pelvic relaxation and incontinence

Question 1

What is another name for when the bladder prolapses into the vagina?

Answer 1

Anterior vaginal prolapse (aka Cystocele)

Question 2

What is a pathognomonic sign that a patient has a lower posterior vaginal prolapse (aka _____)?

Answer 2

Lower posterior vaginal prolapse = rectocele

Pt has to “splint“ to have a poop

Question 3

A female pt complaining that is feels like “something is falling out of her vagina” and that she is “ doesn’t empty her bladder completely and only pees small amounts,” is likely suffering from what pelvic floor dysfunction?

Answer 3

Apical vaginal/uterine prolapse

Question 4

What type of pelvic floor prolapse is commonly seen post-hysterectomy?

Answer 4

Vaginal vault prolapse => sagging uterovaginal canal

Question 5

What ar 4 treatment options for an anterior vaginal prolapse (cystocele)?

Answer 5

1. Do nothing
2. Pelvic floor physical therapy
3. Pessary (ring w support or Gehrung)
4. Surgical correction = anterior colporrhaphy (pubocervical fascia is sutured in the midline and laterally to the arcus tendinous fascia)

Question 6

What are 3 treatment options for a uterine prolapse?

Answer 6

1. Pessary (space-filling = gelhorn, donut, cube)
2. Hysterectomy
3. Colpocleisis

Question 7

What are some ways to diagnose stress incontinence?

Answer 7

1. - Physical exam
2. - Q tip test –> tests for ↑ mobility of urethra seen in incontinence: > 30 degree change with valsalva
3. • Urodynamics => measures abdominal and pelvic pressure
4. - Postvoid residual (<50 mL is normal)

Question 8

List 4 treatment options for stress incontinence?

Answer 8

1. Topical estrogen
2. Pelvic floor PT/kegals
3. Pessary
4. Surgery –> suburethral sling (transvaginal tape or trans-obturator tape for vaginal approach)

Question 9

What is the best treatment option for patient with a rectocele?

Answer 9

Surgery

Question 10

What type of bladder incontinence is caused by detrusor m. hyperactivity?

Answer 10

Urge incontinence/overactive bladder

Question 11

Understand RFs for pelvic floor disorders (7)

Answer 11

1. Parity—1 or more vaginal births
2. Menopause
3. Advancing age
4. Increase intraabdominal pressure (obesity, chronic constipation)​
5. CT disorders
6. Prior pelvic surgery
7. Genetic predisposition

Question 12

What supports the vagina?

Answer 12

Arcus tendinous fascia pelvis

Question 13

What provides apical support for cervix?

Answer 13

Uterosacral and cardinal ligaments

Question 14

Understand signs and sx of pelvic floor disorders

Answer 14

1. Vaginal pressure/heaviness
2. Vaginal/perineal pain or discomfort
3. Abdominal/low back pain
4. Mass sensation
5. Urinary or fecal loss or retention

Question 15

25% of women will have what type of incontinence in the first 4-6 months after vaginal delivery.

Answer 15

Ambulatory stress incontinence (MC) that occurs when you sneeze, cough, laugh, jump.

Question 16

Pt has to rush to the bathroom. what type of incontinence is this?

How is it diagnosed?

Answer 16

Urge incontinence => overactivity of the detrusor muscle caues increase urge and frequency

• Dx:
  
  • 1. PE
  • 2. Urinalysis to check for infection

Question 17

Treatment of urge incontinence/overactive bladder

Answer 17

Behavior modification

1. Decrease caffeine
2. Limit fluids after 7 PM
3. Bladder training

Antispasmadic

1. Oxybutynin
2. Tolterodine

Question 18

Pt has pelvic pressure and bulging cessation with prolonged standing. Denies urinary or bowel complaints

What could they have?

Answer 18

Anterior vaginal prolapse

Question 19

Know the steps in evaluation of pelvic floor disorders

Answer 19

Pelvic Organ Prolapse Quantification exam – POP-Q

• Stage 0: no prolapse; cervix or vaginal cuff is @ top of the vagina
• Stage 1: the leading part of the prolapse is > 1 cm above the hymen
• Stage 2: the leading part of the prolapse is < 1 cm above the hymen
• Stage 3: the leading edge is > 1 cm beyond the hymen; but < the total vaginal length
• Stage 4: complete eversion