Pelvic Floor Disorders

Question 1

what are the types of urinary incontinence

Answer 1

Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence

Question 2

what are risk factors for urinary incontinence

Answer 2

sex [W > M]
age
obesity
smoking

Question 3

what is urgency

Answer 3

complaint of a sudden compelling desire to pass urine which is difficult to defer

Question 4

what is nocturia

Answer 4

having to wake up at night to go to the toilet

Question 5

what is frequency

Answer 5

complaint of having to go to the toilet more often

Question 6

what is urge incontinence

Answer 6

involuntary urine leakage accompanied by or immediately preceded by urgency

Question 7

what is overactive bladder syndrome [OAB]

Answer 7

Urgency, with or without urge urinary incontinence, usually with frequency and nocturia in the absence of pathologic or metabolic conditions that might explain these symptoms

Question 8

what is OAB wet

Answer 8

where urge incontinence is present

Question 9

what is OAB dry

Answer 9

where incontinence is absent

Question 10

what is the definition of urge incontinence

Answer 10

involuntary leakage accompanied by, or immediately preceded by urgency.

Question 11

Urgency, with or without urge incontinence, usually with frequency and nocturia - what is this?

Answer 11

overactive bladder syndrome, or urge syndrome

Question 12

what is mixed urinary incontinence

Answer 12

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

Question 13

what is OAB associated with

Answer 13

detrusor contractions

Question 14

what is the definition of stress incontinence

Answer 14

Urine leaks during increased intra abdominal pressure, without a detrusor contraction

Question 15

what are lifestyle measure that can help make incontinence better

Answer 15

bladder retraining
caffeine reduction
weight reduction if BMI >30

Question 16

what are physio Tx for incontinence

Answer 16

pelvic floor muscle exercises

[only useful for stress and mixed incontinence]

Question 17

what medical Tx can be given for incontinence

Answer 17

1st line = Oxybutymin (anti-muscarinic)

2nd line = Mirabegron (beta3 agonist) [when anti-muscarinic contraindicated or ineffective]

Question 18

what are anti Muscarinic side effects

Answer 18

dry mouth
constipation
blurred vision
somnolence

Question 19

what does a uroflowmetry do

Answer 19

measure the volume of urine expelled from the bladder each second

Question 20

what are indications of investigation by uroflowmetry

Answer 20

hesitance 
voiding difficulty 
neuropathy 
Hx of urine retention 
post-op follow up

Question 21

what is cystometry used for

Answer 21

measure the pressure/volume relationship of the bladder during filling, provocation and during voiding

Question 22

what causes overflow incontinence

Answer 22

Obstruction of urethra

Poor contractile bladder muscle

Question 23

what is needed for a diagnosis of overflow incontinence

Answer 23

post-void residual (PVR)

- a urine test measures the amount of urine left in the bladder after urination

Question 24

what drug must be stopped in overflow incontinence

Answer 24

anti-cholinergics

- atropine, Oxybutynin, TCA drugs

Question 25

pelvic prolapse = what compartments that can prolapse

Answer 25

anterior middle or apical posterior

Question 26

what is the classification of prolapse

Answer 26

``` 1st degree (in vagina), 2nd degree (at vagina orifice), 3rd degree (outside vagina) Procidentia (entirely outside vagina) ```

Question 27

what is an anterior pelvic prolapse called

Answer 27

cystocele

Question 28

what are Sx of cystocele

Answer 28

``` bulging, pressure "mass" difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse. ```

Question 29

what is a middle/apical prolapse also called

Answer 29

enterocele

Question 30

Sx of enterocoele

Answer 30

same as cystocele ``` bulging, pressure "mass" difficulty voiding incomplete emptying splinting vaginal wall difficulty inserting tampon pain with intercourse. ```

Question 31

what is a posterior prolapse also called

Answer 31

rectocele

Question 32

Sx of rectocele

Answer 32

``` bulging, pressure, “mass" difficulty defecation incomplete defecation splinting vaginal wall or perineum difficulty inserting tampon. ```

Question 33

what is it called when all compartments prolapse

Answer 33

complete eversion

Question 34

what are the types of complete eversion

Answer 34

Uterine Procidentia | Complete uterine prolapse

Question 35

Mx of prolapse - conservative

Answer 35

reassure avoid heavy lifting lose weight stop smoking vaginal oestrogens = if sx atrophic vaginitis

Question 36

Mx of prolapse

Answer 36

Physio Pessary Surgery

Question 37

who is suitable to receive pessaries

Answer 37

Women unfit for surgery Relief symptoms whilst awaiting surgery Further pregnancies planned or pregnant As diagnostic test for prolapse/ensure correction of large cystourethrocele not cause SUI Patient request

Question 38

surgical Tx for prolapse

Answer 38

vaginal hysterectomy mesh repair abdominal sacralcolpopexy