Pelvic Floor Disorders

Question 1

what are the types of urinary incontinence

Answer 1

Stress Incontinence
Urge Incontinence
Mixed incontinence
Overflow incontinence

Question 2

Describe stress incontinence

Answer 2

Urine leakage on effort or exertion
Can be brought on by sneezing/coughing/laughing
(anything that increases intra abdominal pressure)

Question 3

Describe urge incontinence

Answer 3

Urine leakage accompanied/preceded by urgency

Question 4

Describe mixed incontinence

Answer 4

urine leakage associated with urgency and exertion

Question 5

Risk factors for incontinence

Answer 5

Female
Age 
Obesity 
Parity 
smoking

Question 6

what is overactive bladder syndrome (OAB)

Answer 6

Urgency, with or without incontinence, usually associated with frequency + nocturia in the absence of pathological or metabolic conditions that might explain the symptoms

Question 7

what is OAB wet

Answer 7

where urge incontinence is present

Question 8

what is OAB dry

Answer 8

where incontinence is absent

Question 9

what is OAB associated with

Answer 9

detrusor contractions

Question 10

what are some lifestyle measures that can improve incontinence

Answer 10

bladder retraining
caffeine reduction
weight reduction if BMI >30

Question 11

investigations for incontinence

Answer 11

Urodynamics
Urinalysis
Cystoscopy

Question 12

physio treatment for incontinence

Answer 12

pelvic floor muscle exercises

Question 13

which types of incontinence are pelvic floor exercises useful in

Answer 13

stress and mixed

Question 14

1st line medical treatment for OAB

Answer 14

Oxybutynin (anti-muscarinic)

Question 15

2nd line medical treatment for OAB

Answer 15

mirabegron (beta 3 agonist)

used when anti-muscarinic is contraindicated/ineffective

Question 16

anti-muscarinic side effects

Answer 16

dry mouth
constipation
blurred vision
somnolence

Question 17

mode of action of mirabegron

Answer 17

relaxes bladder smooth muscle through activation of B3 receptor

Question 18

what drug is given if there is nocturia

Answer 18

desmopressin

Question 19

What drug is used in treating stress incontinence

Answer 19

duloxetine

Question 20

what class of drug is duloxetine

Answer 20

combined noradrenaline + serotonin reuptake inhibitor

Question 21

what does uroflowmetry do

Answer 21

measure the volume of urine expelled from the bladder each second

Question 22

indications for investigation with uroflowmetry

Answer 22

hesitance
voiding difficulty 
neuropathy 
History of urine retention 
Post operation follow up

Question 23

what is cystometry used for

Answer 23

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

Question 24

what causes overflow incontinence

Answer 24

obstruction of urethra

poor contractile bladder muscle

Question 25

what is needed for a diagnosis of overflow incontinence

Answer 25

post void residual (PVR)- a urine test that measures the amount of urine left in the bladder after urination

Question 26

what drugs must be stopped in overflow incontinence

Answer 26

Anticholinergics- atropine, oxybutynin | TCA's

Question 27

what are the 3 compartments that can prolapse

Answer 27

anterior middle/apical posterior

Question 28

Classifications of prolapse

Answer 28

1st degree- in the vagina 2nd degree- at vaginal orriface 3rd degree- outside vagina

Question 29

what does procidentia mean

Answer 29

entirely outside vagina

Question 30

what is an anterior pelvic prolapse called

Answer 30

cystocele

Question 31

symptoms of a cystocele

Answer 31

bulging, pressure, "mass", difficulty voiding/inserting tampon, pain on intercourse

Question 32

what is a middle vaginal prolapse called

Answer 32

enterocoele

Question 33

symptoms of enterocoele

Answer 33

bulging, pressure, "mass", difficulty voiding/inserting tampon, pain during sex

Question 34

what is a posterior vaginal prolapse called

Answer 34

rectocele

Question 35

symptoms of rectocele

Answer 35

bulging, pressure, "mass", difficulty defecting, incomplete defecation, difficulty inserting tampon

Question 36

what is it called when all compartments prolapse

Answer 36

complete eversion

Question 37

what are the types of complete eversion

Answer 37

uterine procidentia | Complete uterine prolapse

Question 38

risk factors for prolapse

Answer 38

Parity + vaginal delivery Post menopausal oestrogen deficiency Obestiy Neurological condition e.g. spina bifida/muscular dystrophy

Question 39

conservative management of prolapse

Answer 39

reassure avoid heavy lifting lose weight stop smoking

Question 40

Non conservative management of prolapse

Answer 40

pessary | surgery

Question 41

who might receive a pessary

Answer 41

woman unfit for surgery relief of symptoms whilst waiting for surgery pregnant ladies patient request

Question 42

how often do pessaries need changed

Answer 42

6 monthly

Question 43

surgical treatment for prolapse

Answer 43

vaginal hysterectomy mesh repair abdominal sacralcolpopexy