Lecture 4: Pelvic Relaxation and Incontinence

Question 1

1. 32 y/o G4P4 female has pelvic pressure and BULGING CESSATION with prolonged STANDING*****. She is a **warehouse worker**

4 treatments?

Answer 1

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

This is…..

Anterior vaginal prolapse

(Cystocele- _bladder_ has prolapsed into vagina)

Question 2

78 G2P2 african american female feels like “SOMETHING IS FALLING OUT of her vagina” and that she is “ doesn’t empy her bladder completely and only voids small amounts.”

• 2 treatments?

Answer 2

1. COLPOCLEISIS**** (obliteration of vagina, irreversible/permanent)
2. Pessary,

This is….

_UTERINE_ prolapse (Apical vaginal)

Question 3

62 y/o G3P3 female complains of urinary incontinence with COUGHING AND SNEEZING. So bad she must wear pads to avoid soiling her pants.

What are 3 diagnostic tools?

4 treatments?

Answer 3

​1. 3 Diagnostic Tools:

1. - Q tip test***–> tests for ↑ mobility of urethra
2. • Urodynamics
3. • Postvoid residual volume (<50 mL is normal)
4. 4 treatments:
5. • Topical estrogen
6. • Pelvic floor PT/kegals
7. • Pessary
8. • Surgery –> suburethral sling (transvaginal tape or transobturator tape for vaginal approach) with marshall-marchetti Krantz or Burch procedure

_STRESS_ incontinence

Question 4

45 y/o G6P female has pressure sensation and fullness in vagine. She has to “SPLINT***“ to have a bowel movement

What is treatment?

Answer 4

1. SURGERY** is best option
   * Splinting is pathgnomonic for POSTERIOR vaginal prolapse*

(RECTOCELE)

Question 5

38 y/o G0 female feels need to rush to bathroom IMMEDIATELY. She gets up 3-4x a night to use bathroom, and only voids a small amount. She drinks 5-6 DIET SODAS daily.

Treatment?

Answer 5

1. REDUCE CAFFEINE intake
2. limit fluids after 7pm
3. bladder training,
4. antispasmodics (oxbutynin, tolterodine)

This is……

• *URGE** incontinence (OVERACTIVE BLADDER)
• Overactive DetrUsor = Urge Continence*

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