Pelvic Organ Prolapse and Urinary Incontinence -Foster

Question 1

What does the term pelvic relaxation mean?

Answer 1

describes the loss of support in general

may see: urethrocele, cystocele, rectocele, enterocele, urterine prolapse

denervation of the pelvic floor may result in decreased resting tone, dec squeeze pressure, lower reflex response with stress, decreased pelvic organ support

Question 2

What are the symptoms of pelvic relaxation?

Answer 2

Vary according to what’s falling and how far –> Often diffuse, “pressure” or “heaviness,” backache, dyspareunia; “something’s falling out”

Worse after standing, late in day

Voiding problems (stress incontinence, incomplete voiding, UTI’s)

Constipation, incomplete defecation, fecal incontinence; may report “splinting” for BM

Question 3

Is incontinence a normal part of aging?

Answer 3

NO!

make sure to ask about this and sexual dysfunction in old people because they are embarrassed

Question 4

What is the difference between stress and urge incontinence? Are these anatomical or functional problems?

Answer 4

Stress: develops when there is a loss of support of the urethrovesical junction –> bladder pressure exceeds utrethral pressure with cough/sneeze, etc anatomical defect

Urge: blader oversensitivity -> think it’s full when it isn’t –> often from infection or neurological disorders
functional problem

Question 5

What are the exam findings associated with urethral diverticula?

Answer 5

Suburethral mass

Tenderness along urethra

Expressed pus from urethral massage

Question 6

What is the recommended treatment for mild symptoms of pre lapse or incontinence?

Answer 6

nonsurgical approach first

Kegels, physical therapy, biofeedback, electrical stimulation, estrogen replacement, bladder training, pessaries (things insert and take out)