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Reproduction > Urinary Incontinence and Prolapse > Flashcards

Urinary Incontinence and Prolapse Flashcards

1
Q

what are the urethral causes of incontinence

A

urethral sphincter incompetence (stress)
detrusor instability (urgency)
retention with overflow
functional

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2
Q

what are the extra urethral causes of incontinence

A

congenital

fistula

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3
Q

what are the 4 types of urinary incontinece

A

stress
urge
mixed
overflow

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4
Q

what are the risk factors for incontinence

A 
female
pregnancy
childbirth (esp large baby)
menopause (weakens pelvic muscles and thinning of urothelium)
age - weakened muscles, bladder capacity decreases
obesity - increased abdo pressure
smoking- chronic cough 
diabetes
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5
Q

what urinary symptoms will you get in overactive bladder

A

urgency

frequency

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6
Q

what is important to ask when assessing QOL in incontinence

A

if having sex- do they leak during sex

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7
Q

what Ix for incontinence

A

Exam:
exclude mass in abdomen
look for atrophic vaginitis in external genitalia
look for prolapse, fistula or malignancy
PR tone, masses
teach kegels
neuro-check reflexes, sensory and motor innervation

standing or supine stress test
post void residue (retention)
urinalysis (exclude infection)
bladder diaries

stress:
- flow volume chart
- exclude UTI
- urodynamics when surgery considered

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8
Q

can fluid restriction help incontinence

A

no- makes urine more concentrated which irritates the bladder causing more leakage

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9
Q

what should you avoid drinking in urinary incontinence

A

fluids that irritate the bladder: caffeine, alcohol

try and space caffeine 6 hours apart

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10
Q

what causes incontinence during intercourse

A

during orgasm- urge

during penetration- stress

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11
Q

how can you tell urgency from a full bladder

A

urgency incontinence will have fear of leackage

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12
Q

what precedes urge incontinece

A

urge to void and triggers e.g. running water

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13
Q

how much are you normally meant to drink

A

24mls/kg/24hrs

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14
Q

what is normal bladder capacity

A

500mls
above 80 y/o ~200mls
can be stretched to litre

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15
Q

why is prolapse associated with stress incontence

A

weakened pelvic support

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16
Q

what is normal urine flow rate

A

20-60mls per second

if >80 slower ~10mls

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17
Q

why might someone have a poor flow rate

A

underactive bladder or obstruction of urethra (commonly prolapse of anterior vaginal wall)

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18
Q

is there a pressure difference in the bladder, bowel or abdominal cavity

A

no

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19
Q

what is cystometry

A

catheters with sensors are inserted to measure pressure - used to differentiate the contractions in the bladder from the basic pressure in the abdomen

if the pressures are the same = no worries
if independent contractions of the bladder might be sign of overactive bladder UI

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20
Q

what is detrusor pressure

A

(cystometry)

vesicle pressure - abdo pressure

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21
Q

what is normal post residual volume

A

<100ml (more than this abnormal, 1st desire to void at 150-200ml, strong desire at 400mls)

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22
Q

how do antimuscarinics affect the bladder

A

cause an underactive bladder- affects storage and voiding

-weaker contractions= reduced flow rate= high post void residue

23
Q

independent contractions of the bladder without accompanying contractions of rectal pressure=?

A

overactive bladder

24
Q

leakage accompanying cough =?

A

stress UI

25
Q

low max flow rate and high bladder pressure =?

A

bladder outlet obstruction

usually prolapse

26
Q

what general treatment for urinary incontinence

A
  • avoid caffeine, spicy food and dark chocolate
  • pads
  • physical therapy
  • control diabetes
  • bladder drills (holding for as long as possible)
27
Q

what is duloxetine

A

SSNRI
increases serotonin and norepinephrin in synaptic cleft
increases contractility and tone of urethral sphincter

28
Q

what is uroflowmetry

A

screens for voiding difficulties- patient urinates in proivate into comode with urinary flow meter

29
Q

what is urodynamics

A

cystometry and uroflowmetry

30
Q

what management for SUI

A
  • surgery in england not scotland
  • conservative: -weight loss, smoking cessation, treat constipation
  • pelvic floor exercises
  • biofeedback
  • duloxetine (rarely used)

Pessaries (work in 50%)
Surgeries (low tension vaginal tapes, intraurethral injections, artificial sphincters, colposuspension)
what s

