Pelvic Relaxation and Incontinence - Wootton

Question 1

32 G4P4 female smoker w/ pelvic pressure and bulging sensation w/ prolonged standing. Denies urinary or bowel complaints. Normal menses. No pain on intercourse. Works in warehouse restocking merchandise. Obese…

Dx?

Tx? (4 options)

Answer 1

Cystocele

• Do nothing
• Pelvic floor PT
• Pessary
• Surgical correction (anterior colporrhaphy)

Question 2

2 good types of Pessary for cystocele

Answer 2

• Ring w/ support

- Gehrung (C-shape thing)

Question 3

What is an anterior colpoprrhaphy?

Answer 3

Cut the anterior vaginal wall, suture the supporting tissues together, then the 2 parts of the wall itself

Question 4

78, G2P2, “something is falling out”, noticed when using bathroom, no pain or bleeding or discharge. Does not feel to empty bladder fully. 2 C-sections and umbilical hernia repair…

Dx?

Tx? (3 options)

Answer 4

Uterine prolapse

• Pessary
• Hysterectomy
• Colpocleisis

Question 5

Which types of pessary would be good for uterine prolapse? (3)

Answer 5

Space-filling ones

• Gelhorn
• Donut
• Cube

Question 6

What is colpocleisis?

Answer 6

Suturing of vaginal walls together, prevents future prolapse

Question 7

62, G3P3, urinary incontinence w/ coughing and sneezing, cannot laugh without peeing herself. Wears pads. No pain or blood. Pees at night. Minor constipation…

Dx?

Tests to order?

Tx options? (4)

Answer 7

Stress incontinence

Q-Tip test (look for movement of Q tip when cough/sneeze
Urodynamics (measures pressure-flow in tract)

• Topical estrogen
• Pelvic flood PT (kegels)
• Pessary
• Surgery (suburethral sling)

Question 8

Best kind of pessary for stress incontinence?

Answer 8

Ring w/ thick portion to block/close urethra

Question 9

45, G6P7, pressure sensation and fullness in vagina. No bladder complaints, needs to splint to have BM. Regular menstrual cycles. PMH = M.S., etc.

Dx?

Tx?

Answer 9

Rectocele

Surgery (posterior colpocleisis)

Question 10

38 G0, urinary urgency and frequency. She leaks immediately after she feels the urge to go. No pain or blood. Gets up 3-4 times at night to pee, only voids a little bit. Drinks 5-6 sodas and lots of water per day…

Dx?

Tx options? (5)

Answer 10

Urge incontinence (overactive bladder)

• Reduce caffeine
• Limit fluids after 7 pm
• Bladder training
• Oxybutynin (antispasmodic)
• Tolterodine (antispasmodic)