Urinary incontinence

1-stress incontinence :
Caused by laxity of pelvic floor muscles; allows proximal urethra to drop
below the pelvic floor so the pelvic floor muscles is not aroud the urethra
anymore
Decreased urethral/vesicle angle allows bladder pressure to exceed
urethral pressure briefly at times of strain
Associated with:
-cystocele (-Bulging of bladder wall into the upper anterior vaginal wall) ,as
the UB become in straight line with the urethra.
-History of vaginal child birth (multiparous women) and Pelvic surgery
-Decreased estrogen level , lowered estrogen levels may lead to lower muscular
pressure around the urethra (this type mainly occurs in women
postmenopause)
-Presentation: Small volume leak with elevated intra-abdominal pressure
as: cough or laughing , sneezing , lifting heavy weight , NOT present in
supine position
-Treatment:
Topical vaginal estrogen
Kegel exercises to strengthen pelvic floor muscles
Alpha-agonists to increase muscle tone of bladder neck
Surgical procedures available as a FINAL option

2-urge incontinence: (overactive bladder syndrome)

Caused by involuntary bladder hyperreactivity, result of increased detrusor
muscle activity due to BPH, urethritis and cystitis
Most common type
Presentation:
Strong unexpected urge to void , small volume voids, Increased frequency,
nocturia
Treatment: anticholinergic to decrease parasympathetic tone of detrusor
muscle

3-Functional incontinence:
Patient cant reach toilet in time, he is normally continent but has large
volume of urine that he cant contain:
Caused by increased urinary volume, secondary to large volume intake or
using diuretics , or excessive caffeinated drinks
Patients are continent without the increased urinary volume

4-Overflow incontinence:
Caused by urinary retention secondary to obstruction (eg BPH) or bladder
atony (eg. Diabetes autonomic neuropathy or parasympathetic denervation
of UB)
Presentation:
History of chronic urine retention:
Dribbling urine, Small volume voids, increased urinary frequency
Treatment:
1- cholinergic agonists to increase detrusor muscle tone (for bladder
atony)
2-alpha-adrenergic antagonists to decrease tone of bladder neck in
case of obstructive lesion as BPH
3- urinary catheter for timed voiding

5-Total Incontinence:
Urinary loss in ALL times in ALL positions due to complete damage of the
sphincter by Cancer , Surgery . OR due to fistula between
bladder/Urethra and skin or vesico vaginal fistula
Treatment is SURGERY

Kegel exercise
repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now
sometimes colloquially referred to as the "Kegel muscles"
The aim of Kegel exercises is to improve muscle tone by strengthening
the pubococcygeus muscles of the pelvic floor.
It is now known that the components of

levator ani (the pelvic diaphragm),

namely pubococcygeus, puborectalis and ileococcygeus, contract and relax as one

muscle. Hence, pelvic floor exercises involve the entire levator ani rather than
pubococcygeus alone.
Kegel exercises are useful in regaining pelvic floor muscle strength in such cases. :

Urinary incontinence and Fecal incontinence

Pelvic floor exercises are recommended for women with urinary
incontinence of the stress, After a prostatectomy in men.

Pelvic prolapse
Sexual function
In 1952, Dr. Kegel published a report in which he claimed that the
women doing his exercises were orgasming more easily, more
frequently and more intensely , A paper found that pelvic floor exercises
could help restore erectile function in men with erectile dysfunction.

site of peritoneal dialysis

Nabothian cyst is due to chronic cervicitis(rarely) and mostly

normal finding in older women where Sq ep grows from ectoCx to cover
and obstruct a duct opening in EndoCx (Metaplasia)
A nabothian cyst (or nabothian follicle)[1] is a mucus-filled cyst on the surface of the cervix.
They are most often caused when stratified squamous epithelium of the ectocervix (toward
the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus).
This tissue growth can block the cervical crypts (subdermal pockets usually 210 mm in
diameter), trapping cervical mucus inside the crypts. The transformation of tissue types is
calledmetaplasia.
Nabothian cysts appear most often as firm bumps on the cervix's surface. A woman may
notice the cyst when inserting adiaphragm or cervical cap, or when checking the cervix as
part of fertility awareness.[2] A health care provider may notice the cysts during a pelvic exam.
Nabothian cysts are considered harmless and usually disappear on their own,[2] although
some will persist indefinitely.[citation needed] Some women notice they appear and disappear in

relation to their menstrual cycle. If a woman is not sure the anomaly she has found on her
cervix is a nabothian cyst, a visit to a doctor is recommended to rule out other conditions.[2]
Rarely, nabothian cysts have a correlation with chronic cervicitis, an inflammatory
infection of the cervix.
Nabothian cysts are not considered problematic unless they grow very large and present
secondary symptoms. A physician may wish to perform a colposcopy orbiopsy on a
nabothian cyst to check for cancer or other problems. Two methods for removing these cysts
include electrocautery and cryofreezing, although new cysts may form after the procedure.

postpartum thyroiditis
The exact cause is not known but it is believed to be an autoimmune disease very similar
to Hashimotos thyroiditis. In fact, these two disorders cannot be distinguished from one
another on pathology specimens. As in Hashimotos thyroiditis, postpartum thyroiditis is
associated with the development of anti-thyroid (anti-thyroid peroxidase, antithyroglobulin) antibodies. Women with positive antithyroid antibodies are at a much higher
risk of developing postpartum thyroiditis than women who do not have have positive
antibodies. It is believed that women who develop postpartum thyroiditis have an underlying
asymptomatic autoimmune thyroiditis that flares in the postpartum period when there are
fluctuations in immune function. The classic description of postpartum thyroiditis
includes thyrotoxicosis followed by hypothyroidism