31
Q

what management for overative bladder

A

avoid caffeine, alcohol, chocolate, tannins, tomatoes, citrus and spicy foods

  • drink at least 25 ml/kg a day
  • BMI <30
  • treat constipation, eat high fibre diet
  • exclude UTI
  • bladder training
  • pelvic floor excercises

(consider topical oestrogen if vaginal atrophy)

should try 3 months non pharmacological management

1st line- tolterodine (antimuscarinic)
review at 4-6 wks
2nd line- solifenacin (antimuscarinic)
review 4-6 weeks 
3rd line- mirabegron (beta 3-adrenoceptor agonist- relaxed bladder) MONITOR BP risk of severe hypertension

botox
neuromodulation (posterior tibial nerve)
surgery

32
Q

what do antimuscarinics increase the risk of

A

dementia and death - monitor mental function

33
Q

what are the antimuscarinic side effects

A

Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting

34
Q

how do antimuscarinics help OAB

A

block parasympathetic innervation and relax detrusor

35
Q

why might OAB be confused with SUI

A

as symptoms can be brought on by coughing/ sneezing

36
Q

how do beta agonists help OAB

A

increase adrenegic (sympathetic) control- increase relaxation of the bladder

37
Q

what are the indications for urodynamics

A 
hesitancy 
voiding difficulty 
neuropathy 
Hx of urinary retention 
post op follow up 
uncertain diagnosis
failure to respond to Tx
prior to surgery
38
Q

what should you teach if high residual volume

A

self catheterisation

39
Q

WHAT DRUGS SHOULD YOU STOP IF PATIENT HAS OVERFLOW INCONTINENCE

A

long term anticholinergics

40
Q

what spine things can cause retention and overflow

A

cauda equina

spinal anaesthesia

41
Q

what is procindentia

A

prolapse when entirely out of vagina

42
Q

what are the degrees of prolpase

A

1st- in vagina
2nd- at interiotus
3rd- outwith vagina
procidentia- entirely outwith vagina

43
Q

what score to quantify prolapse

A

POP-Q

44
Q

what RF for prolase

A

same as incontinence
lifting
surgery

45
Q

why do people with oedema in feet get nocturnal polyuria

A

as when lie down fluids flows into abdomen

46
Q

what is an anterior prolapse

A

cystocele:

-bulging pressure ‘mass’, difficulty voiding, incomplete emptying, splitting vaginal wall

47
Q

what are the features of an anterior/ middle or apical prolapse

A

bulging pressure ‘mass’, difficulty voiding, incomplete emptying, splitting vaginal wall, difficulty inserting tampon, pain with intercourse

48
Q

what is a middle/ apical prolpase

A

enterocele (intestines)

49
Q

what is a posterior prolapse

A

rectocele

50
Q

what are the symptoms of a rectocele

A 
bulging pressure
mass
difficulty defecating 
incomplete defecation 
splitting vaginal wall or perineum 
difficulty inserting tampon
51
Q

what is the management for a prolapse

A 
avoid heavy lifting
weight loss
smoking cessation 
reassure
physio
pessary
surgery
52
Q

what are the surgery options for prolapse

A

vaginal hysterectomy Manchester repair (cervix amputated, uterosacral ligaments shortened), sacrospinous fixation, abo/ laparoscopic sacrocolpexy, mesh techniques (controversial), colpoplexy

53
Q

when would you give a pessary not surgery or conservative

A

do surgery if young and dont want foreign body in vagina

pessary if not fit for surgery/ to relieve while waiting for surgery. also if further pregnancies planned/ pregnant

conservative if not concerned about symptoms/ young and will improve with physio

54
Q

what are the types of pessary

A

supportive pessaries (for mild- mod prolapse):

  • ring (easily inserted and removed, stay in during sex, suited fro all types of prolapse)
  • gehrung (stays in during sex, hard to fit and remove)

space occupying pessaries (advances or severe prolapse):

  • donut (needs to be removed for sex, hard to put in)
  • cube (needs to be removed every night, difficult to put in and take out, remove for sex, may can vaginal erosion)
  • gelhorn (hard to insert and remove, remove for sex)
  • inflatable (easy to insert/ take out, remove for sex)
  • shelf (hard to insert and remove, remove for sex)

Reproduction (51 decks)

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