Pelvic Relaxation Flashcards
WHat are the categories of DeLancey’s vaginal support?
L1: Conn tissue support to upper vagina
L2: Fascia Arcus in mid vagina
L3: Ant: Fusion of anterior vagina and urethra and muscles involved in urethral support
Post: Fusion of post vagina and perineal bo`dy
What are the different types of prolapse?
Anterior Compartment Prolapse
-cystocele/ cystourethro/ hypermobile urethra
Posterior Compartment prolapse -Rectocele
Apical Vaginal Prolapse
-vaginal vault
Uterine Prolapse
What is the Dovetail sign?
Lack of lines around the anus. Shows that there has been past perineal injury
What results from DL vaginal support failure of Level 1?
Uterine or vaginal vault prolapse
What is Apical Prolapse?
Loss of apical support from uterosacral ligament
What is an enterocele (prolapse)
Bowel prolapses out with the Uterus
What results from DL vaginal support failure of Level 2?
Mid level loss of support
- Cystocele
- Rectocele
What results from DL vaginal support failure of Level 3?
Anterior: Hypermobile urethra
Posterior: Perineocele
What causes Pelvic Floor prolapse?
8 fold increase in prolapse after 2 vaginal deliveries
35% anal incontinence after 1 VD, 44% after 2 VD
What are the risk factors for Fecal incontinence?
Instrumental delivery Prolonged 2nd stage labor birth wt > 4kg OP position epesiotomy 1st vaginal delivery Induction of labor Epidural Early pushing Active Restraint of head
What are the two main categories of cause of urinary incontinence?
Hypermobility- Related to Movement of the bladder neck and urethra
Intrinsic Sphincter Deficiency- Intrinsic Weakening of the bladder outlet closure mechanism
What is the cause of urge incontinence?
Urinary tract or vaginal infections
Bladder tumor/stones
Neuro causes
What are the causes of Overflow incontinence?
Obstructive- Fecal impaction
Non-obstructive- MS, Spina bifida, Spinal Cord injury
What are the causes of Functional incontinence?
Decreased mobility
Dementia
Injury- Fistulae
What is the POP-Q classification of prolapse?
S0: no prolapse
S1: distal prolapse is >1cm above hymen
S2: distal prolapse is within 1cm ab/below hymen
S3: distal prolapse is > 1cm below hymen but protrudes 2cm
