Genitourinary Flashcards
Endometriosis
Development of endometrial tissue in extrauterine locations within abdomen and pelvis
Etiology: Unknown. Can cause scarring and adhesions.
Signs/Symptoms: Lower abdominal, pelvic, or low back pain before or during menstruation, irregular menstrual cycles, premenstrual spotting, dyspareunia, pain during defecation, and infertility.
Treatment: Myofascial release, visceral mobilization and soft and deep tissue massage to break up scar tissue and adhesions. Mobility to sustain elongation of tissues. TENS. Pharmacology to alter hormonal balance. Surgery to remove extrauterine endometrial tissue, scarring, and adhesions; total hysterectomy.
Uterine Prolapse
Descent of uterus and cervix into vagina. Bader-Walker System used to classify prolapse.
Etiology: Genetics, denervation, or direct muscle trauma (delivery/labor)
Signs/Symptoms: Pelvic pressure that increases with exertion, urgency, frequency, urinary incontinence, incomplete bladder emptying, discomfort, vaginal dryness, dyspareunia, low back pain relieved by lying down.
Treatment: Pelvic floor muscle training with biofeedback, Kegels, core strengthening, body mechanics. Intravaginal mechanical support device. Reconstruction or obliterative surgery.
Prostatitis
Inflammation of prostate gland
Etiology: Bacterial infection or backup of prostate secretions within gland.
Signs/Symptoms: Watery urethral discharge, urgency, frequency, discomfort with urination, pain with ejaculation. Chronic pelvic pain syndrome manifests as pain in perineum, rectum, prostate, penis, testicles, and abdomen. Asymptomatic inflammatory prostatitis includes prostate inflammation in absence of genitourinary tract symptoms.
Treatment: Biofeedback training, stretching, myofascial techniques, and bladder retraining. Pharmacological intervention like antibiotics, anti-inflammatory medications.
Erectile Dysfunction
Etiology: Diabetes, hypertension, hypothyroidism, hypopituitarism, multiple sclerosis, psychiatric disorders, excessive alcohol consumption, smoking, vessel disease, kidney disease, pharmacological side effects, hormonal imbalances.
Signs/Symptoms: Inability to maintain erection for sexual intercourse
Treatment: Pharmacological intervention, surgical intervention, injections into penis, and Kegel exercises.
Renal Failure
Decreased glomerular filtration rate and fail to filter toxins and waste from the blood. Two forms: acute and chronic.
Etiology: Diabetes, hypertension, poison, trauma, and genetics.
Signs/Symptoms: Nausea, vomiting, lethargy, weakness, hiccups, anorexia, ulceration within GI tract, sleep disorders, headache, peripheral neuropathy, anemia, pruritis, osteomalacia, ecchymosis, pulmonary edema, seizure, and coma.
Treatment:Pharmacology, diuretics, nutrition, hydration, hemodialysis/transfusions.
Acute Renal Failure
Sudden decline in renal function
Increase in BUN and creatine
Oliguria, hyperkalemia, sodium retention
Prerenal etiology is secondary to decrease in blood flow due to shock, hemorrhage, burn, or PE
Postrenal etiology due to obstruction distal to the kidney due to neoplasm, kidney stone or prostate hypertrophy
Chronic Renal Failure
Progressive deterioration in renal function Diabetes Severe hypertension Glomerulopathies Obstructive uropathy Interstitial nephritis Polycystic kidney disease
Hemodialysis
Removes waste, excess sodium, and fluids from blood and returns blood to body. Required 3x/week and each visit requires 3-5 hours.
Side effects include anemia, renal osteodystrophy, pruritis (itching), sleep disorders (restless legs), amyloidosis.
Neurogenic Bladder
Damage to cerebral control that causes urinary dysfunction
Etiology: Diabetes, diminished bladder capacity, hyperactive detrusor muscle, CVA, infection, nerve damage.
Signs/Symptoms: Frequent UTI, leakage of urine, inability to empty bladder or loss of urge to urinate.
Treatment: Dependent on etiology. Bladder techniques, lower abdominal massage, temporary catherterization, pharmacological intervention, timed urination program.
Stress Urinary Incontinence
Due to increased intraabdominal pressure, such as sneezing, coughing, laughing, running, and jumping.
Urge Urinary Incontinence
Sudden, intense urge to void due to the detrusor muscle of the bladder involuntarily contracting the bladder during filling. Most common in geriatric populations.
Etiology: Detrusor mm overactivity due to changes in smooth mm of the bladder, increased afferent activity, increased sensitivity of the detrusor to acetylcholine, and idiopathic. Associated with neurologic disorders including MS, SCI, CVA, and Parkinson’s.
Signs/Symptoms: Triggered by certain events due to a conditioned reflex. Like “key in lock” when coming home and running water
Treatment: Behavior modification. Biofeedback, pelvic floor strengthening, and bladder retraining (scheduled voiding). Pharmacology.
Overflow Urinary Incontinence
Loss of urine when intra-bladder pressure exceeds the urethra capacity to remain closed
Etiology: Caused by outflow obstruction due to narrowed or obstructed urethra from prolapsed pelvic organ or enlarged prostate, chronic constipation, or neurological disease.
Signs/Symptoms: Difficulty initiating urine. Weak stream and post void dribble.
Treatment: Surgical intervention if obstruction. If weakness of detrusor mm, double voiding recommended and strengthening measures.
