Urinary Incontinence and Prolapse Flashcards

1
Q

What 3 layers make up the pelvic floor?

A

pelvic diaphragm
muscles of perineal pouches
perineal membrane

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2
Q

What two muscles make up the pelvic diaphragm?

A

levator ani and coccygeus

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3
Q

What are the features of the pelvic diaphragm?

A

deepest layer

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

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4
Q

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

A

puborectalis
pubococygeus
ileococygeus

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5
Q

What is the function of the puborectalis?

A

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

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6
Q

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

A

tonically contracted most of the time

relaxes to allow urination and defeacation

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7
Q

What is the levator ani innervated by?

A

pudendual nerve + nerve to the levator ani

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8
Q

What is then tendineous arch of the levator ani?

A

thickened layer of fascia that covers the obturator internus

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9
Q

Where do the deep perineal pouch muscles lie?

A

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

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10
Q

What are the deep perineal pouch muscles?

A

compressor urethrae
external urethreal spinchter
deep transverse perineal muscles

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11
Q

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

A

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

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12
Q

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

A

skeletal muscle

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13
Q

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

A

smooth muscle

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14
Q

What does the deep transverse perineal muscles contain?

A

bulbourethral glands

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15
Q

Where does the superficial perineal pouch lie?

A

beneath the perineal membrane

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16
Q

What does the superficial perineal pouch contain in males?

A

root of the penis - bulb and crura

17
Q

What are the characteristics of the bulb in males?

A

corpus spongiosum covered by bulbospongiosus muscle

18
Q

What are the characteristics of the crura in males?

A

corpus cavernosum covered by ischiocavernosum

19
Q

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

A

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

20
Q

What does the superficial perineal pouch contain in females?

A

bulbs of the vestibule

crura

21
Q

What are the characteristics of the bulb in females?

A

paired - bulbospongiosis

22
Q

What are the characteristics of the crura in females?

A

corpus cavernosum covered by ischiocavernosus

23
Q

What is the perineal membrane?

A

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

24
Q

What is a urethrocele?

A

urethra protruding into the vaginal wall

25
Q

What is a cystocele?

A

bladder protruding into the vaginal wall

26
Q

What is a rectocele?

A

rectum protruding into the vaginal wall

27
Q

What is a enterocele?

A

bowel protruding into the vaginal wall

28
Q

How do prolapses present?

A

lump in vagina
dragging feeling
urinary incontinence

29
Q

How are prolapses graded?

A

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

30
Q

What does a procidenta prolapse mean?

A

completely outside the vagina

31
Q

How is the pelvic organ prolapse qunatification system measured?

A

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

32
Q

What lifestyle management options are there for prolapse?

A

loose weight
stop smoking
avoid heavy lifting
reduce constipation

33
Q

What non surgical management is there for prolapse?

A

pessarys - tucked behind the pubic symphysis

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

34
Q

What surgical management is there for prolapse?

A

sacrospinous fixation
vaginal hysterectomy
manchester repair

35
Q

What conditions come under pelvic floor dysfunction?

A

bladder + bowel dysfunction
prolapse
vulvodynia
chronic pelvic pain

36
Q

What are the risk factors for urinary incontinence?

A
women
high BMI (must have BMI = 30 to have surgical treatment)
smoking
diabetes
older age
37
Q

What physical examinations should you do for urinary incontinence?

A

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

38
Q

What is the medical treatment for urge incontinence?

A

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

39
Q

What is the medical treatment for stress incontinence?

A

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