Urogynaecology Flashcards
Incontinence Hx
When and how much?
Frequency of micturition - day and night
Difficulty passing urine
Pain on urination? Blood?
Buldge in vagina? worse with activity?
Difficulty emptying bowels? Faecal leakage?
Pelvic floor problems on sexual activity?
Full gynae and obs hx
PMH, surgical hx, DH, allergies, social
QOL and coping mechanisms e.g. pads, fluid restriction, staying at home, avoiding exercise
Red flags
Visible haematuria
Pain associated with bladder filling
Abdominal swelling
Bladder diaries
Help identify how the bladder is functioning
Identify issues
Track progress with pelvic floor muscle training
Number and quantity, leaks and what pt was doing at time, urge, drinks and food
Prolapse
Most common cause of hysterectomies > 55
Anterior wall - cystocele, posterior wall - rectocele, peritoneum of cul de sac - enterocele
Symptoms - vaginal pressure / heaviness, abdominal or low back pain, vaginal or perineal pain or discomfort, mass sensation, sexual health issues, urinary or faecal symptoms
Management options - pessaries, hysterectomies, abdominal sacral colposcleices
Prolapse RF
Vaginal births Genetic predisposition Menopause Advancing age Prior pelvic surgery Connective tissue disease Obesity Chronic constipation with excessive straining
Stress incontinence
Common 4-6 months post delivery
Leakage of urine on activities that increase intra-abdominal pressure e.g. coughing, sneezing, laughing
Urethral hypermobility / intrinsic sphincter deficiency
Pelvic floor exercises. Surgery.
Urge incontinence
Detrusor muscle overactivity
Behavioural therapy, botox, mirabegron, sacral nerve stimulation
Bladder retraining - lasts at least 6 weeks
Bladder stabilising drugs - antimuscarinics first line
Incontinence RF
Advancing age Previous pregnancy and childbirth High BMI Hysterectomy FH
Initial Investigations
Bladder diaries
Vaginal examination
Urine dipstick and culture
