224 - Pelvic Floor Disorders Urogyn/Uro Flashcards

1
Q

List 2 reflexes that usually protect against fecal incontinence

A
  • Rectosigmoid junction guarding reflex
    • Holds stool in the sigmoid colon
    • Fluid is absorbed here
  • Recto-anal inhibitory reflex
    • Reflex contraction of external anal sphincter, puborectalis
    • Holds stool in the rectum
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2
Q

List the structures responsible for pelvic organ support at each level:

  • Level 1 (top of vagina)
  • Level 2 (length of vagina)
  • Level 3 (most distal)
A
  • Level 1 (top of vagina)
    • Uterosacral + cardinal ligaments
  • Level 2 (length of vagina)
    • Arcus tendineous fascia pelvis
  • Level 3 (most distal)
    • Perineal muscles
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3
Q

List 2 agents that will alter stool consistency and treat fecal incontinece

A

Psyllium-husk fiber supplement

Low dose loperamide

Changing stool consistence = first line treatment to treat functional fecal incontinence

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4
Q

List 5 functional abnormalities that can contribute to fecal incontinence

A
  • Constipation/fecal impaction
  • Stool characteristics
    • Loose stool = hard to control
  • Physical mobility
    • Can’t get to the bathroom
  • Drugs
  • Cognitive impairment

First line tx = psyllium-husk fiber or low dose loperamide

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5
Q

What are the primary supports of the pelvic viscera?

A

Levator ani muscles + coccygeus

Levator ani consists of puborectalis, pubococcygeus, and iliococcygeus

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6
Q

Are pelvic floor disorders a common part of normal aging?

A

No!

But they are prevalent - affect 1/3 women

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7
Q

Which ligament is involved in a sacrocolpopexy surgery for pelvic floor reconstruction?

A

Anterior longitudinal ligament of the sacrum

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8
Q

What kind of incontinence is likely to result from neuromuscular injury to the pudendal nerve?

A

Stress urinary incontinence

  • External urethral sphincter not strong enough to hold pee in, especially during increases in presure (jumping, sneezing)
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9
Q

Is the coccygeus muscle part of levator ani?

A

No

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10
Q

List 5 risk factors for pelvic floor disorders

A
  • Aging
  • Obesity
  • Childbirth
  • Constipation
  • Smoking
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11
Q

List the 3 tiers of management for urgency urinary incontinence

(Tier 1 is the most conservative)

A
  • Tier 1 = conservative
    • Bladder retraining
    • Fluid management
  • Tier 2 = medications
    • Antimuscarinic
    • Beta-3 agonist
  • Tier 3 = procedural (but still kind of medical)
    • Sacral neuromodulation
    • Intravesical onobotulinum toxin
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12
Q

The Levator Ani Muscles include which of the following muscle groups?

  1. Puborectalis, Pubococcygeus, Iliococcygeus
  2. Puborectalis, Pubococcygeus, Obturator internus
  3. Puborectalis, Pubococcygeus, Iliococcxygeus, Coccygeus
  4. Pubococcygeus, Obturator internus, Piriformis
A

a. Puborectalis, Pubococcygeus, Iliococcygeus

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13
Q

What is the innervation to levator ani?

A

Pudendal nerve

And also anterior roots of S2, S3, S4

Thank you @Alba!

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14
Q

What kind of incontinence is likely to occur due to a CNS injury?

A

Urgency urinary incontinence

  • When pressure in the bladder is sensed, there is a problem with the central pathways that are supposed to prevent detrusor contraction and increase sympathetic tone (these things help us hold our pee)
  • Result is spontaneous detrusor contraction

Sx = not enough warning between feeling like you have to go and then going

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15
Q

What is the first line treatment for functional fecal incontenence?

A

Change stool consistency

Psyllium husk fiber or low-dose loperamide

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