Urinary Incontinence and Prolapse

Question 1

What 3 layers make up the pelvic floor?

Answer 1

pelvic diaphragm
muscles of perineal pouches
perineal membrane

Question 2

What two muscles make up the pelvic diaphragm?

Answer 2

levator ani and coccygeus

Question 3

What are the features of the pelvic diaphragm?

Answer 3

deepest layer

has the urogenital hiatus + passage for the urethra + vagina for females

Question 4

What are the 3 parts/muscles of the levator ani?

Answer 4

puborectalis
pubococygeus
ileococygeus

Question 5

What is the function of the puborectalis?

Answer 5

forms a sling around the rectum - tonic contractions bend the anorectum anteriorly

Question 6

What is the usual state of the levator ani - contracted or not?

Answer 6

tonically contracted most of the time

relaxes to allow urination and defeacation

Question 7

What is the levator ani innervated by?

Answer 7

pudendual nerve + nerve to the levator ani

Question 8

What is then tendineous arch of the levator ani?

Answer 8

thickened layer of fascia that covers the obturator internus

Question 9

Where do the deep perineal pouch muscles lie?

Answer 9

above the perineal membrane but below the fascia covering the inferior aspect of the pelvic diaphragm

Question 10

What are the deep perineal pouch muscles?

Answer 10

compressor urethrae
external urethreal spinchter
deep transverse perineal muscles

Question 11

What is the role of the compressor urethrae and external urethreal spinchter? What is their effect on the urethra?

Answer 11

work together BUT
compressor pushes down on the urethra
spinchter contracts the urethra

Question 12

What type of muscle is the deep transverse perineal muscles in men?

Answer 12

skeletal muscle

Question 13

What type of muscle is the deep transverse perineal muscles in women?

Answer 13

smooth muscle

Question 14

What does the deep transverse perineal muscles contain?

Answer 14

bulbourethral glands

Question 15

Where does the superficial perineal pouch lie?

Answer 15

beneath the perineal membrane

Question 16

What does the superficial perineal pouch contain in males?

Answer 16

root of the penis - bulb and crura

Question 17

What are the characteristics of the bulb in males?

Answer 17

corpus spongiosum covered by bulbospongiosus muscle

Question 18

What are the characteristics of the crura in males?

Answer 18

corpus cavernosum covered by ischiocavernosum

Question 19

Apart from the crura and the bulb - what else does the superficial perineal pouch contain in males?

Answer 19

spongy urethra
superficial transverse perineal muscles
branches of the internal pudendual vessels and nerves

Question 20

What does the superficial perineal pouch contain in females?

Answer 20

bulbs of the vestibule

crura

Question 21

What are the characteristics of the bulb in females?

Answer 21

paired - bulbospongiosis

Question 22

What are the characteristics of the crura in females?

Answer 22

corpus cavernosum covered by ischiocavernosus

Question 23

What is the perineal membrane?

Answer 23

thin sheet of tough deep fascia superficial to the perineal pouch
attaches laterally to the pubic arch - closing the urogenital triangle

Question 24

What is a urethrocele?

Answer 24

urethra protruding into the vaginal wall

Question 25

What is a cystocele?

Answer 25

bladder protruding into the vaginal wall

Question 26

What is a rectocele?

Answer 26

rectum protruding into the vaginal wall

Question 27

What is a enterocele?

Answer 27

bowel protruding into the vaginal wall

Question 28

How do prolapses present?

Answer 28

lump in vagina
dragging feeling
urinary incontinence

Question 29

How are prolapses graded?

Answer 29

1 - in vagina
2 - at introitus
3 - outside vagina

Question 30

What does a procidenta prolapse mean?

Answer 30

completely outside the vagina

Question 31

How is the pelvic organ prolapse qunatification system measured?

Answer 31

patient straining = 6 specific sites measured
patient at rest = 3 specific sites measured
each site is measured in relation to the hymen which is fixed

Question 32

What lifestyle management options are there for prolapse?

Answer 32

loose weight
stop smoking
avoid heavy lifting
reduce constipation

Question 33

What non surgical management is there for prolapse?

Answer 33

pessarys - tucked behind the pubic symphysis

used for women who are planning for future pregnancies, or women unsuitable for surgery or women awaiting surgery

Question 34

What surgical management is there for prolapse?

Answer 34

sacrospinous fixation
vaginal hysterectomy
manchester repair

Question 35

What conditions come under pelvic floor dysfunction?

Answer 35

bladder + bowel dysfunction
prolapse
vulvodynia
chronic pelvic pain

Question 36

What are the risk factors for urinary incontinence?

Answer 36

women
high BMI (must have BMI = 30 to have surgical treatment)
smoking
diabetes
older age

Question 37

What physical examinations should you do for urinary incontinence?

Answer 37

standing or supine test
post void residual volume
urine analysis
bladder diary

Question 38

What is the medical treatment for urge incontinence?

Answer 38

1st line: mirabegon - beta 3 adrenigic agonist that relaxes the bladder
2nd line: antecholinergics - stop bladder contracting but get anticholinergic side effects/dementia later in life
botilium toxin into detrouser muscle

Question 39

What is the medical treatment for stress incontinence?

Answer 39

duloetine - combined noradrenaline and serotonin reuptake inhibitor - increases urethral close pressure
surgery - artificial spinchters, low tension vaginal tape