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ESA 4 - Reproductive System > Pelvic Floor Dysfunction > Flashcards

Pelvic Floor Dysfunction Flashcards

1
Q

When can the pelvic floor be damaged?

A

During childbirth

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2
Q

When is the anal sphincter endangered in childbirth?

A

If there is a midline tear or episiotomy

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3
Q

When is the anal sphincter protected in childbirth?

A

If there is a mediolateral tear or episiotomy

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4
Q

When are episiotomies performed?

A

If there is a clinical need, such as intrumental birth, or a suspected fetal compromise

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5
Q

What are perineal tears classified into?

A

Four degree

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6
Q

What is a first degree perineal tear?

A

Where the fourchette and vaginal mucosa are damaged, and the underlying muscles are exposed, but not torn

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7
Q

What is a second-degree perineal tear?

A

Tears to posterior vaginal walls and perennial muscles, but the anal sphincter is intact

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8
Q

What is a third-degree perineal tear?

A

Extends to the anal sphincter that is torn, but the rectal mucosa is intact

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9
Q

What is a fourth-degree perineal tear?

A

When the anal canal is opened, and the tear may spread to the rectum

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10
Q

How is a episiotomy performed?

A

Use a mediolateral technique; 45-60 degrees to the right side, originating from the vaginal fourchette, and use tested, effective analgesia

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11
Q

Other than tears, what other damage can childbirth cause?

A
  • Stretch of the pudendal nerve
  • Stretch and damage of the pelvic floor and perineal muscles
  • Stretch/rupture of ligaments supporting muscles
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12
Q

What does a stretch of the pudendal nerve cause?

A
  • Neuropraxia
  • Muscle weakness
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13
Q

What does stretching and damage to the pelvic floor and perineal muscles cause?

A

Muscle weakness

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14
Q

What does stretching/rupture of ligaments supporting muscles cause?

A

Ineffective muscle action

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15
Q

What happens if ligaments supporting muscles in the perineal area get stretched overtime?

A

They remodel and get longer

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16
Q

Does a caeserean avoid the damage caused by childbirth?

A

No, appears that the damage can occur due to just having the child in the pelvis area

17
Q

What factors contribute to pelvic floor dysfunction?

A
  • Age
  • Menopause
  • Obesity
  • Chronic cough
  • Intrinsic connective tissue laxity
18
Q

Why does menopause predispose to pelvic floor dysfunction?

A

Atrophy of tissues after oestrogen withdrawal

19
Q

What can cause intrinsic connective tissue laxity leading to prolapse?

A

Defined conditions or constitutional

20
Q

What are the types of prolapse?

A
  • 1st degree
  • 2nd degree
  • 3rd degree
21
Q

What is a first degree prolapse?

A

Uterus falls into vagina, but doesn’t fall out of the body

22
Q

What happens in a 2nd degree prolapse?

A

Uterus reaches vaginal opening (cervix peeks out near the labia)

23
Q

What happens in a 3rd degree prolapse?

A

Uterus partially or completely falls externally, and the vagina is turned inside out

24
Q

When does a 3rd degree prolapse most commonly occur?

A

Post-hysterectomy

25
Q

What % of women over 50 will have urinary incontience problems?

A

50%

26
Q

What % of prolapses reoccur after corrective surgery in women?

A

10-15%

27
Q

How can prolapse and urinary incontinence be treated?

A
  • Pelvic floor muscle
  • Surgery
28
Q

What is the advantage of pelvic floor muscle exercise in treatment of prolapse and urinary incontinence?

A
  • Easy
  • Safe
  • Effective
29
Q

How effective are pelvic floor muscle exercises in treating incontinence?

A

Cure of incontinence occurs in 50-75% of patients

30
Q

What is the effect of pelvic floor muscle exercises in prolapse management?

A

Will prevent or delay worsening of prolapse

31
Q

What do surgical continence procedures do?

A

Increase support to the sphincter mechanism and prevent descent of the bladder neck

32
Q

Give two examples of surgical continence procedures

A
  • Colposuspension
  • Tension-free vaginal tape
33
Q

How effective are surgical continence procedures?

A

Cure rate 85-90%

34
Q

What are the disadvantages of surgical continence procedures?

A
  • Voiding difficulty/retention
  • Overactive bladder disease (obstruction)
35
Q

Give 3 surgical prolapse procedures

A
  • Removed prolapsed organs
  • Restoring connective tissue supports
  • Maintaing functions
36
Q

What are the side effects of surgical prolapse procedures?

A
  • Recurrence
  • New incontinence
  • Dyspareunia (painful intercourse)

ESA 4 - Reproductive System (31 decks)

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