9: Urinary incontinence and prolapse Flashcards Preview

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Flashcards in 9: Urinary incontinence and prolapse Deck (35)
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1

What is stress incontinence?

Leakage on increased intra-abdominal pressure

2

What is urge incontinence?

Urinary leakage preceded by a strong urge to go

3

An overactive bladder causes urgency (with / without) incontinence.

either

'wet' or 'dry' overactive bladder

4

Incontinence becomes (more / less) common as you have more children.

more common

multiparity is a risk factor

5

Which body state increases your risk of incontinence?

Obesity

6

What happens in the menopause to cause incontinence?

Relaxation of pelvic muscles, endopelvic fascia and pelvic ligaments

7

Which type of infection can cause urinary incontinence?

UTI

8

Which structure should be felt for in any abdominal/pelvic examination of a woman?

Bladder

9

What examinations should you do in a woman complaining of urinary incontinence?

Abdominal exam

Pelvic exam

PR exam

10

What test should you do in any woman complaining of urinary symptoms?

Urinalysis

11

What is the conservative management of an overactive bladder?

Lifestyle modifications:

drink less alcohol and caffeine

drink less fluid in general

lose weight

pelvic floor exercises and/or bladder training

12

Which muscle do antimuscarinics act on?

How?

Detrusor smooth muscle

Inhibit parasympathetics, reducing contraction

13

What are some examples of antimuscarinic drugs used for urge incontinence?

Oxybutynin

Tolterodine

14

What are some side effects of antimuscarinics like oxybutynin and tolterodine?

Dry mouth

Blurred vision

Constipation

Fatigue

15

Which new drug will soon be used instead of antimuscarinics to manage overactive bladder?

Mirabegron

B3 adrenoceptor agonist

RELAXES detrusor smooth muscle, reducing urge to void

16

What agents can be injected into the bladder to paralyse the smooth muscle, reducing incontinence but requiring catheterisation?

Botox

Botulinum toxin

17

How is stress incontinence managed?

Weight loss

Pelvic floor exercises

Incontinence pessaries - like pads, kind of

Anticholinergics e.g duloxetine

Injection of botulinum toxin

18

How do anticholinergics e.g duloxetine treat stress incontinence?

Constrict urethral smooth muscle

Maintain tone of internal urethral sphincter

19

If all else fails, urinary incontinence can be treated using ___.

surgery

20

What is a common gynae problem caused by increasing age and obesity?

Pelvic organ prolapse

21

What are some risk factors for pelvic organ prolapse?

Increasing age

Multiparity

Menopause

Obesity

Chronic constipation

22

Which three closely related organs, found in the pelvis, can prolapse into one another?

Bladder

Vagina/Uterus

Rectum

23

Which conditions, causing hypermobility, predispose women to pelvic organ prolapse?

Marfan's syndrome

Ehlers-Danlos syndrome

24

What sort of symptoms are caused by pelvic organ prolapse?

Sensation of pressure, dragging in the pelvis

Urinary symptoms

Lower GI symptoms

Pain or discomfort during sex

25

What is an anterior pelvic prolapse also known as?

Cystocele

26

Cystocele causes ___ symptoms.

urinary symptoms

incomplete emptying, incontinence

27

What has prolapsed inferiorly in a woman with dragging sensation, back pain and dyspareunia?

Uterus

28

What is a posterior pelvic prolapse also known as?

Rectocele

29

What has prolapsed in a woman with dragging sensation and difficulty defaecating?

Rectum

30

What system is used to figure out what exactly has prolapsed in a woman with pelvic organ prolapse?

POP-Q