Benign Disorders of Reproductive Tract Flashcards
Pelvic Organ Prolapse (POP)
the abnormal decent or herniation of the pelvic organs from their original attachment sites or normal position in the pelvis
Pelvic Support Disorders
Pelvic organ prolapse
Urinary and Fecal Incontinence
-cause significant physical and psychological morbidity
What causes pelvic support disorders?
weakening of the connective tissue and muscular support of pelvic organs due to a number of factors:
- vaginal childbirth
- age
- heavy work
- poor nutrition
- increasing body mass
What are the 4 types of Pelvic Organ Prolapse?
- Cystocele
- Rectocele
- Enterocele
- Uterine Prolapse
Cystocele
occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall
Rectocele
occurs when the rectum sags and pushes against or into the posterior vaginal wall
Enterocele
when the small intestine bulges through the posterior vaginal wall (straining)
Uterine prolapse
the uterus descends through the pelvic floor and into the vaginal canal
Stages of Pelvic Organ Prolapse
Stages 0-4
Stage 0
NO descent of pelvic structure during straining
Stage 1
prolapsed descending organ is > 1 cm above the hymenal ring
Stage 2
prolapsed organ extends 1 cm below the hymenal ring
Stage 3
prolapsed organ extends 2-3 cm below the hymenal ring
Stage 4
the vagina is completely everted or the prolapsed organ is > 3 cm below the hymenal ring
Risk factors for Pelvic Organ Prolapse
- constant downward gravity
- atrophy of supporting tissues b/c aging
- childbirth trauma
- reproductive surgery (hysterectomy)
- family history
- young age at first birth
- connective tissue disorders
- straining
- obesity
Symptoms of Pelvic Organ Prolapse
- feeling of dragging, a lump in the vagina, or something “coming down”
- vaginal bulging
- pelvic pressure
- difficulty defecating
- stress/urge incontinence
Therapeutic Management for POP
- Kegel exercises
- Hormone replacement therapy
- Dietary and lifestyle modifications
- Pessaries Colpexin Sphere
- Surgery
Vaginal Pessaries
synthetic devices inserted into the vagina to provide support to the bladder and other pelvic organs as a corrective measure
What type of individuals would be recommended to use Pessaries rather than surgery?
- Elderly clients
- Woman who wish to have more children
- Woman who prefer it over surgery
Surgical Options for POP
- Anterior or posterior colporrhaphy (cystocele/rectocele)
- Vaginal Hysterectomy (uterine)
What to look for on physical examination for POP
Pelvic exam for any obvious protrusions and bladder function
Diagnostic tests for POP
urinalysis, ultrasound, urine culture, postvoid urine volume
What are the most common types of urinary incontinence?
Urge, stressed, and mixed
Management of Urge Incontinence
- Kegel exercises
- Pessary ring
- Pharmacotherapy-Anticholinergics
- Surgery if all else fails
Management of Stress Incontinence
- weight loss
- smoking cessation
- avoid constipation
- Kegel exercises
- Meds-Duloxetine
- Estrogen replacement therapy
- Pessaries, weighted vaginal cones
- surgery
Most Common Benign Growths
Polyps Fibroids Cysts Fistulas Bartholin cysts
Cervical Polyps
small benign growths; frequently result from infection
-grayish white
Where are Polyps most commonly found?
Cervix and uterus
When do cervical polyps typically appear?
After menstruation
What are the three types of polyps?
Cervical Polyps , Endocervical polyps and Endometrial polyps
Endocervical Polyps
- multiparous women age 40 to 60
- cherry red
Endometrial Polyps
benign tumors or localized over growths of the endometrium
-rare in women under 20; peak in fifth decade; and decline after menopause
Symptoms of Polyps
Usually asymptomatic
abnormal vaginal bleeding or discharge
Nursing Management for Polyps
- explanation of condition
- rationale for removal
- follow-up care instructions
Uterine Fibroids
“Leimyomas”
benign tumors composed of smooth muscle and fibrous connective tissue in the uterus
When do Uterine fibroids experience rapid growth and when do they shrink?
Rapid growth during childbearing years due to estrogen dependency and will shrink during menopause
What are the three classifications of uterine fibroids?
Subserosol fibroids, Intramural fibroids, and Submucosal fibroids
Subserosol Fibroids
lie underneath the outermost peritoneal layer of the uterus and grow outside the uterus; attached to uterus by a stalk or peduncle
Intramural Fibroids
grow within the wall of the uterus and are the most common
Submucosal Fibroids
grow immediately below the inner uterine surface (endometrium) into the uterine cavity
Predisposing factors for Fibroids
- age
- genetic predisposition
- African American ethnicity
- Hypertension
- Nulliparity
- Obesity
Medical Management for Fibroids
GnRH agonists
Progestin agonists
Uterine artery embolization
Surgical Management of Fibroids
Myomectomy
Laser surgery
Hysterectomy
Myomectomy
removing the fibroid alone; for women who still want to have children
Laser Surgery
destroying small fibroids with lasers
Hysterectomy
the surgical removal of the uterus
Symptoms of Fibroids
chronic pelvic pain, low back pain, anemia, bloating, constipation, infertility, dysmenorrhea, miscarriage, sciatica, dyspareunia, urinary frequency/incontinence, menorrhagia, feeling of heaviness
What are the 3 most common types of fistulas?
- Vesicovaginal
- Urethrovaginal
- Rectovaginal
Vesicovaginal Fistula
communication between the bladder and genital tract
Urethrovaginal Fistula
communication between the urethra and the vagina
Rectovaginal Fistula
communication between the rectum and the vagina
Managing small fistulas
heal without treatment
Managing large fistulas
will require surgical repair
Fistula Symptoms
urine leakage, flatus leakage, discomfort
Bartholin Cysts
swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin gland becomes blocked
What can happen because of a Bartholin cyst?
infection and an abscess may develop
Management of Bartholin Cysts
- may heal on their own
- sitz baths and analgesics for discomfort
- antibiotics if infected
- surgery
Symptoms of Bartholin Cysts
- asymptomatic if small and not infected
- pain with walking/sitting
- unilateral edema
- redness around gland
- dyspareunia
- abscess
Ovarian Cyst
fluid-filled sac that forms on the ovary
What are the 4 types of ovarian cysts?
- Follicular
- Corpus luteum
- Theca lutein
- Polycystic ovarian syndrome (PCOS)
Polycystic Ovarian Syndrome
Most common endocrine condition of women of reproductive age
- multiple inactive follicle cysts within ovary
- interfere with ovarian function
- multifaceted disorder
What is the central pathogenesis for PCOS?
hyperandrogenemia or hyperinsulinemia
