pelvic relaxation and incontinence Flashcards
What is another name for when the bladder prolapses into the vagina?
Anterior vaginal prolapse (aka Cystocele)
What is a pathognomonic sign that a patient has a lower posterior vaginal prolapse (aka _____)?
Lower posterior vaginal prolapse = rectocele
Pt has to “splint“ to have a poop
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?
Apical vaginal/uterine prolapse
What type of pelvic floor prolapse is commonly seen post-hysterectomy?
Vaginal vault prolapse => sagging uterovaginal canal
What ar 4 treatment options for an anterior vaginal prolapse (cystocele)?
- Do nothing
- Pelvic floor physical therapy
- Pessary (ring w support or Gehrung)
- Surgical correction = anterior colporrhaphy (pubocervical fascia is sutured in the midline and laterally to the arcus tendinous fascia)
What are 3 treatment options for a uterine prolapse?
- Pessary (space-filling = gelhorn, donut, cube)
- Hysterectomy
- Colpocleisis
What are some ways to diagnose stress incontinence?
- - Physical exam
- - Q tip test –> tests for ↑ mobility of urethra seen in incontinence: > 30 degree change with valsalva
- Urodynamics => measures abdominal and pelvic pressure
- - Postvoid residual (<50 mL is normal)
List 4 treatment options for stress incontinence?
- Topical estrogen
- Pelvic floor PT/kegals
- Pessary
- Surgery –> suburethral sling (transvaginal tape or trans-obturator tape for vaginal approach)
What is the best treatment option for patient with a rectocele?
Surgery
What type of bladder incontinence is caused by detrusor m. hyperactivity?
Urge incontinence/overactive bladder
Understand RFs for pelvic floor disorders (7)
- Parity—1 or more vaginal births
- Menopause
- Advancing age
- Increase intraabdominal pressure (obesity, chronic constipation)
- CT disorders
- Prior pelvic surgery
- Genetic predisposition
What supports the vagina?
Arcus tendinous fascia pelvis
What provides apical support for cervix?
Uterosacral and cardinal ligaments
Understand signs and sx of pelvic floor disorders
- Vaginal pressure/heaviness
- Vaginal/perineal pain or discomfort
- Abdominal/low back pain
- Mass sensation
- Urinary or fecal loss or retention
25% of women will have what type of incontinence in the first 4-6 months after vaginal delivery.
Ambulatory stress incontinence (MC) that occurs when you sneeze, cough, laugh, jump.
Pt has to rush to the bathroom. what type of incontinence is this?
How is it diagnosed?
Urge incontinence => overactivity of the detrusor muscle caues increase urge and frequency
- Dx:
- PE
- Urinalysis to check for infection
Treatment of urge incontinence/overactive bladder
Behavior modification
- Decrease caffeine
- Limit fluids after 7 PM
- Bladder training
Antispasmadic
- Oxybutynin
- Tolterodine
Pt has pelvic pressure and bulging cessation with prolonged standing. Denies urinary or bowel complaints
What could they have?
Anterior vaginal prolapse
Know the steps in evaluation of pelvic floor disorders
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
