Urinary Incontinence and Pelvic Organ Prolapse

Question 1

what is the main cause of stress incontinence?

Answer 1

weak external urethral sphincter/pelvic floor muscles

Question 2

what is the main cause of urge incontinence?

Answer 2

overactive bladder

Question 3

what are the risk factors for urinary incontinence in women?

Answer 3

age
parity (+mode of delivery)
being overweight
smoking
pelvic trauma
previous surgery
lifestyle factors (caffeine, fizzy drinks)

Question 4

what are some of the symptoms women with stress incontinence present with?

Answer 4

urinary leakage during activities that cause a rise in intra-abdominal pressure

Question 5

what are the three main investigations carried out for women with urinary incontinence?

Answer 5

• urine dipstick
• bladder scanning (ultrasound)
• urodynamics
• bladder diary

Question 6

what is the main treatment option for stress incontinence in women?

Answer 6

pelvic floor exercises
lifestyle changes (reduce coffee/fizzy drinks/weight loss)

Question 7

how can stress incontinence be managed medically?

Answer 7

with duloxetine

Question 8

how can stress incontinence be managed surgically?

Answer 8

tension-free vaginal tape (TVT)
transobturator tape (TOT)
colposuspension

Question 9

what are the main features of an overactive bladder?

Answer 9

increased frequency
increased urgency
urge incontinence
nocturia

Question 10

how long are women asked to complete a bladder diary for if they present with urinary incontinence?

Answer 10

3 days

Question 11

what is the main reason for treating urinary incontinence?

Answer 11

improving QoL for women who want treatment

Question 12

how can urge incontinence be managed conservatively?

Answer 12

lifestyle changes (weight loss, no caffeine/fizzy drinks)
bladder retraining (timed voiding)

Question 13

how can urge incontinence be managed medically?

Answer 13

antimuscarinics and anticholinergics
betmiga (mirabegron)
tricyclic antidepressants
botox injections

Question 14

what is the reason for treating urge incontinence with antimuscarinics and anticholinergics?

Answer 14

the aim is to block the parasympathetic input to the bladder, which causes it to contract and void

Question 15

what is the sympathetic input to the bladder?

Answer 15

hypogastric nerve (T10-L2)

Question 16

what is the parasympathetic input to the bladder?

Answer 16

S2-S4

Question 17

what are the risk factors for urge incontinence?

Answer 17

age
diabetes
smoking
recurrent UTIs

Question 18

name the three layers of the pelvic floor

Answer 18

• endopelvic fascia
• pelvic diaphragm
• urogenital diaphragm

Question 19

what ligaments make up the endopelvic fascia?

Answer 19

uterosacral/cardinal ligament
pubocervical ligament
rectovaginal ligament

Question 20

what are the major risk factors for developing pelvic organ prolapse (POP)?

Answer 20

pregnancy/vaginal delivery/large baby
advancing age
obesity
previous pelvic surgery

Question 21

what are the main symptoms of pelvic organ prolapse?

Answer 21

vaginal symptoms: feeling of dragging, fullness, visible lump, inability to have intercourse, difficulty with tampons
urinary symptoms: frequency/urgency, incomplete voiding
bladder symptoms: flatus, diarrhoea/constipation, straining, splinting during bowel movement, incomplete evacuation

Question 22

what is the best assessment of the severity/extent of pelvic organ prolapse?

Answer 22

POPQ

Question 23

what investigations are done to diagnose and assess severity of pelvic organ prolapse?

Answer 23

ultrasound/MRI
urodynamics (for concurrent UI/SI)
IVU if suspicion of ureter compression

Question 24

what is the conservative treatment for pelvic organ prolapse?

Answer 24

pelvic floor exercises, only in mild cases

Question 25

what are the interventional therapies for pelvic organ prolapse?

Answer 25

pessary

surgery