Urinary Incontinence and Prolapse Flashcards
(44 cards)
What are the 3 layers that make up the pelvic floor?
(ext to int)
perineal membrane -> muscles of perineal pouches -> pelvic diaphragm
What are the 2 muscle groups of the pelvic diaphragm?
levator ani and coccygeus
What are the 3 parts of the levator ani muscle?
PPI
Puborectalis
Puboccocygeus
Illiococcygeus
What are the supporting structures of level 1 of the pelvic floor (cervix and upper vagina)?
uterosacral, transverse cervical and pubocervical ligaments
What is the supporting structure of level 2 of the pelvic floor (middle vagina)?
pelvic fascia
What are the supporting structures of level 3 of the pelvic floor (lower vagina)?
levator ani muscles and perineal body
What is contained within the female deep perineal pouch?
part of urethra vagina clitoral neurovascular bundle extensions of ischioanal fat pads smooth muscle external urethral sphincter and compressor urethrae
What is contained within the female superficial perineal pouch?
- Clitoris and crura (‘legs’ of the clitoris, invisible to the naked eye) - Bulbs of vestibule - Bulbospongiosus - Ischiocavernosus - Also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
What are the 3 main causes of pelvic floor weakness?
1 - increased intra-abdominal pressure
2 - pelvic floor muscle trauma and denervation
3 - connective tissue disorder
Give examples of causes of increased intra-abdominal pressure in pelvic floor weakness?
obesity, chronic cough, occupational/recreational
exercise, constipation, intra-abdominal mass
Give examples of causes of pelvic floor muscle trauma and denervation in pelvic floor weakness?
obstetric trauma, pelvic fracture or surgery,
congenital
Give examples of causes of connective tissue disorders in pelvic floor weakness?
Age related, Oestrogen deficiency, Congenital or acquired
connective tissue disorders, Drug related: e.g. steroids
Define stress incontinence
Involuntary leakage of urine when there is increase intra-abdominal pressure, with the absence of detrusor muscle contraction
Name common predisposing risk factors of stress incontinence
Childbirth, pelvic surgery and oestrogen deficiency
Is prolapse seen in stress incontinence?
prolapse of urethra and anterior vagina wall can be present
What are some lifestyle changes and conservative methods that are used to manage stress incontinence?
Lifestyle: weight loss, smoking cessation, avoid constipation, smoking cessation, avoid heavy
lifting, caffeine reduction
Conservative: Pelvic floor muscle exercises for 3 months (often with physiotherapists), use of pads
What medical management is available for stress incontinence?
(if unsuitable for conservative or surgical options)
1st line: Duloxetine (adequate counselling of side effects needed)
What are some side effects of duloxetine?
difficulty sleeping, headaches, dizziness, blurred vision, change in bowel habits, nausea and vomiting, dry mouth, sweating, decreased appetite and weight loss
and decreased libido
What are some surgical options for managing stress incontinence?
-Bulking agents
-Autologous rectus fascial sling
-Laparoscopic or open colposuspension
-Artificial urinary sphincters (In severe cases where previous surgery has failed)
-Tension free vaginal tape is the most commonly performed procedure, after other methods
are tried (Currently a national pause on mesh vaginal surgery so not recommended)
Define urge incontinence
When an individual has increased urgency and frequency to void urine
What are some causes of urge incontinence in women?
idiopathic, pelvic surgery, multiple sclerosis, spina bifida
What is the volume of leakage difference in stress and urge incontinence?
Much larger volumes of leakage in urge incontinence
Name some triggers of urge incontinence
Hearing running water, cold weather
Name some triggers of stress incontinence
Sneezing, coughing, exercise
