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reproductive > Urinary Incontinence & Prolapse in Women > Flashcards

Urinary Incontinence & Prolapse in Women Flashcards

1
Q

Lack of voluntary control over urination or defecation

A

incontinence

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2
Q

urinary incontinence affects 10-70% of women and peaks around

A

middle age

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3
Q

Involuntary leakage accompanied by urgency
Need to “rush to the toilet”
Uninhibited bladder contraction

A

Urge Incontinence (Detrusor overactivity)

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4
Q

Involuntary leakage with effort (coughing, laughing, sneezing, exercise)
Increase in intra-abdominal pressure overcomes sphincter closure

A

Stress Incontinence

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5
Q

Combination of stress and urge incontinence

A

Mixed Incontinence

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6
Q

Frequent voids of very small amounts of urine

A

Overflow Incontinence

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7
Q

what can worsen symptoms of incontinence

A

COPD/smoking (cough stress)

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8
Q

in office testing for incontinence

A
  1. cough stress test
  2. postvoid residual volume (PVR)
    - ultrasound /catheter- inaccurate
  3. urodynamic testing
  4. cystourethroscopy
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9
Q

In general a PVR less than ____ mL shows adequate emptying

A

50

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10
Q

Anal and bulbocavernosus

(Osinski) reflex can be used to assess

A

sacral reflex activity

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11
Q

Q tip test

A

Measures urethral mobility- there is a problem of urethral support

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12
Q

is a polysynaptic reflex that is useful in testing for spinal shock and gaining information about the state of spinal cord injuries (SCI).

A

The bulbocavernosus reflex (BCR) or “Osinski reflex”

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13
Q

M1, M2 (80%) and M3 (20%) cholinergic receptors involved in ____________

A

detrusor contraction

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14
Q

Only M3 cholinergic receptors are responsible for the ________________ detrusor contraction

A

parasympathetic

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15
Q

detrusor relaxations usually involves which receptor

A

beta-3 adrenergic receptor

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16
Q

anticholinergic side effects

A 
Dry mouth
Constipation. 
Heartburn
Blurry vision
Rapid heartbeat (tachycardia)
Flushed skin,
Urinary retention 
Impaired memory
Confusion.
Skin irritation (from oxybutinin patch)
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17
Q
  • 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
A

mirabegron

18
Q
  • 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??
A

Botox

19
Q
  • 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

A

Imipramine - tricyclic antidepressant - antagonizes everything !!!

20
Q
  • 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.
A

Duloxetine- cymbalta

21
Q

decrease in estrogen affects how the bladder

A

deterioration of the supportive tissue around the bladder and urethra— weakens the tissue and potentially aggravates stress incotinence

22
Q

topical estrogen for incontienence

A

not much scientific evidence

23
Q

Combination systemic hormone replacement therapy (estrogen plus progestin) not effective
for incontinence

A

yep

24
Q

Oral estrogen replacement may worsen/improve incontinence symptoms

A

worsen

25
Q
  • 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
A

Sacral Neuromodulation

26
Q

management options for incontinence

A
  1. behavioral approaches such as bladder training

2. pelvic floor physical therapy to strengthen the peri-urethral and peri-vaginal muscles

27
Q

goal for management of stress urinary incontinence

A

Focused on improving bladder neck support

Reducing urinary leakage

28
Q

for moderate to severe stress urinary incotinence

A

surgery

29
Q

first step for preventing urine loss

A

kegle’s exercises

30
Q

Designed specifically for the treatment of stress incontinence
Especially useful for women who leak urine during specific activities such as exercise

A

occlusive devices such as uretrhal plug

31
Q

large cystocele

A

bladder prolapse

32
Q

severe procidentia

A

prolapse of the cervix

33
Q

rectocele is considered

A

hernia

34
Q

pessary

A

used for prolapse of the vagina to keep everything in

35
Q

vaginal/ urehtral slings

A

Pubovaginal slings have excellent overall success and durable cure rates

36
Q

Acts as a physical support to prevent bladder neck and urethral descent during physical activity

A

sling

37
Q

involuntary leakage associated with a sudden pressure on the bladder, as with coughing, sneezing or exercise

A

stress Ui

38
Q

involuntary leakage associated with a sudden strong need to void; often associated with overactive bladder

A

urge Ui

39
Q

involuntary leakage associated with a combination of urge and stress UI symptoms

A

mixed UI

40
Q

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

A

overflow UI

41
Q

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

A

functional UI

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