GENITAL PROLAPSE AND URINARY INCONTINENCE
Prophase: the slipping or falling out of place of an organ (as the uterus)
Incontinence: involuntary urination or defecation
All patients should be referred to a specialist for initial evaluation. Baseline investigations can, however, be done at lower level.
GENERAL MEASURES
Detrusor overactivity: bladder training, fluid restriction and physiotherapy.
Stress incontinence: pelvic floor exercises.
Surgical procedures as dictated by the diagnosis at specialist care.
MEDICINE TREATMENT
Treat urinary tract infections and underlying conditions, as appropriate.
For detrusor overactivity as demonstrated on urodynamic studies:
• Oxybutynin, oral, 2.5 mg 12 hourly, increasing to 5 mg 6 hourly.
Specialist initiated.
Note: Dry mouth is a common side effect of treatment.
REFERRAL
a. All patients with prolapse.
b. Patients not responding to therapy.
c. Incontinence:
1. Stress incontinence as surgical repair will be likely.
2. Total incontinence as a fistula has to be excluded.
3. Urge incontinence resistant to 3 months’ medicine treatment.
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p style=”margin-left: 35pt”>4. Mixed incontinence (both stress and urge incontinence present) as surgery will play a role.
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