Urinary Incontinence & Prolapse in Women Flashcards
Lack of voluntary control over urination or defecation
incontinence
urinary incontinence affects 10-70% of women and peaks around
middle age
Involuntary leakage accompanied by urgency
Need to “rush to the toilet”
Uninhibited bladder contraction
Urge Incontinence (Detrusor overactivity)
Involuntary leakage with effort (coughing, laughing, sneezing, exercise)
Increase in intra-abdominal pressure overcomes sphincter closure
Stress Incontinence
Combination of stress and urge incontinence
Mixed Incontinence
Frequent voids of very small amounts of urine
Overflow Incontinence
what can worsen symptoms of incontinence
COPD/smoking (cough stress)
in office testing for incontinence
- cough stress test
- postvoid residual volume (PVR)
- ultrasound /catheter- inaccurate - urodynamic testing
- cystourethroscopy
In general a PVR less than ____ mL shows adequate emptying
50
Anal and bulbocavernosus
(Osinski) reflex can be used to assess
sacral reflex activity
Q tip test
Measures urethral mobility- there is a problem of urethral support
is a polysynaptic reflex that is useful in testing for spinal shock and gaining information about the state of spinal cord injuries (SCI).
The bulbocavernosus reflex (BCR) or “Osinski reflex”
M1, M2 (80%) and M3 (20%) cholinergic receptors involved in ____________
detrusor contraction
Only M3 cholinergic receptors are responsible for the ________________ detrusor contraction
parasympathetic
detrusor relaxations usually involves which receptor
beta-3 adrenergic receptor
anticholinergic side effects
Dry mouth Constipation. Heartburn Blurry vision Rapid heartbeat (tachycardia) Flushed skin, Urinary retention Impaired memory Confusion. Skin irritation (from oxybutinin patch)
- Relaxes the bladder muscle - β3 agonist
- Can increase the amount of urine bladder can hold
- Increase the amount one is able to urinate at one time
- Side effects Increased blood pressure Common cold symptoms (nasopharyngitis) Urinary tract infection Headache Constipation. Cleared by kidney and liver Interactions with other medications
mirabegron
- Blocks the actions of acetylcholine
- Paralyzes the bladder muscle
- Helpful for people who are non-responders to other medications
- Benefits can last several months
- Repeat injections once or twice a year
- Side effects
Significantly improves symptoms of incontinence
Causes few side effects
May increase urinary tract infections??
Botox
- Alpha antagonist (blocking uptake of norepinephrine at nerve endings)
- It makes the bladder muscle relax
- Makes the smooth muscles at the bladder neck contract
- May be used to treat mixed incontinence — (urge and stress incontinence)
-Side effects
Can include cardiovascular problems (irregular heartbeat)
Dizziness or fainting
Orthostatic hypotension.
Older adults may be especially susceptible to these side effects
Dry mouth
Blurry vision
Constipation
Interactions with many different medications
Imipramine - tricyclic antidepressant - antagonizes everything !!!
- Serotonin and norepinephrine reuptake inhibitor
- Approved to treat depression and anxiety
- Can help the urethral sphincter relax
- Can improve urinary incontinence in some women
- May be helpful for women who have urinary incontinence and depression
- Side effects Nausea Dry mouth Dizziness Constipation Insomnia and fatigue.
Duloxetine- cymbalta
decrease in estrogen affects how the bladder
deterioration of the supportive tissue around the bladder and urethra— weakens the tissue and potentially aggravates stress incotinence
topical estrogen for incontienence
not much scientific evidence
Combination systemic hormone replacement therapy (estrogen plus progestin) not effective
for incontinence
yep
Oral estrogen replacement may worsen/improve incontinence symptoms
worsen
- Provides bladder control therapy
- Neurologic component of bladder control
• FDA-approved in 1997 for urge incontinence
FDA-approved1999 for urgency-frequency and urinary retention
• Minimally invasive evaluation and implant procedure
• Proven efficacy – up to 5 years
For patients for whom more conventional therapy has been unsatisfactory
Sacral Neuromodulation
management options for incontinence
- behavioral approaches such as bladder training
2. pelvic floor physical therapy to strengthen the peri-urethral and peri-vaginal muscles
goal for management of stress urinary incontinence
Focused on improving bladder neck support
Reducing urinary leakage
for moderate to severe stress urinary incotinence
surgery
first step for preventing urine loss
kegle’s exercises
Designed specifically for the treatment of stress incontinence
Especially useful for women who leak urine during specific activities such as exercise
occlusive devices such as uretrhal plug
large cystocele
bladder prolapse
severe procidentia
prolapse of the cervix
rectocele is considered
hernia
pessary
used for prolapse of the vagina to keep everything in
vaginal/ urehtral slings
Pubovaginal slings have excellent overall success and durable cure rates
Acts as a physical support to prevent bladder neck and urethral descent during physical activity
sling
involuntary leakage associated with a sudden pressure on the bladder, as with coughing, sneezing or exercise
stress Ui
involuntary leakage associated with a sudden strong need to void; often associated with overactive bladder
urge Ui
involuntary leakage associated with a combination of urge and stress UI symptoms
mixed UI
involuntary leakage associated with loss of bladder muscle contractile strength and/or bladder outlet obstruction, resulting in incomplete emptying of the bladder and retention of urine
overflow UI
involuntary leakage associated with cognitive, functional, or mobility difficulties that impair the ability to use the toilet but without failure of the bladder’s capacity for storage and emptiying
functional UI
