Urinary Incontinence and Prolapse

Question 1

leakage on exertion…

Answer 1

stress incontinence

Question 2

leakage accompanied or immediately preceded by urgency…

Answer 2

urge incontience

Question 3

urgency with or without incontinence often with frequency and nocturia

Answer 3

overactive bladder (dont need incontinence to have this)

Question 4

what frequency of urination per night is abnormal?

Answer 4

6-7 times a night

Question 5

causes of incontinence

Answer 5

BMI >35
age
parity - vaginal delivery
menopause
UTI
FH

Question 6

name storage symptoms?

Answer 6

FUN
frequency
urgency
nocturia
inconience

Question 7

what should you ask about the incontinence?

Answer 7

exacerbating factors
timing
VOLUME!

Question 8

name voiding symptoms?

Answer 8

hesitancy
straining
stream

Question 9

what postmicturition symptoms should you ask about?

Answer 9

dribble?

incomplete emptying?

Question 10

how should you ask about prolapse?

Answer 10

can you see anything coming out?

do you ever feel something has come loose inside?

Question 11

important diet questions to ask about?

Answer 11

how much are they DRINKING?

coffee? alcohol? diet?

Question 12

method of finding out the patient’s bladder activity?

Answer 12

bladder diary for 3 days

Question 13

what examinations are done in a patient with incontinence?

Answer 13

general first
abdo exam
vaginal exam
PR

Question 14

what are you looking for on abdo exam of someone with incontinence?

Answer 14

masses pain

Question 15

what are you looking for on vaginal exam of someone with incontinence?

Answer 15

atrophy
prolapse
incontinence - ask to cough

Question 16

Ix incontinence in women

Answer 16

urinalysis
post-voidal residual volume - emptying bladder properly

+/-
urodynamics
cystoscopy - bladder tumour/stones
imaging - haematuria?

Question 17

conservative Tx of OAB

Answer 17

lifestyle advice eg remove caffeine/alcohol
fluid intake 1.5-2.5l
weight loss
pelvic floor physio for 3 months
bladder retraining 6 weeks

Question 18

pharm Tx of OAB

Answer 18

1. anticholinergics (be wary in elderly)
2. B3 agonist eg mirabegron
   - desmopressin if nocturia
   - topical oestrogen if atrophy
   - botox only in those who can self-catheterise

Question 19

MoA of antimuscarinics in OAB

Answer 19

reduce intravesical pressure
raises volume threshold for micturition
reduce uninhibited contractions

Question 20

when should you review someone on anti-muscarinics for OAB

Answer 20

review after 4-6 weeks

Question 21

side effects of antimuscarinics

Answer 21

dry mouth
constipation
blurred vision
confusion
dementia

Question 22

what is mirabegron?

Answer 22

B3 agonist

Question 23

what do B3 agonists do?

Answer 23

relaxes bladder
increases voiding interval
inhibits spontaneous bladder contractions

Question 24

what drug is recommended if nocturia is a specific complaint along with OAB?

Answer 24

desmopressin

Question 25

what drug is recommended if vaginal atrophy is a problem along with OAB?

Answer 25

topical oestrogen

Question 26

Tx of stress incontinence?

Answer 26

``` weight loss physio incontinence pessary bladder neck bulking via injection surgery medication - duloxetine ```

Question 27

pharm Tx of stress incontinence?

Answer 27

duloxetine NB not used much now

Question 28

surgical Tx of stress incontinence

Answer 28

TVT (tension free vaginal tape) - outpatient autologous sling - inpatient colpo suspension to stitch urethra

Question 29

what do incontinence pessaries do?

Answer 29

go under urethra to support it

Question 30

how common is pelvic organ prolapse?

Answer 30

up to 50% of parous women

Question 31

causes of prolapse?

Answer 31

``` age parity MoD menopause status obesity neuro disease marfans/ehler dahlos ```

Question 32

what should you ask about prolapse?

Answer 32

pressure? dragging sensation? do you have to push something in to go to the toilet?

Question 33

storage symptoms of prolapse?

Answer 33

frequency | urgency

Question 34

incontinence symptoms of prolapse?

Answer 34

timing | volume

Question 35

voiding symptoms of prolapse?

Answer 35

hesitancy | straining

Question 36

bowel symptoms to ask about prolapse?

Answer 36

incomplete emptying? is anything stuck? is the stool hard? (if no consider prolapse)

Question 37

presentation of cystocele?

Answer 37

``` bulge pressure incomplete bladder emptying need to move something when inserting tampon dyspareunia urgency incontinence stress incontinence ```

Question 38

most common prolapse?

Answer 38

cystocele

Question 39

symptoms of uterine prolapse?

Answer 39

``` back pain dragging sensation mass alot of difficulty inserting tampon dyspareunia ```

Question 40

symptoms of rectocele?

Answer 40

bulging pressure difficulty defaecating put fingers into vagina to assist

Question 41

Ix prolapse and why

Answer 41

USS - mass concerns MRI - assoc bowel dysfunction/considering surgery anorectal manometry

Question 42

when would you suspect malignancy in prolapse?

Answer 42

sudden onset | unknown cause

Question 43

conservative Tx of prolapse?

Answer 43

weight loss pelvic floor exercises - 3 months, better in younger vaginal pessary

Question 44

an asymptomatic woman with prolapse should be referred T or F

Answer 44

F, only if asymptomatic

Question 45

how are pessaries given?

Answer 45

if young and sexually active you can manage it and take it in/out yourself - if older they are put in 6 monthly

Question 46

surgical Tx of prolapse?

Answer 46

pelvic floor repairs - high failure rate sacrospinous fixation- for vault/uterine prolapse colpocliesis - close over vagina sacrohysteropexy

Question 47

what is the vault?

Answer 47

the high point of the vagina