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Reproduction and Sexual Health > Urinary Incontinence and Prolapse > Flashcards

Urinary Incontinence and Prolapse Flashcards

1
Q

What essentially, is urinary incontinence?

A

The complaint of any involuntary leakage of urine

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2
Q

POP

A

Protrusion of pelvic organs

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3
Q

What are the 3 general categories of pelvic floor disorders?

A
  1. Urinary incontinence.
  2. Pelvic organ prolapse.
  3. Anal incontinence.
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4
Q

Stress

A

Involuntary urine leakage on effort or exertion or on sneezing or coughing.

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5
Q

Urgency

A

Involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay)
- going to the toilet around 8 times a day

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6
Q

Mixed

A

Involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing

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7
Q

Overactive Bladder

A

Defined as urgency that occurs with or without urgency UI and usually with frequency and nocturia. OAB that occurs with incontinence is known as ‘OAB wet’. OAB that occurs without incontinence is known as ‘OAB dry’

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8
Q

List common causes of urinary incontinence.

A
  • Age – more common with urgency incontinence
  • Parity – vaginal birth (although c-section isn’t 100% protective)
  • Obesity – BMI >35 (increased pressure on bladder due to increased weight)
  • Pregnancy
  • Obstetric history
  • Menopause – oestrogen levels drop and everything becomes more ‘baggy’
  • UTI
  • Smoking - a chronic cough can cause episodes of incontinence, or aggravate incontinence that has other causes (smokers are also at risk of developing overactive bladder)
  • FH
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9
Q

The older you get, the more likely you are to become incontinent …

A

Yes, sadly

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10
Q

Why does getting older make you more likely to become incontinent?

A

As people get older, the muscles in the bladder and urethra lose some of their strength.
Changes with age reduce how much your bladder can hold and increases the changes of involuntary urine release

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11
Q

What 4 life factors, make women more likely to become incontinent?

A
  • Pregnancy
  • Childbirth
  • Menopause
  • Short urethra
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12
Q

What should you always ask about when someone presents with UI?

A

Caffeine intake

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13
Q

What should you ask someone to do when they present with UI?

A

Keep a bladder diary for 3 days

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14
Q

List 6 storage symptoms.

A
  • Frequency
  • Nocturia
  • Urgency
  • UUI – urge urinary incontinence
  • SUI – stress urinary incontinence
  • Constant leak
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15
Q

List 3 voiding symptoms.

A
  • Hesitancy
  • Straining to void
  • Poor flow
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16
Q

List 3 incontinence symptoms.

A
  • Exacerbating factors
  • Timing
  • Volume
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17
Q

List 2 postmicturition symptoms.

A
  • Incontinence

* Incomplete emptying

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18
Q

If someone says they have large volumes of urine, what do they probably have?

A

Urge incontinence

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19
Q

What 5 things should be part of an examination of someone with UI?

A
  • BMI
  • Abdo exam – look for masses, incl. bladder
  • Vaginal exam – atrophy, prolapse, SUI, fistula
  • PR – masses, tone
  • Cognitive impairment
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20
Q

During an examination ask the patient to cough, if they pee then they have ______ incontinence

A

Stress

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21
Q

In OAB, there is involuntary ________ contractions

A

Detrusor

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22
Q

Detrusor instability can cause symptoms of urgency + sudden loss of urine

What does this describe?

A

Urge urinary incontinence

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23
Q

What can stress urinary incontinence be caused by?

A

This can be caused by urethral hypermotility; significant displacement of the urethra and bladder neck during exertion and increased abdominal pressure; or urethral sphincter weakness, in which the bladder sphincter cannot generate enough resistance to retain urine during stress maneuvers

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24
Q

In women, when can urethral sphincter weakness occur after?

