Urinary Incontinence & Prolapse in Women

Question 1

Lack of voluntary control over urination or defecation

Answer 1

incontinence

Question 2

urinary incontinence affects 10-70% of women and peaks around

Answer 2

middle age

Question 3

Involuntary leakage accompanied by urgency
Need to “rush to the toilet”
Uninhibited bladder contraction

Answer 3

Urge Incontinence (Detrusor overactivity)

Question 4

Involuntary leakage with effort (coughing, laughing, sneezing, exercise)
Increase in intra-abdominal pressure overcomes sphincter closure

Answer 4

Stress Incontinence

Question 5

Combination of stress and urge incontinence

Answer 5

Mixed Incontinence

Question 6

Frequent voids of very small amounts of urine

Answer 6

Overflow Incontinence

Question 7

what can worsen symptoms of incontinence

Answer 7

COPD/smoking (cough stress)

Question 8

in office testing for incontinence

Answer 8

1. cough stress test
2. postvoid residual volume (PVR)
   - ultrasound /catheter- inaccurate
3. urodynamic testing
4. cystourethroscopy

Question 9

In general a PVR less than ____ mL shows adequate emptying

Answer 9

50

Question 10

Anal and bulbocavernosus

(Osinski) reflex can be used to assess

Answer 10

sacral reflex activity

Question 11

Q tip test

Answer 11

Measures urethral mobility- there is a problem of urethral support

Question 12

is a polysynaptic reflex that is useful in testing for spinal shock and gaining information about the state of spinal cord injuries (SCI).

Answer 12

The bulbocavernosus reflex (BCR) or “Osinski reflex”

Question 13

M1, M2 (80%) and M3 (20%) cholinergic receptors involved in ____________

Answer 13

detrusor contraction

Question 14

Only M3 cholinergic receptors are responsible for the ________________ detrusor contraction

Answer 14

parasympathetic

Question 15

detrusor relaxations usually involves which receptor

Answer 15

beta-3 adrenergic receptor

Question 16

anticholinergic side effects

Answer 16

Dry mouth
Constipation. 
Heartburn
Blurry vision
Rapid heartbeat (tachycardia)
Flushed skin,
Urinary retention 
Impaired memory
Confusion.
Skin irritation (from oxybutinin patch)

Question 17

• Relaxes the bladder muscle - β3 agonist
• Can increase the amount of urine bladder can hold
• Increase the amount one is able to urinate at one time

- Side effects
Increased blood pressure
Common cold symptoms (nasopharyngitis)
Urinary tract infection
Headache
Constipation.
Cleared by kidney and liver
Interactions with other medications

Answer 17

mirabegron

Question 18

• Blocks the actions of acetylcholine
• Paralyzes the bladder muscle
• Helpful for people who are non-responders to other medications
• Benefits can last several months
• Repeat injections once or twice a year
• Side effects
  Significantly improves symptoms of incontinence
  Causes few side effects
  May increase urinary tract infections??

Answer 18

Botox

Question 19

• Alpha antagonist (blocking uptake of norepinephrine at nerve endings)
• It makes the bladder muscle relax
• Makes the smooth muscles at the bladder neck contract
• May be used to treat mixed incontinence — (urge and stress incontinence)

-Side effects
Can include cardiovascular problems (irregular heartbeat)
Dizziness or fainting
Orthostatic hypotension.
Older adults may be especially susceptible to these side effects
Dry mouth
Blurry vision
Constipation
Interactions with many different medications

Answer 19

Imipramine - tricyclic antidepressant - antagonizes everything !!!

Question 20

• Serotonin and norepinephrine reuptake inhibitor
• Approved to treat depression and anxiety
• Can help the urethral sphincter relax
• Can improve urinary incontinence in some women
• May be helpful for women who have urinary incontinence and depression

- Side effects
Nausea
Dry mouth
Dizziness 
Constipation
Insomnia and fatigue.

Answer 20

Duloxetine- cymbalta

Question 21

decrease in estrogen affects how the bladder

Answer 21

deterioration of the supportive tissue around the bladder and urethra— weakens the tissue and potentially aggravates stress incotinence

Question 22

topical estrogen for incontienence

Answer 22

not much scientific evidence

Question 23

Combination systemic hormone replacement therapy (estrogen plus progestin) not effective
for incontinence

Answer 23

yep

Question 24

Oral estrogen replacement may worsen/improve incontinence symptoms

Answer 24

worsen

Question 25

- Provides bladder control therapy - Neurologic component of bladder control • FDA-approved in 1997 for urge incontinence FDA-approved1999 for urgency-frequency and urinary retention • Minimally invasive evaluation and implant procedure • Proven efficacy – up to 5 years For patients for whom more conventional therapy has been unsatisfactory

Answer 25

Sacral Neuromodulation

Question 26

management options for incontinence

Answer 26

1. behavioral approaches such as bladder training | 2. pelvic floor physical therapy to strengthen the peri-urethral and peri-vaginal muscles

Question 27

goal for management of stress urinary incontinence

Answer 27

Focused on improving bladder neck support | Reducing urinary leakage

Question 28

for moderate to severe stress urinary incotinence

Answer 28

surgery

Question 29

first step for preventing urine loss

Answer 29

kegle's exercises

Question 30

Designed specifically for the treatment of stress incontinence Especially useful for women who leak urine during specific activities such as exercise

Answer 30

occlusive devices such as uretrhal plug

Question 31

large cystocele

Answer 31

bladder prolapse

Question 32

severe procidentia

Answer 32

prolapse of the cervix

Question 33

rectocele is considered

Answer 33

hernia

Question 34

pessary

Answer 34

used for prolapse of the vagina to keep everything in

Question 35

vaginal/ urehtral slings

Answer 35

Pubovaginal slings have excellent overall success and durable cure rates

Question 36

Acts as a physical support to prevent bladder neck and urethral descent during physical activity

Answer 36

sling

Question 37

involuntary leakage associated with a sudden pressure on the bladder, as with coughing, sneezing or exercise

Answer 37

stress Ui

Question 38

involuntary leakage associated with a sudden strong need to void; often associated with overactive bladder

Answer 38

urge Ui

Question 39

involuntary leakage associated with a combination of urge and stress UI symptoms

Answer 39

mixed UI

Question 40

involuntary leakage associated with loss of bladder muscle contractile strength and/or bladder outlet obstruction, resulting in incomplete emptying of the bladder and retention of urine

Answer 40

overflow UI

Question 41

involuntary leakage associated with cognitive, functional, or mobility difficulties that impair the ability to use the toilet but without failure of the bladder's capacity for storage and emptiying

Answer 41

functional UI