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Pelvic Floor Disorders Flashcards

(52 cards)

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1
Q

What are the 3 categories of pelvic floor issues?

A

Urinary Incontinence
Pelvic floor prolapse
Anal incontinence

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2
Q

What urethral problems cause urinary incontinence?

A

Urethral sphincter incompetence
Detrusor instability
Retention with overflow
Functional

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3
Q

What Extraurethral problems can cause urinary incontinence?

A

Congenital

Fistula

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4
Q

What are the 4 types of urinary incontinence?

A

Stress
Urge
Mixed
Overflow

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5
Q

What is the incidence of Urinary Stress Incontinence?

A

1 in 33 women aged 55 and over

1 in 10 will need surgery

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6
Q

What are risk factors for urinary incontinence?

A 
Sex - women
Age - older
Obesity
Smoking
Kidney disease
Diabetes
Higher number of children
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7
Q

What is OAB?

A

Overactive Bladder Syndrome

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8
Q

What is OAB wet?

A

Urge incontinence is present

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9
Q

What is OAB dry?

A

Incontinence is absent

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10
Q

Describe urge incontinence

A

Preceded by an urge to void

Can involve triggers such as running water etc.

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11
Q

Describe Mixed urinary incontinence?

A

Involuntary leakage associated with urgency and also with exertion, sneezing or coughing (stress)

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12
Q

What physical examinations should be done on a patient with incontinence?

A

Abdomen - masses, palpable bladder etc.
Pelvis/Perineum - External genitalia, atrophic vaginitis
Vagina - prolapse, malignancy, fistula
Rectal - tone, massesm teach Kegels during exam
Neurological - reflexes, sensory, motor

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13
Q

What bladder specific examinations should be done with someone with incontinence?

A

Stress test
Post void residual
Urine analysis (dipstick)
Bladder diary

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14
Q

What lifestyle measures can help with incontinence?

A

Bladder retraining
Sensible fluid intake
Caffeine reduction
Weight reduction if BMI >30

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15
Q

If a women urinates during penetrative sex, is that stress or urge?

A

Stress

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16
Q

If a women urinates during orgasm, is that stress or urge?

A

Urge

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17
Q

What physical treatments can help with incontinence?

A

Pelvic floor muscle exercises (PFME) - helps mixed and stress

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18
Q

What help do antimuscarinic agents do for incontinence?

A

Reduce intra-vesical pressure
Increase compliance
Raise volume threshold for micturation
Reduce uninhibited contractions

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19
Q

Give 3 examples of antimuscarinics

A

Oxybutynin
Solifenacin
Tolterodine

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20
Q

What are side effects of anti-muscarinics?

A

Dry mouth
Constipation
Blurred vision
Somnolence

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21
Q

What are Beta3 agonists?

Study These Flashcards
A

First class selective B3 adrenoceptor agonist

22
Q

What is the method of action of Beta3 agonists?

Study These Flashcards
A

Relaxes bladder smooth muscle through activation of the B3 adrenoceptor
Selective agonist for the human B3 adrenoceptor with low intrinsic activity for B1 and B2

23
Q

How much liquid should be taken in each day?

Study These Flashcards
A

24ml per kg per 24 hours

24
Q

What do B3 adrenoceptors do?

