EXAM #1: PELVIC RELAXATION Flashcards
What structure anatomically is in very close proximity to the uterus that must be accounted for during surgery?
Ureter
What are the signs/symptoms of pelvic floor prolapse?
1) Pelvic pain/pressure
2) Bulging from the vagina
3) Dysparenuia
4) Difficulty voiding/evacuating bowels
What are Delancye’s three levels of vaginal support?
I= connective tissue support to upper vagina
II= fascial arcus in mid vagina
III=
- Anterior fusion of anterior vagina/ urethra
- Posterior fusion between vagina and perineum
What is anterior compartment prolapse?
Bladder and urethra prolapse
What is posterior compartment prolapse?
Rectal prolapse
What is apical vaginal prolapse?
Vaginal vault prolapse
- S/p hysterectomy
- Top of vagina normally attached to uterosacral ligaments
- Vault pulls free from uterosacral ligaments
*This term is only used if there is no uterus; if there is a uterus, then this is a uterine prolapse
What is the most important support to the upper vagina?
Level I i.e. connective tissue to the upper vagina
Weakness of the connective tissue to the upper vagina will result in what kind of prolapse?
- Uterine prolapse
- Vaginal vault prolapse
What does failure of the fascial arus of the mid vagina result in?
Bladder prolapse and rectal prolapse into the vaginal vault
*This is a Level II loss of support
What does loss of the anterior fusion of the vagina result in?
Hypermobile urethra
What does loss of the posterior fusion of the vagina result in?
Perinocele or perineal prolapse
How is a hypermobile urethra diagnosed?
- Urethra should be parallel to exam table on exam
- Insert Q-tip; it will be at an angle greater than 30 degrees
- Also, will move with coughing
Why don’t women with grade III or IV prolapse have urinary incontinence?
Functional obstruction from prolapse
What is stress incontinence?
Involuntary loss of urine during exertion
Is stress incontinence more common in men or women?
Women
*Urge incontinence is more common in men
What are the two main categories of stress incontinence?
1) Hypermobility
2) Intrinsic Sphincter Deficiency
What is hypermobility incontinence?
Loss of urine related to movement of the bladder neck and urethra
What is urge incontinence?
Incontinence with the “OMG I need to get to the bathroom” feeling
What is mixed incontinence?
Mix of stress and urge incontinence
What is overflow incontinence?
Involuntary loss of urine associated with bladder overdistension
What is functional incontinence?
Loss of urine from dementia, decreased mobility, fistula
How is pelvic organ prolapse evaluated?
1) Determine extent/stage of prolapse
2) Assess pelvic muscle function on PE
3) Evaluating resting tone and voluntary contraction of anal sphincters
What testing is indicated in a women with pelvic organ prolapse?
1) Screen for UTI
2) Measure post-void residual urine volume
3) Determine presence/absence of bladder sensation
What is Grade I Baden-Walker?
Prolapsed tissue descends halfway to the hymen
What is Grade II Baden-Walker?
Prolapsed tissue descends to the hymen
What is Grade III Baden-Walker?
Prolapse extends beyond the hymen with straining
What is Grade IV Baden-Walker?
Prolapse extends beyond the hymen at rest/ without straining
What are the non-surgical options for POP?
1) Kegels
2) Pessary
What ligament can be used to anchor pelvic structures in surgical management of POP?
Sacrospinous ligament
What three mechanisms are part of the surgical support of the vagina?
1) Closure of the introitus
2) Vertical suspension of the vagina
3) Flap effect of near horizontal vagina
