Pelvic Floor Dysfunction Flashcards
what is a prolapse
descend of vaginal/pelvic organs through the vagina
what are the risk factors for a prolapse
obesity pelvic surgery menopause - reduced oestrogens multiple vaginal births chronic constipations smoking - chronic cough heavy lifting uterine fibroids
what are the 3 types of prolapse
anterior - cystocele
middle - apical
posterior - rectocyele
what is an anterior prolapse and how does it present
bladder protruding onto anterior vaginal wall
bulging pressure/dragging sensation
pain on urination, intercourse
difficulty inserting tampon
what is a middle prolapse and how does it present
vaginal vault prolapse
similar to anterior, dragging sensation, pain on urination
difficulty inserting tampon
pain on intercourse
what is a posterior prolapse and how does it present
front wall or rectum bulges onto back wall of vagina difficulty or pain on defaecation incomplete emptying difficulty inserting tampon dragging pressure
what is a first degree vaginal prolapse
cervix into vaginal wall
what is a second degree vaginal prolapse
cervix descends to the level of intriotus
what is a third degree vaginal prolapse
cervix descends outside the vagina
what is procidentia
cervix entirely outside the vagina - similar to 4th degree prolapse
outline conservative methods of managing a prolapse
avoid heavy lifting, stop smoking, weight loss
if signs of atrophic vaginitis give vaginal oestrogens
if a prolapse is found incidentally and asymptomatic, is treatment required
no, if no symptoms no management required
what are some of the physical methods of managing a prolapse
pelvic floor exercises if prolapse is within the vagina
pessaries
state the indications for a pessary
women unfit for surgeries
women awaiting surgeries to provide relief of symptoms
what are the surgical options for prolapse
mesh to repair vaginal vault prolapse
amputate the cervix and shorten uterosacral ligaments
supraspinous fixation
vaginal hysterectomy
what are the main types of urinary incontinence
stress
urge
overflow
mixed
outline the main risk factors for developing urinary incontinence
female - due to pregnancy and shorter urethra
increasing age
large babies + multiple vaginal births
smoking causing chronic cough
how does stress incontinence arise
sphincter weakness
external pressure on the bladder such as coughing or sneezing causing small volume or urine leakage
how is stress incontinence managed conservatively
lifestyle such as smoking cessation, weight loss, treat constipation
pelvic floor exercises, trial for 3 months
what is the only drug licensed for stress incontinence
duloxetine but rarely used
how is stress incontinence managed surgically
injection of bulking agents
use of tension free vaginal tape
how does urge incontinence arise
due to overactive bladder - detrusor overactivity
what conditions increase risk of developing urge incontinence
MS and spina bifida
provoked by cold weather, opening the front door, running tap
what are the findings on frequency/volume chart for urge incontinence
increased diurnal frequency
nocturia
what is the conservative management for urge incontinence
avoid excessive fluid intake, caffeine and alcohol
bladder retraining to suppress urinary urge
what drug class can be used to manage urge incontinence
anticholinergics
what are some examples of anticholinergics
oxybutynin
tolterodine
solifenacin
what are the main side effects of anticholinergics
dry mouth
constipation
blurred vision
drowsiness
