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Reproduction Cortex > Urinary Incontinence and Prolapse > Flashcards

Urinary Incontinence and Prolapse Flashcards

1
Q

What does the pelvic floor separate?

A

Pelvic Cavity
Perineum
(perineum –> Pelvic Floor –> Pelvic Cavity)

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2
Q

What are the 2 main functions of the pelvic floor?

A

Support Pelvic organs

Maintains both urinary and faecal continence in women

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3
Q

Which 3 muscles maintain urinary continence?

A

External urethral sphincter
Compressor Urethrae
Levator ani

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4
Q

Which muscle maintains faecal continence?

A

Puborectalis muscle (contraction)

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5
Q

What are the 3 layers of the Pelvic Floor?

A

external –> internal

Perineal membrane
Muscles of perineal pushes
Pelvic Diaphragm

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6
Q

Which 2 muscles make up the pelvic diaphragm?

A

Levator Ani

Coccygenous

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7
Q

what are the 3 muscles of the levator ani?

A

(PPI)
Puborectalis (U-shaped sling)
Pubococcygenus
Iliococcygeus

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8
Q

Is the pelvic diaphragm normally contracted?

A

Yes,

Must relax to release urine and faeces

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9
Q

What nerves innervate the pelvic diaphragm?

A

Pudendal nerve

Nerve to Levator Ani

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10
Q

What structures support the pelvic Diaphragm?

A

Endopelvic Fascia

Ligaments

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11
Q

What are the main ligaments which support the pelvic diaphragm?

A 
Utero-sacral ligament 
Transverse cervical ligament 
tendinous arch of pelvic fascia 
tendinous arch of levator ani 
lateral ligament of bladder
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12
Q

Which nerves supply the Detrusor muscle?

A

Parasympathetic nerves
–> from pelvic splanchnic
(S2,3,4)

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13
Q

Which nerve supplies urethral smooth muscle?

A

Sympathetic nerves
–> from spinal cord
(T10 to L2)

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14
Q

Which nerve supplied striated urethral sphincter and pelvic floor muscles?

A

Branches of pudendal nerve

S2,3,4

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15
Q

Which structures support the cervix and upper vagina?

A

Uterosacral
Transverse cervical
Pubocervical ligaments

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16
Q

Which structures support the middle vagina?

A

Pelvic fascia

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17
Q

Which structures support the lower vagina?

A

Levator ani muscles

Perineal Body

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18
Q

What causes the pelvic floor to weaken?

A

Increased intra-ado pressure
Pelvic floor muscle trauma and denervation
Connective tissue disorder

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19
Q

what are causes of increased intra-abdominal pressure?

A 
Obesity 
Chronic cough 
Occupational/recreational exercise 
Constipation 
Intra-abdominal mass
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20
Q

What are casues of pelvic floor muscle trauma and denervation?

A

Obstetric trauma
Pelvic fracture
Pelvic Surgery
Congenital

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21
Q

What are causes of connective tissue disorder?

A 
Age related 
Oestrogen deficiency 
Drug related (steroids)
22
Q

What is urinary incontinence?

A

Involuntary leakage of urine

23
Q

What is stress incontinence?

A

Involuntary leakage of urine when intra-ado pressure, with the absence of detrusor muscle contraction

24
Q

what are some triggers of stress incontinence?

A

Coughing
Sneezing
Exercise

25
Q

What are the investigations for stress incontinence?

A

EXCLUDE UTI

  • Frequency/volume charts
  • Urodynamic studies
26
Q

What are some lifestyle changes which can manage stress incontinence

A 
Weight loss
Smoking Cessation 
Avoid constipation 
Avoid heavy lifting 
Caffeine reduction
27
Q

What a medical treatment for stress incontinence?

A

Duloxetine

LOTS of side effects

28
Q

What is urge incontinence?

A

Individual has increased and frequency to void urine

–> Nocturia

29
Q

How much urine is expelled in stress incontinence?

A

small amounts

30
Q

How much urine is expelled in urge incontinence?

A

large volumes

31
Q

what are causes of urge incontinence?

A

Idiopathic
Pelvic surgery
MS
Spina bifida

32
Q

what are some triggers of urge incontinence?

A

Hearing running water

Cold weather

33
Q

What will be the results of frequency/volume charts in stress incontinence?

A

Normal levels

34
Q

What will be the results of frequency/volume charts in urge incontinence

A

Increased frequency

Urodynamic testing
–> over-activity of detrusor muscle

35
Q

What are medical managements of stress incontinence?

A 
Tolterdoine or Solifenacin 
Oxybutin 
- not in elderly (cognitive impairment)
Mirabegron 
- safe in elderly 
Intravaginal oestrogens
Desmopressin if nocturne
36
Q

What is overflow incontinence?

A

leakage of full urinary bladder

- absence of urge to urinate

37
Q

Causes of overflow incontinence?

A 
Inactive detrusor muscle 
Involuntary bladder spasms 
- cardio disease 
- diabetes 
Cystocele or uterine prolapse
Men more common
38
Q

What is a urogenital prolapse?

A

descent of one of the pelvic organs resulting of protrusion of vaginal wall

39
Q

What pelvic organs can prolapse?

A

Bladder (cystocele)
Uterus
Vagina
Rectum

40
Q

What are risk factors for urogenital prolapse?

A 
Increasing age 
Multiparity 
Vaginal deliveries 
Obesity 
Spina bifida
41
Q

What are the clinical signs of urogenital prolapse?

A

Sensation or pressure
Heaviness
Bearing down

Urinary incontinence
Frequency
Urgency

42
Q

What is the treatment for a mild prolapse?

A

Asymptomatic

- no treatment needed

43
Q

What are some symptoms of a Lower UTI?

A 
Dysuria 
increased frequency 
increased urge 
cloudy/smelly urine 
Lower abdomen pain 
Fever 
Malaise 
If elderly --> delirium
44
Q

what is the 1st line investigation of a lower UTI in a non-pregnant women?

A

Urine culture if >65 or haematuria

45
Q

what is the management of a lower UTI in a non-pregnant women?

A

Trimepthoprim

46
Q

what is the 1st line investigation of a lower UTI in a symptomatic pregnant woman?

A

urine culture done

47
Q

what is the management of a lower UTI in a symptomatic woman?

A

Nitrofurantoin
–> 1st and 2nd trimester
Trimethoprim
–> 3rd trimester

48
Q

what is the 1st line investigation of a lower UTI in an asymptomatic pregnant woman?

A

urine culture at 1st antenatal visit

49
Q

An asymptomatic pregnant woman is at high risk of developing … after a lower UTI

A

Acute polynephritis

50
Q

what is the management of culture +ve asymptomatic pregnant woman?

A

Nitrofurantoin, amoxicillin, cefalexin for 7 days

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