Urogynaecology and prolapses Flashcards
(27 cards)
What are risk factors for incontinence- particularly stress incontinence?
age (especially post-menopause), parity, obesity, smoking
Why is menopause a risk factor for incontience?
Tissues become thinner around urethra
What causes stress incontinence?
sphincter weakness
What causes an overactive bladder/ urge incontinence?
Detrusor overactivity because of neurological damage eg MS, spinal cord compression
What are the types of bladder incontinence?
stress incontinence, overactive, fistula, prolapse, overflow, functional, mixed incontinence
What causes a fistula?
caused by cervical cancer, obstructive labour, surgical complication
What is a fistula?
fistula is a hole between two epithelial surfaces
What is a cystocele?
prolapse type where the bladder bulges into the vagina
What are symptoms of an overactive bladder?
Urgency Frequency Nocturia Nocturnal enuresis- wetting the bed “key in the door” “handwashing” intercourse causes incontinence
What can trigger stress incontinence?
Leakage due to a:
Cough Laugh Lifting Exercise movement
What investigations do you do for incontinence?
Frequency volume chart- bladder diary
MSU
U/S for residual urine - if incomplete emptying or voiding issues
EPAQ questionaiire to evaluate QOL
urodynamics (if OAB, voiding dysfunction, prolapse, or surgery failed)
What is urodynamics?
use to differentiate whether diagnosis is stress or overactive, catheter is inserted to back passage and bladder to calculate pressure
What do the results on a MSU mean?
look at nitrites and leukocytes (UTI), blood (nephropathy, cancer, infection), protein (renal and heart disease), glucose (nephropathy, DM, IGT)
What is the management for incontinence?
Lifestyle- lose weight, smoking cessation, less caffeine, avoid straining
Physiotherapy
Containment- catheter (if is going to be permanent do suprapubic), leakage barrier eg pads, skin care, odour control
Oestrogen PV especially if post-menopausal
Beta-3 agonist
Anticholinergics
How fo the beta 3 agonists works for incontinence?
relaxes SM of detrusor and so increases bladder capacity
How fo the anticholinergics work for incontinence?
works as bladder is innervated by sacral parasympathetic with Ach
What are some examples of anticholinergics?
oxybutynin, trospium, tolterodine, solefenacin (1st line)
What are the SE of anticholinergics?
dry mouth, drowsiness, constipation, confusion, blurry vision, sweating, tachycardia
What management would you specifically do for an overactive bladder?
1st line: Bladder drill (bladder training - slowly stretch the bladder)
2nd line: Anticholinergics / Mirabegron
3rd line: Botox
4th line: Bypass - surgery to put in catheter
What management would you specifically do first line for stress incontinence?
PT- pelvic floor (increases pressures on urethra), electric stimulation, vaginal cones
What is second line management for stress incontinence?
Surgery- sling or suspension
What is a pelvic floor prolapse?
where muscle/fascia/ligaments in pelvis fail causing the uterus, bladder and bowel descend from the normal anatomic position towards or through the vaginal opening.
What are the causes of a prolapse?
connective tissue disorder, CHILDBIRTH, age, obesity, chronic constipation
Wht are the symptoms of a prolapse?
Lump, pain (if prolpase outside vagina and can become irritated and ulcerated), dragging sensation, dyspareunia and sexual symptoms
