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Duke PA Pelvic Floor Disease

As many as __% of women will have urinary incontinence at some point in their lifetime 45
Hypermobility, intrinsic sphincter deficiency Stress incontinence
Detrusor overactivity, overactive bladder Urge incontinence (hyper-irritable, unstable, detrusor contractions)
Urge incontinence, think __ Neurologic problem
Overflow incontinence, think __ Inability to void
Increased abdominal pressure, coughing or straining, not associated with urge Stress incontinence
Often large volume, associated with strong desire to void, may be precipitated by sounds Urge incontinence
Pinpoints the site of urinary incontinence by assessing the bladder, urethra and pelvic support Urodynamic testing (considered gold standard)(although has poor neg predictive value)
__ has proven ineffective for the treatment of stress incontinence Pharmacotherapy
Premise of the suburethral sling Support the urethra and bladder neck with hammock that provides stabilization of urethra at rest and dynamic compression of urethra with increased intraabdominal pressure
Intrinsic Sphincter Deficiency, think: stress incontinence
Contributors to intra-abdominal pressure (may lead to incontinence) Childbirth, obesity, asthma, smoking, chronic heavy lifting
MOA of pelvic floor damage Mx disruption; Peripheral nerve damage; Connective tissue damage (inc lacerations of perineal body)
the most commonly associated inciting factor for incontinence. Childbirth
Causes of stress UI Childbirth; PF mx weakness; decreased collagen synthesis; previous pelvic surgery (eg, hysterectomy); Smoking, chronic constipation; Aging, estrogen deficiency
Extraurethral incontinence: fistulas
Goal of urodynamic testing reproduce symptoms of leakage in order to direct therapy
Effective tx for SUI Behavioral (mx exercises, biofeedback); Pessary; surg
Tx for urge incontinence Behavioral Tx; Meds (Anticholinergics); Peripheral neuromodulation (inter-stim); Botox Injections
Created by: bwyche