W05: Pelvic Organ Prolapse & Female Urinary Incontinence

Question 1

Outline the predisposing factors for uterovaginal prolapse

Answer 1

• prgo, vag birth
• Forceps Delivery
  Large baby (> 4500 gm)
  Prolonged Second Stage

*Prev pelvic sx: continence procedures

• hormonal factors
• connective tissue factors
• constipation
• heavy lifting occupation hx
• exercise

Question 2

Outline the different types of prolapse

Answer 2

cystocele = upper bladder into vagna
urethrocele = urethra only

uterovagnial = prolapse of the uterus, cervix and upper vagina.

enteerocele = loops of small bowel

rectocele = lower vagina and rectum

Question 3

Explain the effect of Pelvic organ prolapse (POP) on women’s quality of life

Answer 3

can be largely asymptomatic but symptoms incl:

vaginal
- sensation of bulge
- heaviness / pressur
- difficulty inserting tampons

+urinary symptoms
+ bowel symptoms

Question 4

Explain the principles of conservative & surgical management of POProlapse

Answer 4

• USS/MRI
• urodynamics
• IVUrogram / Renal USS

> Physiotx: peelv. floor muscl training

> Pessaries: firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage.
* silicone

Pessaries as effective as sx

> Sx: relieve symptoms, restoration of affected functions

Question 5

Describe the main types of female urinary incontinence

Answer 5

1. STRESS URNARY INCONTINENCE
   intra-abdo pressure exceeds urinary pressure = leakage

> Stop smoking
Lose weight
Eat more healthily to avoid constipation
Stop drinking alcohol and caffeine

2. URGE INCONTINENCE
   sudden and very intense need to pass urine and you’re unable to delay going to the toilet.

Question 6

Describe the principles of diagnosis, investigations and management of female incontinence

Answer 6

• 3 day urinary diary
  *. dipstick
• Examination: gen., abdo., neuro., gynae.
• bladder scan
• Urodynamics

> Lifestyle changes: conservative 1st Line
Pelvic Floor Muscle Training +Physio
Duloxetine (restricted use and in tandem with other tx.)
Sx: vaginal tape application; LT benefit

Question 7

Objective assessment of POP

Answer 7

Baden- Walker- Halfaway Grading: descent starting from cervical os, and comparative to hymen

POPQ Score

Question 8

RF of Ur. Incontinence

Answer 8

Age
Parity
Menopause
Smoking
Medical problems

Intra abdo pressure
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery

Question 9

Overactive Bladder Syndrome

Answer 9

urodynamically demonstrable detrusor overactivity (DO)

Defining symptoms: urgency (with/without urgency incontinence), usually with frequency and nocturia

OAB is a chronic condition therefore Symptoms may wax and wane

> conservative: lifestyle coffee liquids chocolate; smoking; wt loss

> Bladder training programme: Timed voiding with gradually increasing intervals - Continence nurse

> Antimuscarinics; Transdermal patches; Botox; Neuromodulation

Question 10

RF for Urinary Incontinence

Answer 10

Advanced age
Diabetes
Urinary tract infections
Smoking