13.06.06 Incontinence and prolapse

Causes of incontinence

    • Incontinence

    • Stress

      • Urge

      • Mixed (stress + urge)

      • True (No control over urinary flow)

      • Vesico-vaginal fistula

      • Uretero-vaginal fistula

      • Ectopic ureter

      • Bladder exstrophy

    • Vaginal prolapse

    • Abdo/pelvic mass

    • Diabetes

    • UTI

    • Neurological

    • Drugs

Management of incontinence

    • Duloxetine

      • SNRI

      • For stress incontinence

    • Oxybutinin

      • M1, M2, and M3 muscarinic acetylcholine receptor antagnoist

      • For urge incontinence

      • Anticholinergic side effects

    • Bladder training

    • Tension-free vaginal tape

      • 85-90% success rate

      • 30 min operation under local anesthetic

Types of prolapse

    • Cystocele

      • Bladder pokes into top of anterior wall of vagina

    • Urethrocele

      • => Descent of the anterior distal wall of the vagina

    • Rectocele

      • Rectum pushes into posterior wall of vagina

    • Enterocele

    • Protrusion of the small intestines and peritoneum into the vaginal canal

Degrees of uterine prolapse

    • 1st degree

      • Descent of cervix into vagina

      • Nothing to see

    • 2nd degree

      • Descent of cervix to vaginal introitus

    • 3rd degree

      • Descent of cervix outside introitus

    • Procedentia

      • Entire uterus outside introitus

Prolapse treatment

    • Anterior repair

    • Posterior repair

    • Vaginal pessaries

      • Ring

      • Gehrung

      • Hodge

      • Cube

      • Donut

      • Gellhorn

    • Vaginal hysterectomy