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
2
Q
Pelvic floor importance
A
- Maintains intraabdominal pressure
- Maintains organ position
- Assists in balance
- Plastic in regards to the birthing process
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
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
5
Q
UI:
A
urinary incontinence
6
Q
Gravida:
A
to have been pregnant
7
Q
Parous (Para):
A
to have delivered an infant
8
Q
Nulliparous:
A
never having given birth
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
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
11
Q
Nocturia:
A
getting up at least once in the night to urinate
12
Q
Micturition:
A
emptying of the bladder
13
Q
Post Void Residual (PVR):
A
amount of urine left in bladder after urination
14
Q
Urgency:
A
a sudden compelling desire to urinate that can’t be deferred
15
Q
Hesitancy:
A
Delay in initiating urination
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
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 %
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
- High post void residuals
30
Q
Fluid Intake
A
- Both too much and too little
- Too much
- Over distention of the bladder
- Too little
- Concentrated urine
- Increased infection
- Too much
- 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
