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Special Populations > Pelvic health > Flashcards

Pelvic health Flashcards

1
Q

Why you need to know it

A
  • The pelvic floor is a sling between the innominates the pubis and the sacrum/coccyx
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2
Q

Pelvic floor importance

A
  • Maintains intraabdominal pressure
  • Maintains organ position
  • Assists in balance
  • Plastic in regards to the birthing process
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3
Q

Difference between male and female pelvis

A
  • Male long sacrum with inward coccyx
  • Female shorter sacrum with straight or slight outward coccyx
  • Male angle between rami
  • Female wider angle (up to double) between rami
  • Male pubic outlet round
  • Female pubic outlet more oval
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4
Q

Pelvic Triangles

A
  • Urogenital
    • Muscular border reinforced with Ischiopubic ramus
    • Infant passes through this triangle for birthing
  • Anal
    • Structurally identical in men and women
  • Musculature
    • You need to know and understand the function of each muscle of the pelvic floor
    • Both for men and women
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5
Q

UI:

A

urinary incontinence

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6
Q

Gravida:

A

to have been pregnant

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7
Q

Parous (Para):

A

to have delivered an infant

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8
Q

Nulliparous:

A

never having given birth

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9
Q

Incontinence- Prevalence

A
  • 17 million community dwelling Americans
  • 34 million have overactive bladder syndrome
    • 2.9 million of which have periods of incontinence
  • An additional 1.5 million long-term care
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10
Q

Women vs Men

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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11
Q

Nocturia:

A

getting up at least once in the night to urinate

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12
Q

Micturition:

A

emptying of the bladder

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13
Q

Post Void Residual (PVR):

A

amount of urine left in bladder after urination

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14
Q

Urgency:

A

a sudden compelling desire to urinate that can’t be deferred

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15
Q

Hesitancy:

A

Delay in initiating urination

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16
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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17
Q

CO$T

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

***While more money is still spent on baby diapers, sales of baby diapers have decreased 8 percent while adult diapers have increased 20 %

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18
Q

Types of 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

19
Q

Stress Incontinence

A
  • Cause
    • Weak pelvic floor muscles
    • Occurs with abdominal pressure exceeds urethral pressure
20
Q

What are types of stress than can cause stress incontinence?

A

Sneeze and a dribble

21
Q

OAB Syndrome

A
  • Cause
    • Detrusor over activity
    • Associated with involuntary bladder muscle contraction during filling phase
    • Does not always result in an incontinent episode
22
Q

UUI

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
23
Q

Etiology (non-neurologic)

A
  • Functional
  • Weak pelvic floor
  • OAB
  • Medications
  • Retention
  • Over distension
  • Fluid intake
24
Q

Functional

A
  • Inability to undress in a timely fashion
  • Inability to navigate to the restroom quickly
  • Examples
    • Post CVA pt trying to pull pants and undergarment down with one arm
    • Trying to walk to restroom with walker and due to obstacles can’t make it in time
25
Q

Weak pelvic floor

A
  • Hysterectomy
  • Prolapse
  • Straining with constipation
  • Poor biomechanics with lifting
  • Shift of the pelvis affecting muscle length
  • Scaring in the perineal and pelvic area
26
Q

OAB and UUI specifically

A
  • OAB and UUI specifically
  • UTIs
    • Irritation of the lining of the bladder
  • Neoplasia
    • Cancers or other abnormal tissue growth
  • Poster surgery status
  • Bladder outlet obstruction
    • Enlarged prostate
  • Anxiety
  • Poor toileting habits
27
Q

Retention

A
  • Enlarged prostate
    • Increased difficulty in passing urine due to decreased diameter of urethra
  • Hyper active pelvic floor syndrome
    • Inability to relax pelvic floor
    • Can cause pelvic pain syndrome and painful bladder syndrome
  • Poor toileting habits
28
Q

Medications

A
  • Anticholinergic meds
  • Antiscychotic meds
    • Sedation
    • Rigid pelvic floor
  • Diuretics
    • Worsen many forms of UI
29
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
30
Q

Fluid Intake

A
  • Both too much and too little
    • Too much
      • Over distention of the bladder
    • Too little
      • Concentrated urine
      • Increased infection
  • Intake of bladder irritating fluids
    • Spicy foods
    • Caffeine
    • Sugary drinks
    • Carbonation
    • Acidic foods/drinks
31
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
32
Q

Prolapse

A
  • POP: pelvic organ prolapse
  • Occurs
    • Women and Men
33
Q

Prolapse- symptoms

A
  • Symptoms
    • Discomfort
    • Bleeding
    • Urinary symptoms
      • Leakage
      • Frequency
      • Increased infection
      • Hesitancy
    • Difficult bowel movements
    • Bulging near pelvic opening/s
    • Sensation of pressure in pelvic region or lower abdomen
34
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
35
Q

Prolapse-Causes and Risk Factors

A
  • Increased age (risk factor not cause)
  • Childbirth
    • Multiple births, long labors, large infants
  • Chronic straining
    • During bowel movements or micturition
  • Obesity
    • Increased weight of organs and strain on pelvic floor
  • Hysterectomy
    • Uterus supports other structures
  • Prior pelvic surgeries
  • Poor lifting mechanics over time
36
Q

Stages of Prolapse

A

Stage 0 (1) no prolapse

Stage 1 (2) 1 cm or more above hymen

Stage 2 (3) 1 cm or less above or below hymen

Stage 3 (4) greater than 1 cm below hymen

Stage 4 (5) full eversion of organ

37
Q

Types of prolapse

A
  • Cystocele
    • bladder prolapse
    • Urethrocele
      • Urethra prolapse
      • Occurs in conjunction with cystocele
      • Combined called a cystourethrocele
  • Enterocele
    • small bowel prolapse
  • Rectocele
    • rectum prolapse
  • Uterine prolapse
    • AKA uterocele
    • prolapse of the uterus
  • Vaginal vault prolapse
38
Q

Cystocele

A
  • Front of vaginal wall is weak
  • Bladder herniates into vaginal vault
  • Herniation leads to alteration of urethral angle
    • Causes stress incontinence
    • Can cause urinary retention
39
Q

Enterocele

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
40
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’
41
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
42
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)
43
Q

Types of rectal prolapse

A
  • External (complete) rectal prolapse: is a full thickness, circumferential, telescoping of the rectal wall which protrudes from the anus and is visible externally.
  • Internal rectal prolapse: a funnel shaped infolding of the upper rectal wall that can occur during defecation
  • Mucosal prolapse: loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall —ie: hemorrhoids (piles)
  • Internal mucosal prolapse: refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally –ie: internal hemorrhoids

*Other types: some described in literature but not accepted as true prolapses

Special Populations (11 decks)

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