Study These Flashcards
A

Increase the voiding interval and inhibit spontaneous bladder contractions

25
Give an example of a B3-adrenoceptor agonist?
Mirabegron
26
When would a B3-adrenoceptor agonist be recommended?
When there is contraindications of antimuscarinics or they are ineffective
27
What are the 3 first choice drugs for women with OAB or mixed UI according to NICE?
Oxybutynin Tolterodine Propiverine (All immediate release)
28
What are the 3 second choice drugs for women with OAB or mixed UI according to NICE?
Trospium (immediate) Oxybutynin (extended) Darifenacin
29
What are indications for using Uroflowmetry?
``` Hesitancy Voiding difficulty Neuropathy History of urine retention Post-operative follow up ```
30
What are indications for Multichannel Urodynamics?
Uncertain diagnosis Fail to respond to treatment Prior surgery
31
What does flow rate enable you to measure?
Peak flow Mean flow Voided volume (min of 200ml needed)
32
What is cystometry?
Method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding
33
What is the normal range for Post Void Residual (PVR) and what is abnormal?
``` Normal = 10-80cc (age dependant Abnormal = >100-150cc ```
34
What are causes of Overflow incontinence?
Obstruction of urethra Poor contractile bladder muscle Find out PVR Stop antimuscarinics
35
What is conservative treatment of stress UI?
Lifestyle changes Physiotherapy Drugs - Duloexetine (combined noradrenaline and serotonin reuptake inhibitor) - Increase intraurethral closure pressure Incontinence pads, vaginal pessaries
36
What are surgical treatments of stress UI?
Low tension vaginal tape Intraurethral injection Artificial sphincters Colposuspension
37
What is PTNS?
Percutaneous Posterior Tibial Nerve Stimulation - 12 week treatment
38
What does the FemSoft do?
Inserted into the urethra Tip inserts into bladder Fluid fills a balloon Creates a seal at the bladder neck and urethra
39
What is the conservative treatment of an Overactive Bladder?
Lifestyle Physiotherapy Drugs - Antimuscarinics - block muscarinic receptors and decrease the ability of detrusor muscles to contract
40
What are the surgical treatments of an Overactive Bladder?
``` Augmentation cytoplasty Sacral nerve modulation Tibial nerve stimulation Bladder overdistension Botox injections ```
41
What are the 3 compartments involved in a prolapse?
Anterior Middle/Apical Posterior
42
What are the degrees of uterine descent in a Uterovaginal Prolapse?
1st degree - In vagina 2nd degree - At interiotus 3rd degree - Outside vagina Procidentia - Entirely outside vagina
43
What are symptoms of Cystocele (Anterior)?
``` Bulging Pressure Mass Difficulty voiding Incomplete emptying Splinting vaginal wall Difficulty inserting tampon Pain with intercourse ```
44
What are symptoms of Vaginal vault prolapse / Enterocele (Middle/Apical)?
``` Bulging Pressure Mass Difficulty voiding Incomplete emptying Splinting vaginal wall Difficulty inserting tampon Pain with intercourse ```
45
What are symptoms of a Rectocele? (Posterior)
``` Bulging Pressure Mass Difficulty defecating Incomplete defecation Splinting vaginal wall or perineum Difficulty inserting tampon ```
46
What is a Complete Eversion (All compartments)
Uterine procidentia | Complete uterine prolapse
47
What is the Pelvic Organ Prolapse Quantification System (POP-Q)?
Patient straining, 6 specific sites are evaluated, and 3 rest sites measured Measure each site in relation to the hymen ring (cm) (zero point of reference) If site is above hymen = negative number If site is below hymen = positive number
48
What are risk factors for a vaginal apical prolapse?
``` Aging Pelvic surgery Menopause/Hypoestrogenism Loss of muscle tone Multiple vaginal births Obesity Uterine fibroids Chronic constipation, coughing or heavy lifting FHx Connective tissue disorders e.g. Marfan's syndrome ```
49
What is the conservative management of Uterovaginal Prolapse?
``` Reassure Avoid heavy lifting Lose weight Stop smoking Reduce constipation Vaginal oestrogens - if symptomatic atrophic vaginitis ```
50
What are prolapse treatment options?
Expectant management Physiotherapy Pessary Surgery - Abdominal, Vaginal, Laparoscopic, Robotic assisted laparoscopy, mesh kits
51
Who is suitable for prolapse treatment with Pessaries?
If unfit for surgery Relief symptoms while awaiting surgery Further pregnancies planned or current pregnancy As diagnostic test/Ensure correction of large cystourethrocele not cause SUI Patient request
52
What are repairs of Uterine prolapse/Vault prolapse?
Vaginal hysterectomy Manchester repair (Cervix amputated, uterosacral ligaments shortened) Sacrospinous fixation Abdominal/Laparoscopic sacrocolpopexy, mesh techniques, colpocleisis

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