Lecture 4: Pelvic Relaxation and Incontinence

Question 1

What is another name fo when the bladder prolapses into the vagina?

Answer 1

Anterior vaginal prolapse (aka Cystocele)

Question 2

What is a pathognomonic sign that a patient has a lower posterior vaginal prolapse (rectocele)?

Answer 2

Pt has to “splint” to have a bowel movement

Question 3

A female pt complaining that is feels like “something is falling out of her vagina” and that she is “ doesn’t empy her bladder completely and only voids small amounts,” is likely suffering from what pelvic floor dysfunction?

Answer 3

Apical vaginal/uterine prolapse

Question 4

What type of pelvic floor prolapse is commonly seen post-hysterectomy?

Answer 4

Vaginal vault prolapse

Question 5

What ar 4 treatment options for an anterior vaginal prolapse (cystocele)?

Answer 5

• Do nothing
• Pelvic floor physical therapy
• Pessary
• Surgical correction = anterior colporrhaphy (pubocervical fascia is sutured in the midline and laterally to the arcus tendinous fascia)

Question 6

What are 3 treatment options for a uterine prolapse?

Answer 6

• Pessary
• Hysterectomy
• Colpocleisis

Question 7

What are some ways to diagnose stress incontinence?

Answer 7

• Physical exam
• Q tip test –> tests for ↑ mobility of urethra
• Urodynamics
• Postvoid residual (<50 mL is normal)

Question 8

List 4 treatment options for stress incontinence?

Answer 8

• Topical estrogen
• Pelvic floor PT/kegals
• Pessary
• Surgery –> suburethral sling (transvaginal tape or transobturator tape for vaginal approach)

Question 9

What is the best treatment option for patient with a rectocele?

Answer 9

Surgery

Question 10

What type of bladder incontinence is caused by detrusor m. hyperactivity?

Answer 10

Urge incontinence