GU

Question 1

A post-pregnancy pt presents with vaginal fullness and lower abdominal aching that is worse after prolonged standing and better when lying down – dx? Tx?

Answer 1

Uterine prolapse (grades 0-4)
Tx – weight reduction, pelvic exercises, vaginal pessary
- Surgery may be necessary

Question 2

What is a rectocele?

Answer 2

Distal sigmoid colon sagging into posterior vagina

Question 3

What is a cystocele?

Answer 3

Posterior bladder descending into the vagina

Question 4

What 3 things should you always evaluate in a woman with cystocele?

Answer 4

amount of loss

• Amount of events (cough, sneeze, change in position)
• Associated sxs (loss of urine at night, urgency, nocturia, fullness, pressure)

Question 5

How do we evaluate for a cystocele?

Answer 5

Valsalva during speculum exam

Question 6

How do we treat cystocele?

Answer 6

Kegels, PT, estrogen tx, weight loss, treat constipation
Anti-spasmodic or anti-cholinergic may help
*based on severity of sxs and impact on life

Question 7

What are the 3 types of urinary incontinence?

Answer 7

Stress – due to incompetent sphincter w/ increased intra-abdominal pressure
Urge – overactive detrusor muscle
Mixed – likely MC

Question 8

In general how do we treat urinary incontinence?

Answer 8

Reduce caffeine and alcohol, Kegels
Meds – anti-cholinergic (oxybutynin, tolterodine)
Control DM and HF