21. Pelvic Floor Relaxation

Question 1

Anterior vaginal prolapse is aka?

Answer 1

Cystocele (bladder prolapse)

Question 2

Lower posterior vaginal prolapse is aka?

Answer 2

Rectocele (rectum prolapse)

Question 3

Apical vaginal prolapse is aka?

Answer 3

Uterine prolapse (uterus comes down into vagina)

Question 4

Vaginal Vault prolapse occurs after removal of?

Answer 4

Uterus, in which the space apically comes down

Question 5

urethrocele is aka?

Answer 5

urethral prolapse

Question 6

Pt presents with pelvic pressure and bluging sensation with prolonged standing, no urinary or bowel complaints, has had *4 vaginal deliveries of large bbs, she smokes and lifts alot (intra-abdominal pressure inc), what is the most likely dx?

Answer 6

Anterior Vaginal prolapse (cystocele)

Question 7

Tx for cystocele is nothing, pelvic floor physical therapy, pessary or?

Answer 7

surgical correction called anterior colporrhaphy

Question 8

Pt presents with feeling like something is falling out, symptoms present for years, doesnt empty bladder completely and she voids small amounts frequently, not sexually active, dense medical history, dx?

Answer 8

Uterine Prolapse (apical vaginal prolapse)

Question 9

Tx for apical vaginal prolapse or uterine prolapse include a pessary, hysterectomy and colpocleisis- this procedure is only done if the patient doesnt desire to do what anymore?

Answer 9

HAVE A VAGINA OR HAVE SEX

Question 10

Pt presents with urinary incontinence with coughing and sneezing, cannot laugh without leaking, wears pads daily, denies bowel complaints, largest baby was 8lbs- 3 vaginal deliveries.. dx?

Answer 10

Stress Incontinence (+ possible prolapse- do more testing to determine)

Question 11

To determine if symptoms are being caused by stress incontinence alone or with a prolapse as well, do a physical exam, postvoid residual test, Urodynamics and a?

Answer 11

Q Tip Test (if Qtip makes an angle when bearing down of greater than 30 degrees then stress urinary incontinence)

Question 12

To treat stress urinary incontinence, one can try topical estrogen (postmeno), pelvic floor therapy/kegels, pessary or?

Answer 12

surgery (suburethral sling with transvaginal tape)

marshall marchetti krantz procedure is invasive and only done if a hysterectomy is going to be preformed

Question 13

Pt presents with 6 vaginals deliveries, complaints of pressure sensation and fullness in her vagina, denies any bladder complains, but needs to splint to have a bowel movement, what is the dx?

Answer 13

Rectocele (posterior vaginal prolapse)

*TX W SURGERY IS BEST OPTION

Question 14

Pt presents with urinary urgency and frequency, no kids, denies dysuria or hematuria, gets up 3-4 per night and only pees a little, no bowel complaints, drinks alot of soda and not much water, physical exam in NL* and urinalysis is neg for bacteria.. dx?

Answer 14

Urge Incontinence/Overactive Bladder

Question 15

Urge Incontinence/Overactive Bladder is treated via behavior modication, such as decreasing caffeine, limiting fluids after 7pm, and bladder training, along with antispasmodics such as tolterodine or? (what gma is on)

Answer 15

Oxybutynin