Functional Urinary Incontinence
Inability or unwillingness to use bathroom prior to involuntary bladder release.
Etiology: Decreased level of mental awareness or a decreasing mobility. Usually seen with other bladder issue or neurological involvement.
Signs/Symptoms: Impaired cognition and/or mobility and will experience incontinence secondary to inability to use bathroom to void.
Treatment: Improve mobility, modify clothing style, increase independence with ambulation. Behavioral toileting schedule or program.
Urinary Tract Infection
Can be classified as uncomplicated, complicated, recurrent, or chronic
Etiology: bacteria infiltrate urethra (urethritis)or bladder (cystitis). Can spread to kidney if untreated.
Signs/Symptoms: Frequency of urination, pain or burning with urination, cloudy urine, pressure above pubic bone in women, shakiness, fever, back pain, and fatigue.
Treatment: Early treatment has best results. Pharmacological treatment includes bacteria antibiotics. Drink excess fluids.
Coccydynia
Joint between coccyx and sacrum becomes hypermobile after childbirth, causing soft tissue surrounding coccyx to be painful.
Etiology: Subluxation during delivery, adherence to tear or episiotomy scar
Signs/Symptoms: Difficulty sitting on hard surfaces, referred pain to low back, SIJ, hip, buttock, groin, or rectum, pain with bowel movements, dyspareunia, and formation of hemorrhoids.
Treatment: Heat, external joint mobs, myofascial release, muscle energy techniques, biofeedback for pelvic floor muscle relaxation, postural training, abdominal strengthening, cushion for sitting.
Diastasis Recti
Separation of rectus abdominis along linea alba that can occur during pregnancy. Should test for presence on all pregnant women prior to doing abdominal exercises. Note how many fingers fit into separation and modify treatment accordingly.
Etiology: Likely biomechanical and hormonal changes .
Signs/Symptoms: If separation greater than width of two fingers when women lifts head and shoulders off plinth.
Treatment: Stabilization and support with abdominal strengthening, postural awareness, and body mechanics
Piriformis Syndrome
Persistent, severe radiating low back and buttock pain spanning from sacrum to the hip and posterior thigh.
Etiology: During pregnancy, piriformis can shorten or spasm due to postural changes and hip lateral rotation during walking.
Signs/Symptoms: Sciatic paresthesia due to nerve entrapment as sciatic nerve passes under or through piriformis.
Treatment: Manual techniques for pelvic and sacral alignment like muscle energy techniques, joint mobs, self-correction, heat application, deep tissue massage, myofascial release, strain-counterstrain, abdominal strengthening, stretching for piriformis body mechanics, and postural education.
Symphysis Pubic Pain
Symphysis pubic joint becomes mobile in order to allow joint to separate during delivery
Etiology: Postural adaptations, ligament laxity, complications during delivery or birthing of large infant.
Signs/Symptoms: Pain in pubic symphysis and SIJ as well as blood in urine during injury to urethra or bladder neck.
Treatment: Pharmacological intervention for pain and surgical intervention based on degree of separation. Heat or ice if acute, manual for correcting pelvic or sacral alignment (muscle energy, self correction), positioning and postural training, gait training, pelvic and lumbar stabilization exercises, lumbo-pelvic brace or binder.
Physiological Changes During Pregnancy
Anemia may occur
Increased depth of respiration, tidal volume, and minute ventilation
Increased oxygen consumption (15-20%), blood volume (40-50%), and cardiac output (30-40%)
Hypotension in supine from pressure on inferior vena cava
Pregnancy and Exercise
Mild to moderate rate exercise , 50-60% of max HR for about 30 minutes per session.
Non-weight bearing exercises preferred.
Loose clothing for adequate heat loss and adequate fluids
Avoid becoming overtired
Do not exercise in supine position after first trimester - can decrease cardiac output
Avoid prolonged motionless standing
Physiological/morphological changes may persist 4-6 weeks post partum, so pre-pregnancy exercise routines should be resumed gradually
Pelvic floor exercises
Transition from gravity assisted to standing and functional tasks during contractions.
Recommended 80-100 contractions per day combining quick, long hold, and functional contractions.
Exercises for High-Risk Pregnancies
- L sidelying best position to reduce pressure on inferior vena cava, maximize CO, enhance maternal and fetal circulation, and reduce risk of incompetent cervix
- Abdominal exercises may stimulate uterine contractions. Modify or discontinue exercises.
- Keep exercises slow, simple, smooth, and with minimal exertion
- Avoid valsalva
- Provide instruction to limit strain during abdominal contractions
- Encourage maximal muscle efficiency during exercise
Overactive Bladder Agents
Action: Relieves symptoms of involuntary bladder contractions
Indications: Urinary urgency, frequency, urge incontinence, nocturnia
Side effects: Vary based on classification; typically GI distress, nausea, dizziness, photosensitivity, headache, constipation, pulmonary reactions
Examples: Ditropan (oxybutynin chloride), Detrol (tolterodine tartrate)
Urinary Anti-Infective Agents
Treat UTI but are not traditional antibiotic or sulfonamide agents.
Indications: Cystitis, urinary urgency, burning with urination, urinary tract infection, nocturnia
Side effects: Vary; GI distress, nausea, dizziness, photosensitivity, headache, constipation, rash
Examples: Cinobac (cinoxanic), Furadantiin (nitrofurantoin)
