urinary incontinence and prolapse Flashcards
define stress incontinence
leakage on exertion
define urge incontinence
leakage accompanied or immediately preceded by urgency
define mixed incontinence
leakage associated with both urgency and stress
aetiology of incontinence
age parity obesity pregnancy obstetric history menopause UTI smoking FHx
examples of storage symptoms
frequency nocturia urgency UUI SUI constant leak
examples of voiding symptoms
hesitancy
straining to void
poor flow
what physical examinations might be helpful in the investigation of urinary incontinence
BMI abdo exam (masses) vaginal exam (atrophy, prolapse, SUI, fistula) PR (masses, tone) cognitive impairment
which investigations might be required to diagnose urinary incontinence
urinalysis post ovoidal residual urodynamics cystoscopy imaging
conservative management of incontinence
reduce caffeine intake fluid intake 1.5-2.5 L weight loss PFE - 3 months bladder retraining - 6 weeks
examples of antimuscarinics used to treat incontinence
oxybutynin
tolterodine
darifenicin
how do antimuscarinics help incontinence
reduce intra-vesicle pressure
increase compliance
raise volume threshold for micturition
reduce uninhibited contractions
side effects of antimuscarinics
dry mouth constipation blurred vision somnolence link to dementia
example of B3 agonist
mirabegron
action of mirabegron
relaxes bladder smooth muscle through activation of the B3 adrenoreceptor
increase voiding interval and inhibit spontaneous bladder contraction during filling
overactive bladder management
desmopressin (if nocturia) topical oestrogen botox precutaneous sacral nerve stimulator augmentation cystoplasty
surgical management of stress incontinence
tension free tape
colposuspension
intramural bulking agents
artificial sphincters
what are the three compartments of prolapse
anterior (bladder)
middle or apical (uterus)
posterior (rectum)
why is the incidence of female pelvic organ prolapse increasing
women’s life expectancy is increasing
increased expectations for quality of life
what is a cystocele
bladder prolapsing into vagina
symptoms of a cystocele
bulging pressure 'mass' difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse
what is an enterocoele
vaginal vault prolapse
symptoms of enterocoele
bulging pressure 'mass' difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse
what is a rectocele
rectum prolapsing into vagina
symptoms of rectocele
bulging pressure 'mass' difficulty defecating splinting vaginal wall or perineum difficulty inserting tampon
aetiology of prolapse
age
parity and vaginal delivery
postmenopausal oestrogen deficiency
obesity
neurological condition eg spina bifida and muscular dystrophy
genetic connective tissue disorder (marfans, EDS)
investigation of prolapse
clinical diagnosis USS MRI anorectal manometry endoanal USS
