incontinence symptoms of prolapse?

A

timing

volume

35
Q

voiding symptoms of prolapse?

A

hesitancy

straining

36
Q

bowel symptoms to ask about prolapse?

A

incomplete emptying?
is anything stuck?
is the stool hard? (if no consider prolapse)

37
Q

presentation of cystocele?

A 
bulge
pressure
incomplete bladder emptying
need to move something when inserting tampon
dyspareunia
urgency incontinence
stress incontinence
38
Q

most common prolapse?

A

cystocele

39
Q

symptoms of uterine prolapse?

A 
back pain
dragging sensation
mass
alot of difficulty inserting tampon
dyspareunia
40
Q

symptoms of rectocele?

A

bulging
pressure
difficulty defaecating
put fingers into vagina to assist

41
Q

Ix prolapse and why

A

USS - mass concerns
MRI - assoc bowel dysfunction/considering surgery
anorectal manometry

42
Q

when would you suspect malignancy in prolapse?

A

sudden onset

unknown cause

43
Q

conservative Tx of prolapse?

A

weight loss
pelvic floor exercises - 3 months, better in younger
vaginal pessary

44
Q

an asymptomatic woman with prolapse should be referred T or F

A

F, only if asymptomatic

45
Q

how are pessaries given?

A

if young and sexually active you can manage it and take it in/out yourself
- if older they are put in 6 monthly

46
Q

surgical Tx of prolapse?

A

pelvic floor repairs - high failure rate
sacrospinous fixation- for vault/uterine prolapse
colpocliesis - close over vagina
sacrohysteropexy

47
Q

what is the vault?

A

the high point of the vagina

3 reproduction and sexual health (51 decks)

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