Pelvic Relaxation and Incontinence Flashcards
Structures responsible for pelvic floor support in females
Cardinal and uterosacral ligaments — attach cervix to pelvic side walls providing apical support
Arcus tendenious fascia pelvis — support vagina laterally and cervix anteriorly
Types of pelvic organ prolapse
Anterior vaginal prolapse (cystocele)
Lower posterior vaginal prolapse (rectocele)
Apical vaginal/uterine prolapse
Vaginal vault prolapse
Urethrocele
Anterior vaginal prolapse (cystocele) treatment options
Do nothing
Pelvic floor physical therapy
Pessary
Surgical correction — anterior colporrhaphy (pubocervical fascia is sutured in the midline and laterally to the arcus tendinous fascia)
Treatments for uterine prolapse
Pessary
Hysterectomy
Colpocleisis (obliteration of vaginal lumen)
Diagnostic tests utilized when stress incontinence is suspected
Q tip test (demonstrates increased mobility of urethra with incontinence)
Urodynamics
Postvoid residual (less than 50 mL is normal)
Treatment options for stress incontinence
Topical estrogen
Pelvic floor PT/kegels
Pessary
Surgery — suburethral sling (transvaginal tape or transobturator tape for vaginal approach); abdominal approach with Marshall-Marchetti-Krantz or Burch procedure
What is the best treatment option for rectocele?
Surgery
Treatment for urge incontinence/overactive bladder
Behavior modification — decrease caffeine, limit fluids after 7pm, bladder training
Antispasmodics (anticholinergics)— oxybutynin, tolterodine
A herniation at the top of the vagina that allows the peritoneum of the cul de sac containing small bowel to come through is called a ______
Enterocele
Symptoms of pelvic organ prolapse
Vaginal pressure or heaviness
Abdominal or low back pain
Vaginal or perineal pain or discomfort
Mass sensation
Urinary or fecal loss or retention
Sexual health issues
Risk factors for pelvic organ prolapse
Parity
Genetic predisposition
Advancing age
Menopause
Connective tissue disorders
Elevated intraabdominal pressure (obesity, chronic constipation)
What is the POP-Q?
Pelvic Organ Prolapse Quantification examination
Staged 0-IV based on degree of prolapse
Define stress incontinence
Leakage of urine with activities that increase intraabdominal pressure (coughing, jumping, sneezing, laughing)
Most common type of incontinence among ambulatory women
Primary risk factor is vaginal delivery
Etiology of stress incontinence
Urethral hypermobility (occurs d/t loss of integrity of underlying pelvic floor muscles)
Intrinsic sphincter deficiency (weakness of urethral sphincter itself)
Etiology of urge incontinence
Detrusor muscle overactivity (causes bladder pressure to rise) —> pts feel that they must run to the bathroom urgently and frequently
