urogynae

Question 1

types of female incontinence

Answer 1

stress
urge
overflow

Question 2

stress incontinence - what is it, how does it happen, what worsens it?

Answer 2

weakened pelvic floors can’t support sphincter

menopause, pregnancy + 4mo post childbirth - increased abdo pressure overstretches muscle

Question 3

urge incontinence - how does it happen + present?

Answer 3

detrusor overactivity
can’t hold it
commonly caused by OAB

Question 4

overflow incontinence - how does it happen + present?

Answer 4

rare in women

weakened bladder muscles/urethral stenosis → constant dribbling as bladder doesn’t empty properly

Question 5

incontinence - general lifestyle treatment

Answer 5

limit fluids before bed
reduce caffeine + alc
healthy weight
pads

Question 6

OAB (urge incontinence) - management (non-surgical and surgical)

Answer 6

Bladder retraining
oxyButinin - anticholinergics block bladder spasms
Botox injection into detrusor
miraBegron - relaxes detrusor

sacral nerve stimulation - implant stimulation controls bladder spasms

Question 7

incontinence - investigations

Answer 7

bladder diary 3 days
examine - masses
VE - ?prolapse
urinalysis - ?UTI

Question 8

stress incontinence - management

Answer 8

med review - Stop alpha blocker + Stop Smoking
refer to community physio/continence team:
pelvic floor training + bladder diary

pessary - ring holds up bladder neck
oestrogen cream/patch - tone muscles around urethra

bulking injections around urethra
mid urethral tape
bladder suspension sling

Question 9

red flags of incontinence/prolapse

Answer 9

visible haematuria - bladder cancer
painful bladder filling - bladder cancer
abdo swelling - mass

Question 10

what is a cystocoele?

Answer 10

prolapse of anterior vagina wall

Question 11

what is a rectocoele?

Answer 11

prolapse of posterior vaginal wall

Question 12

what is an enterocoele?

Answer 12

herniation of top of vagina so peritoneum containing small bowel herniates through

Question 13

prolapse - symptoms

Answer 13

vaginal / perineal pressure, heaviness, discomfort
abdo / lower back pain
mass sensation
urinary / faecal loss or retention
sexual health probs

Question 14

RFs for prolapse

Answer 14

parity, FH, age
menopause
pelvic surgery
CTDs
elevated intra-abdo pressure eg obesity, constipation w straining

Question 15

prolapse - mgmt

Answer 15

pessaries - ring or cube
hysterectomy + ligament suspension
mesh suspending vaginal apex to sacrum