Urinary Incontinence and Prolapse Flashcards
leakage on exertion…
stress incontinence
leakage accompanied or immediately preceded by urgency…
urge incontience
urgency with or without incontinence often with frequency and nocturia
overactive bladder (dont need incontinence to have this)
what frequency of urination per night is abnormal?
6-7 times a night
causes of incontinence
BMI >35 age parity - vaginal delivery menopause UTI FH
name storage symptoms?
FUN frequency urgency nocturia inconience
what should you ask about the incontinence?
exacerbating factors
timing
VOLUME!
name voiding symptoms?
hesitancy
straining
stream
what postmicturition symptoms should you ask about?
dribble?
incomplete emptying?
how should you ask about prolapse?
can you see anything coming out?
do you ever feel something has come loose inside?
important diet questions to ask about?
how much are they DRINKING?
coffee? alcohol? diet?
method of finding out the patient’s bladder activity?
bladder diary for 3 days
what examinations are done in a patient with incontinence?
general first
abdo exam
vaginal exam
PR
what are you looking for on abdo exam of someone with incontinence?
masses pain
what are you looking for on vaginal exam of someone with incontinence?
atrophy
prolapse
incontinence - ask to cough
Ix incontinence in women
urinalysis
post-voidal residual volume - emptying bladder properly
+/-
urodynamics
cystoscopy - bladder tumour/stones
imaging - haematuria?
conservative Tx of OAB
lifestyle advice eg remove caffeine/alcohol fluid intake 1.5-2.5l weight loss pelvic floor physio for 3 months bladder retraining 6 weeks
pharm Tx of OAB
- anticholinergics (be wary in elderly)
- B3 agonist eg mirabegron
- desmopressin if nocturia
- topical oestrogen if atrophy
- botox only in those who can self-catheterise
MoA of antimuscarinics in OAB
reduce intravesical pressure
raises volume threshold for micturition
reduce uninhibited contractions
when should you review someone on anti-muscarinics for OAB
review after 4-6 weeks
side effects of antimuscarinics
dry mouth constipation blurred vision confusion dementia
what is mirabegron?
B3 agonist
what do B3 agonists do?
relaxes bladder
increases voiding interval
inhibits spontaneous bladder contractions
what drug is recommended if nocturia is a specific complaint along with OAB?
desmopressin
what drug is recommended if vaginal atrophy is a problem along with OAB?
topical oestrogen
Tx of stress incontinence?
weight loss physio incontinence pessary bladder neck bulking via injection surgery medication - duloxetine
pharm Tx of stress incontinence?
duloxetine NB not used much now
surgical Tx of stress incontinence
TVT (tension free vaginal tape) - outpatient
autologous sling - inpatient
colpo suspension to stitch urethra
what do incontinence pessaries do?
go under urethra to support it
how common is pelvic organ prolapse?
up to 50% of parous women
causes of prolapse?
age parity MoD menopause status obesity neuro disease marfans/ehler dahlos
what should you ask about prolapse?
pressure?
dragging sensation?
do you have to push something in to go to the toilet?
storage symptoms of prolapse?
frequency
urgency
incontinence symptoms of prolapse?
timing
volume
voiding symptoms of prolapse?
hesitancy
straining
bowel symptoms to ask about prolapse?
incomplete emptying?
is anything stuck?
is the stool hard? (if no consider prolapse)
presentation of cystocele?
bulge pressure incomplete bladder emptying need to move something when inserting tampon dyspareunia urgency incontinence stress incontinence
most common prolapse?
cystocele
symptoms of uterine prolapse?
back pain dragging sensation mass alot of difficulty inserting tampon dyspareunia
symptoms of rectocele?
bulging
pressure
difficulty defaecating
put fingers into vagina to assist
Ix prolapse and why
USS - mass concerns
MRI - assoc bowel dysfunction/considering surgery
anorectal manometry
when would you suspect malignancy in prolapse?
sudden onset
unknown cause
conservative Tx of prolapse?
weight loss
pelvic floor exercises - 3 months, better in younger
vaginal pessary
an asymptomatic woman with prolapse should be referred T or F
F, only if asymptomatic
how are pessaries given?
if young and sexually active you can manage it and take it in/out yourself
- if older they are put in 6 monthly
surgical Tx of prolapse?
pelvic floor repairs - high failure rate
sacrospinous fixation- for vault/uterine prolapse
colpocliesis - close over vagina
sacrohysteropexy
what is the vault?
the high point of the vagina
