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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
Q

What 2 investigations should be done in someone with UI?

A

Urinalysis
+
Post-void residual (shows if person is emptying bladder properly)

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26
Q

What, seen on urinalysis, should make you cautious of bladder cancer and renal stones?

A

Blood

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27
Q

__________ must be done before any bladder cancer surgery is done

A

Cystoscopy

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28
Q

What are the 3 categories of management of UI?

A
  • 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)
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29
Q

Why can not drinking enough actually make you pee more?

A

If you don’t drink enough your urine becomes very concentrated which irritates your bladder and you pee more

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30
Q

Going from least to most invasive, what are the different categories of management for OAB.

A
  1. Lifestyle
  2. Bladder drill
  3. Pelvic floor physiotherapy
  4. Drugs
  5. Botox
  6. Neuromodulation
  7. Reconstructive surgery
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31
Q

Name 3 antimuscarinic drugs.

A
  • Oxybutynin
  • Tolterodine
  • Darifenicin
32
Q

Outline the 4 functions of antimuscarinic drugs in UI.

A
  • Reduce intra-vesical pressure
  • Increase compliance
  • Raise volume threshold for micturition
  • Reduce uninhibited contractions
33
Q

What should be done after 4-6 weeks of starting a patient on antimuscarinics?

A

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
Q

List the 4 main side effects of antimuscarinics.

A
  • Dry mouth
  • Constipation
  • Blurred vision
  • Somnolence - sleepy
35
Q

Why do the side effects of antimuscarinics occur?

A

As antimuscarinics are anti-cholingeric

36
Q

What is Mirabegron?

A

A selective agonist for the human β3 adrenoreceptor with low intrinsic activity for β1 and β2

37
Q

What does Mirabegron do to the bladder?

A

Relaxes bladder smooth muscle through activation of the β3 adrenoreceptor

Increase – voiding interval
Decrease – spontaneous bladder contractions during filling

38
Q

If a patient suffers from nocturia, what should you prescribe them?

A

Desmopressin

39
Q

What does botox do to the bladder?

A

Paralyses the bladder and makes it less likely to contract BUT the person must be capable of self-catheterisation to perform this

40
Q

What does sympathetic (adrenergic) control of the bladder do?

A

Increases relaxation

41
Q

What does parasympathetic (cholingeric) control of the bladder do?

A

Inhibits involuntary contractions

42
Q

B3 adrenoreceptor agonists act to activate sympathetic (adrenergic) receptors. What is the result of this?

A

Increases relaxation of the detrusor muscle wall

Increases storage capacity
+
Decreases voiding frequency

43
Q

Antimuscarinics act to block parasympathetic (cholingeric) receptors. What is the action of this?

What does parasympathetic (cholingeric) control of the bladder do?

A

Inhibits involuntary contractions of the detrusor muscle wall

Delayed voiding

44
Q

What is Duloxetine?

A

Combined noradrenaline and serotonin reuptake inhibitor (increase intraurethral closure pressure)

45
Q

What is always 1st line management for stress incontinence?

A

Weight loss !!!

Then you can use Duloxetine

46
Q

What is always 1st line management for UI?

A

Weight loss !!!

Then you can use Duloxetine

47
Q

Name 4 surgical options for UI.

A
  • Tension free tape
  • Colposuspension
  • Intramural bulking agents
  • Artificial sphincters
48
Q

What are the 3 categories of pelvic prolapse?

A
  • Anterior
  • Middle/apical
  • Posterior
49
Q

How many parous (had a baby before) women have a pelvic prolapse?

A

50%

50
Q

What is a Cystocele?

A

An ANTERIOR pelvic prolapse

51
Q

What is an Enterocele?

A

Vaginal wall prolapse

52
Q

What is a Rectocele?

A

Posterior pelvic prolapse

53
Q

If someone has bladder symptoms with a prolapse, what type of prolapse is it?

A

Anterior - Cystocele

54
Q

Describe a complete eversion prolapse.

A

ALL compartments !!

Uterine Procidentia
+
Complete uterine prolapse

55
Q

What are the 2 main symptoms of a rectocele?

A
  • Difficulty defecation

* Incomplete defecation

56
Q

What are the 2 main symptoms of a cystocele?

A
  • Difficulty voiding

* Pain on intercourse

57
Q

What is the 1 main symptom of a enterocoele?

A
  • Incomplete emptying
58
Q

List potential causes of a pelvic prolapse.

A
  • 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
Q

What 4 main features should you cover in a history of someone with a suspected pelvic prolapse?

A
  • Pressure, dragging
  • Urinary symptoms
  • Bowel symptoms
  • Sexual dysfunction
60
Q

Ix’s are rarely done in a suspected prolapse

A

TRUE

61
Q

Outline the results of a POP-Q.

A

If a site is above the hymen, assigned a negative number

If site prolapses below the hymen, the measurement is positive

62
Q

Look at different stages of a pelvic prolapse.

A

If a site is above the hymen, assigned a negative number

If site prolapses below the hymen, the measurement is positive

63
Q

Outline management of pelvic prolapse.

A
  • Conservative management
  • Mechanical devices (Pessaries)
  • Surgery
64
Q

What should be done in a woman with a pelvic prolapse but no symptoms?

A

Nothing

65
Q

When can an asymptomatic prolapse often be found?

A

Smear

66
Q

What are pessaries?

A

Things you stick in the vagina to keep everything up and out the way

67
Q

Who likes pessaries?

A

Young girls usually as you can take them out

68
Q

What complications are associated with pessaries?

A
  • Discharge
  • Ulcerations (leading to fistula)
  • Fibrous bands
69
Q

How often should pessaries be changed?

A

6 monthly

70
Q

What may be given to keep tissues healthy, not dry etc in women who use pessaries?

A

Topical oestrogen

71
Q

What type of surgery is done for an anterior prolapse?

A

Vaginal repair

72
Q

What type of surgery is done for an posterior prolapse?

A

Vaginal repair

73
Q

What types of surgery can be done for an apical prolapse?

A

Vaginal – sacrospinous fixation, colpocliesis.

Abdominal – sacrohysteropexy, sacrocolpopexy, pectopexy.

74
Q

If there are no symptoms of a prolapse, what should be done?

A

NOTHING !!!

75
Q

People with what type of incontinence often have a prolapse too?

A

Stress

76
Q

Describe sacrospinous fixation for a prolapse.

A

Fix vagina or cervix back up to the top

Reproduction and Sexual Health (51 decks)

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