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Reproduction Week 4 2018/19 > 9: Urinary incontinence and prolapse > Flashcards

9: Urinary incontinence and prolapse Flashcards

1
Q

What is stress incontinence?

A

Leakage on increased intra-abdominal pressure

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2
Q

What is urge incontinence?

A

Urinary leakage preceded by a strong urge to go

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3
Q

An overactive bladder causes urgency (with / without) incontinence.

A

either

‘wet’ or ‘dry’ overactive bladder

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4
Q

Incontinence becomes (more / less) common as you have more children.

A

more common

multiparity is a risk factor

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5
Q

Which body state increases your risk of incontinence?

A

Obesity

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6
Q

What happens in the menopause to cause incontinence?

A

Relaxation of pelvic muscles, endopelvic fascia and pelvic ligaments

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7
Q

Which type of infection can cause urinary incontinence?

A

UTI

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8
Q

Which structure should be felt for in any abdominal/pelvic examination of a woman?

A

Bladder

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9
Q

What examinations should you do in a woman complaining of urinary incontinence?

A

Abdominal exam

Pelvic exam

PR exam

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10
Q

What test should you do in any woman complaining of urinary symptoms?

A

Urinalysis

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11
Q

What is the conservative management of an overactive bladder?

A

Lifestyle modifications:

drink less alcohol and caffeine

drink less fluid in general

lose weight

pelvic floor exercises and/or bladder training

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12
Q

Which muscle do antimuscarinics act on?

How?

A

Detrusor smooth muscle

Inhibit parasympathetics, reducing contraction

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13
Q

What are some examples of antimuscarinic drugs used for urge incontinence?

A

Oxybutynin

Tolterodine

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14
Q

What are some side effects of antimuscarinics like oxybutynin and tolterodine?

A

Dry mouth

Blurred vision

Constipation

Fatigue

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15
Q

Which new drug will soon be used instead of antimuscarinics to manage overactive bladder?

A

Mirabegron

B3 adrenoceptor agonist

RELAXES detrusor smooth muscle, reducing urge to void

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16
Q

What agents can be injected into the bladder to paralyse the smooth muscle, reducing incontinence but requiring catheterisation?

A

Botox

Botulinum toxin

17
Q

How is stress incontinence managed?

A

Weight loss

Pelvic floor exercises

Incontinence pessaries - like pads, kind of

Anticholinergics e.g duloxetine

Injection of botulinum toxin

18
Q

How do anticholinergics e.g duloxetine treat stress incontinence?

A

Constrict urethral smooth muscle

Maintain tone of internal urethral sphincter

19
Q

If all else fails, urinary incontinence can be treated using ___.

A

surgery

20
Q

What is a common gynae problem caused by increasing age and obesity?

A

Pelvic organ prolapse

21
Q

What are some risk factors for pelvic organ prolapse?

A

Increasing age

Multiparity

Menopause

Obesity

Chronic constipation

22
Q

Which three closely related organs, found in the pelvis, can prolapse into one another?

A

Bladder

Vagina/Uterus

Rectum

23
Q

Which conditions, causing hypermobility, predispose women to pelvic organ prolapse?

A

Marfan’s syndrome

Ehlers-Danlos syndrome

24
Q

What sort of symptoms are caused by pelvic organ prolapse?

A

Sensation of pressure, dragging in the pelvis

Urinary symptoms

Lower GI symptoms

Pain or discomfort during sex

25
Q

What is an anterior pelvic prolapse also known as?

A

Cystocele

26
Q

Cystocele causes ___ symptoms.

A

urinary symptoms

incomplete emptying, incontinence

27
Q

What has prolapsed inferiorly in a woman with dragging sensation, back pain and dyspareunia?

A

Uterus

28
Q

What is a posterior pelvic prolapse also known as?

A

Rectocele

29
Q

What has prolapsed in a woman with dragging sensation and difficulty defaecating?

A

Rectum

30
Q

What system is used to figure out what exactly has prolapsed in a woman with pelvic organ prolapse?

A

POP-Q

31
Q

What structure is used as a reference point in the POP-Q quantification of pelvic prolapse?

A

Hymen

negative numbers - above hymen, good

positive numbers - below hymen, bad

32
Q

How is pelvic prolapse investigated?

A

Ultrasound

MRI scan

33
Q

How is pelvic prolapse managed conservatively?

A

Lose weight

Pelvic floor exercises

+/- Insert a vaginal pessary to keep things in place

34
Q

What is a vaginal pessary?

A

Plate which is inserted to keep the pelvic organs in place

can be permanent (replaced every 6 months) or self-inserted depending on needs of patient

35
Q

If conservative management and vaginal pessaries aren’t appropriate, how is vaginal prolapse managed?

A

Surgery

Reproduction Week 4 2018/19 (9 decks)

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