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SPECIAL POPS > pelvic floor > Flashcards

pelvic floor Flashcards

1
Q

PF Anatomy sling between two whats of the pubis?

A

innominates

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2
Q

What is the importance of the pelvic floor?

A

Maintains intraabdominal pressure
Maintains organ position
Assists in balance
Plastic in regards to the birthing process

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3
Q

Male/female pubic angle

A

50-80

90-100

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4
Q

important muscles of pelvic floor

A

Ischiocavernosus– more anterior

Transverese perinei superficialis- posterior

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5
Q

Vocab
Gravida meaning?
Parous Meaning?
Nulliparous-?

A

Gravida: to have been pregnant
Parous (Para): to have delivered an infant
Nulliparous: never having given birth
Examples
Gravida 1: Para 1=one pregnancy and one birth
Gravida 2: Para 1=two pregnancies and one birth

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6
Q

Men vs Women UTI

A

Women
Over 60 twice the prevalence of UI as men of the same age
Most women with UI are parous
~1/3 women have UI
Men
~30% of men over 60 report increased daytime frequency
27% reported increased urgency or over active bladder

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7
Q

nulliparous athlete

A

high impact sport athletes are more likely to have UI

17% of boys age 5014 are incontinent

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8
Q 
Nocturia meaning?
Micturition?
Post void residual?
Urgency?
Hesitancy?
A

Nocturia: getting up at least once in the night to urinate
Micturition: emptying of the bladder
Post Void Residual (PVR): amount of urine left in bladder after urination
Urgency: a sudden compelling desire to urinate that can’t be deferred
Hesitancy: Delay in initiating urination

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9
Q

Risk factors

A

Obesity:
increased pressure on pelvic floor
Smoking
Decreased collagen synthesis
Anatomical and neuro changes to bladder=decreased functionality
Increased coughing causes increased strain on the pelvic floor
Diabetes
Decreased sensitivity in bladder
Larger bladder capacity with larger post void residuals

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10
Q

UI one of the most prevalent chronic disease

A

One of the most prevalent chronic diseases
Only ¼ to ½ of those affected seek medical intervention
In 2000
$19.5 billion spent on UI
$12.6 billion spent on OAB
SUI (~35% of those with UI)
More per pt cost as surgery is often used for treatment

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11
Q

ratio of women with UI

A

1/3 women are affected by UI in UK

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12
Q

Stress UI
urge UI
OAB Syndrome:
Mixed UI

A

Stress UI (SUI): loss of urine associated with strain on pelvic floor
Urge UI (UUI) loss of urine associated with urge to urinate
OAB Syndrome: urinary urgency with increased frequency and nocturia without UTI
Mixed UI: loss of urine associated with both stress and urge

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13
Q

Stress UI

A

Cause
Weak pelvic floor muscles
Occurs with abdominal pressure exceeds urethral pressure

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14
Q

OAB Syndrome Cause

A

Cause
Detrusor over activity
Associated with involuntary bladder muscle contraction during filling phase
Does not always result in an incontinent episode

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15
Q

Urge UI

A

Cause
Detrusor instability
A contraction of the bladder before it is full
Associated with an undeniable urge to urinate
Urge can be so strong voiding can occur prior to reaching bathroom

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16
Q

Etiology (non-neurologic)

A 
Functional
Weak pelvic floor
OAB
Medications
Retention
Over distension
Fluid intake
17
Q

Medications

A 
Anticholinergic meds
See image to right
Antiscychotic meds
Sedation
Rigid pelvic floor
Diuretics
Worsen many forms of UI

meds->retention-> overflow-> Urgency->frequency

18
Q

over distended bladder

A 
Overflow incontinence
Results 
Constant or intermittent dribbling
General patient presentation
 High post void residuals
Can feel that their bladder isn’t completely emptied
Can also have sensory problems
Can’t feel bladder filling
19
Q

fluid intake

to much to little?

A 
Both too much and too little
Too much
Over distention of the bladder
Too little
Concentrated urine
Increased infection
20
Q

Pregnancy and UI

A

Associated with weakened pelvic floor musculature
Over stretching
Injury to ligaments
Damage to pudendal nerve
Pressure on pelvic floor from weight of fetus
Can occur during and after pregnancy

21
Q

Symptoms of severe prolapse

A

Heavy sensation in the pelvis
Sensation of “sitting on a ball”
Needing to push stool out
Placing fingers in vagina to physically push stool out
Hesitation with weak stream or spraying of urine
Increased frequency and constant sensation of full bladder
Low back pain
Need to lift up a ‘bulge’ to start urination

22
Q

Prolapse causes and risk factors

A 
Childbirth
Multiple births, long labors, large infants
Chronic straining 
During bowel movements or micturition
Obesity
Increased weight of organs and strain on pelvic floor
Increased age (risk factor not cause)
Hysterectomy
Uterus supports other structures
Prior pelvic surgeries
Poor lifting mechanics over time
23
Q

Stages of prolapse

A 
Stage 0- none
Stage 1- 1cm or more above hymen
stage2- 1cm or less above or below hymen
stage 3- 1cm below hymen disstance 2 cm less total genital tract
Stage 4- complete lower genital tract
24
Q

enterocoele

A

Front and or back of vaginal walls weakens
Small bowel presses against vaginal walls
Front and or back of vaginal walls separate
Small bowel herniates into vagina
Most common after hysterectomy
Uterus no longer present
Can’t hold other abdominal organs back

25
Q

Rectocele

A 
Posterior wall of vagina weakens
Rectum presses against vaginal wall
Posterior wall of vagina separates
Rectum herniates into vagina
Generally most obvious as a bulge when having a bowel movement
Pts feel need to ‘push stool out’
26
Q

Uterine Prolapse

A

Uterosacral ligaments weaken
Ligaments that support the vagina and uterus
Uterus prolapses into vagina
Telescoping action

27
Q

Vaginal Vault Prolapse

A 
Removal of uterus
10% of women post hysterectomy
Vaginal vault prolapses into vaginal canal
Telescoping action
Often occurs with enterocele
28
Q

Rectal prolapse

A

Rectum prolapses into our out of anus
Occurs more in men
Generally young active men
Or those with predisposition (congenital abnormality

29
Q

External rectal prolapse

A

is a full thickness, circumferential, telescoping of the rectal wall which protrudes from the anus and is visible externally.

30
Q

Internal rectal prolapse

A

: a funnel shaped infolding of the upper rectal wall that can occur duringdefecation

31
Q

Mucosal prolapse

A

loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall ie: hemorrhoids (piles)

32
Q

Internal mucosal prolapse

A

refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally ie: internal hemorrhoids

SPECIAL POPS (3 decks)

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