A

Trauma, hypoestrogenism, aging, or surgical procedures

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25
What 2 investigations should be done in someone with UI?
Urinalysis + Post-void residual (shows if person is emptying bladder properly)
26
What, seen on urinalysis, should make you cautious of bladder cancer and renal stones?
Blood
27
__________ must be done before any bladder cancer surgery is done
Cystoscopy
28
What are the 3 categories of management of UI?
* Lifestyle interventions – cut down on caffeine, alcohol, fluid intake (1.5-2.5 L), weight loss (BMI <30) * Pelvic floor exercise (minimum of 3 months before you can see a difference) * Bladder retraining (takes 6 weeks)
29
Why can not drinking enough actually make you pee more?
If you don’t drink enough your urine becomes very concentrated which irritates your bladder and you pee more
30
Going from least to most invasive, what are the different categories of management for OAB.
1. Lifestyle 2. Bladder drill 3. Pelvic floor physiotherapy 4. Drugs 5. Botox 6. Neuromodulation 7. Reconstructive surgery
31
Name 3 antimuscarinic drugs.
* Oxybutynin * Tolterodine * Darifenicin
32
Outline the 4 functions of antimuscarinic drugs in UI.
* Reduce intra-vesical pressure * Increase compliance * Raise volume threshold for micturition * Reduce uninhibited contractions
33
What should be done after 4-6 weeks of starting a patient on antimuscarinics?
Review the patient at 4-6 weeks after initiating this medication to see if they are taking it and if they are tolerating it
34
List the 4 main side effects of antimuscarinics.
* Dry mouth * Constipation * Blurred vision * Somnolence - sleepy
35
Why do the side effects of antimuscarinics occur?
As antimuscarinics are anti-cholingeric
36
What is Mirabegron?
A selective agonist for the human β3 adrenoreceptor with low intrinsic activity for β1 and β2
37
What does Mirabegron do to the bladder?
Relaxes bladder smooth muscle through activation of the β3 adrenoreceptor Increase – voiding interval Decrease – spontaneous bladder contractions during filling
38
If a patient suffers from nocturia, what should you prescribe them?
Desmopressin
39
What does botox do to the bladder?
Paralyses the bladder and makes it less likely to contract BUT the person must be capable of self-catheterisation to perform this
40
What does sympathetic (adrenergic) control of the bladder do?
Increases relaxation
41
What does parasympathetic (cholingeric) control of the bladder do?
Inhibits involuntary contractions
42
B3 adrenoreceptor agonists act to activate sympathetic (adrenergic) receptors. What is the result of this?
Increases relaxation of the detrusor muscle wall Increases storage capacity + Decreases voiding frequency
43
Antimuscarinics act to block parasympathetic (cholingeric) receptors. What is the action of this? What does parasympathetic (cholingeric) control of the bladder do?
Inhibits involuntary contractions of the detrusor muscle wall Delayed voiding
44
What is Duloxetine?
Combined noradrenaline and serotonin reuptake inhibitor (increase intraurethral closure pressure)
45
What is always 1st line management for stress incontinence?
Weight loss !!! Then you can use Duloxetine
46
What is always 1st line management for UI?
Weight loss !!! Then you can use Duloxetine
47
Name 4 surgical options for UI.
* Tension free tape * Colposuspension * Intramural bulking agents * Artificial sphincters
48
What are the 3 categories of pelvic prolapse?
* Anterior * Middle/apical * Posterior
49
How many parous (had a baby before) women have a pelvic prolapse?
50%
50
What is a Cystocele?
An ANTERIOR pelvic prolapse
51
What is an Enterocele?
Vaginal wall prolapse
52
What is a Rectocele?
Posterior pelvic prolapse
53
If someone has bladder symptoms with a prolapse, what type of prolapse is it?
Anterior - Cystocele
54
Describe a complete eversion prolapse.
ALL compartments !! Uterine Procidentia + Complete uterine prolapse
55
What are the 2 main symptoms of a rectocele?
* Difficulty defecation | * Incomplete defecation
56
What are the 2 main symptoms of a cystocele?
* Difficulty voiding | * Pain on intercourse
57
What is the 1 main symptom of a enterocoele?
* Incomplete emptying
58
List potential causes of a pelvic prolapse.
* Age * Parity and vaginal delivery * Postmenopausal oestrogen and deficiency * Obesity * Neurological condition e.g. spina bifida and muscular dystrophy * Genetic connective tissue disorder e.g. Marfans, EDS
59
What 4 main features should you cover in a history of someone with a suspected pelvic prolapse?
* Pressure, dragging * Urinary symptoms * Bowel symptoms * Sexual dysfunction
60
Ix's are rarely done in a suspected prolapse
TRUE
61
Outline the results of a POP-Q.
If a site is above the hymen, assigned a negative number | If site prolapses below the hymen, the measurement is positive
62
Look at different stages of a pelvic prolapse.
If a site is above the hymen, assigned a negative number | If site prolapses below the hymen, the measurement is positive
63
Outline management of pelvic prolapse.
* Conservative management * Mechanical devices (Pessaries) * Surgery
64
What should be done in a woman with a pelvic prolapse but no symptoms?
Nothing
65
When can an asymptomatic prolapse often be found?
Smear
66
What are pessaries?
Things you stick in the vagina to keep everything up and out the way
67
Who likes pessaries?
Young girls usually as you can take them out
68
What complications are associated with pessaries?
* Discharge * Ulcerations (leading to fistula) * Fibrous bands
69
How often should pessaries be changed?
6 monthly
70
What may be given to keep tissues healthy, not dry etc in women who use pessaries?
Topical oestrogen
71
What type of surgery is done for an anterior prolapse?
Vaginal repair
72
What type of surgery is done for an posterior prolapse?
Vaginal repair
73
What types of surgery can be done for an apical prolapse?
Vaginal – sacrospinous fixation, colpocliesis. | Abdominal – sacrohysteropexy, sacrocolpopexy, pectopexy.
74
If there are no symptoms of a prolapse, what should be done?
NOTHING !!!
75
People with what type of incontinence often have a prolapse too?
Stress
76
Describe sacrospinous fixation for a prolapse.
Fix vagina or cervix back up to the top

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