224 - Pelvic Floor Disorders Urogyn/Uro Flashcards Preview

Repro/GU by Minnie (she/her) > 224 - Pelvic Floor Disorders Urogyn/Uro > Flashcards

Flashcards in 224 - Pelvic Floor Disorders Urogyn/Uro Deck (15)
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1

List 2 reflexes that usually protect against fecal incontinence

  • Rectosigmoid junction guarding reflex
    • Holds stool in the sigmoid colon
    • Fluid is absorbed here
  • Recto-anal inhibitory reflex
    • Reflex contraction of external anal sphincter, puborectalis
    • Holds stool in the rectum

 

2

List the structures responsible for pelvic organ support at each level:

  • Level 1 (top of vagina)
  • Level 2 (length of vagina)
  • Level 3 (most distal)

  • Level 1 (top of vagina)
    • Uterosacral + cardinal ligaments
  • Level 2 (length of vagina)
    • Arcus tendineous fascia pelvis 
  • Level 3 (most distal)
    • Perineal muscles 

 

3

List 2 agents that will alter stool consistency and treat fecal incontinece

Psyllium-husk fiber supplement

Low dose loperamide

 

Changing stool consistence = first line treatment to treat functional fecal incontinence

4

List 5 functional abnormalities that can contribute to fecal incontinence

  • Constipation/fecal impaction
  • Stool characteristics
    • Loose stool = hard to control
  • Physical mobility
    • Can't get to the bathroom
  • Drugs
  • Cognitive impairment

 

First line tx = psyllium-husk fiber or low dose loperamide

5

What are the primary supports of the pelvic viscera?

Levator ani muscles + coccygeus

 

Levator ani consists of puborectalis, pubococcygeus, and iliococcygeus

6

Are pelvic floor disorders a common part of normal aging?

No!

 

But they are prevalent - affect 1/3 women

7

Which ligament is involved in a sacrocolpopexy surgery for pelvic floor reconstruction?

Anterior longitudinal ligament of the sacrum

8

What kind of incontinence is likely to result from neuromuscular injury to the pudendal nerve?

Stress urinary incontinence

  • External urethral sphincter not strong enough to hold pee in, especially during increases in presure (jumping, sneezing)

9

Is the coccygeus muscle part of levator ani?

No

10

List 5 risk factors for pelvic floor disorders

  • Aging
  • Obesity
  • Childbirth
  • Constipation
  • Smoking

 

11

List the 3 tiers of management for urgency urinary incontinence

(Tier 1 is the most conservative)

  • Tier 1 = conservative
    • Bladder retraining
    • Fluid management
  • Tier 2 = medications
    • Antimuscarinic
    • Beta-3 agonist
  • Tier 3 = procedural (but still kind of medical)
    • Sacral neuromodulation
    • Intravesical onobotulinum toxin

 

12

The Levator Ani Muscles include which of the following muscle groups?

  1. Puborectalis, Pubococcygeus, Iliococcygeus
  2. Puborectalis, Pubococcygeus, Obturator internus
  3. Puborectalis, Pubococcygeus, Iliococcxygeus, Coccygeus
  4. Pubococcygeus, Obturator internus, Piriformis

a. Puborectalis, Pubococcygeus, Iliococcygeus

13

What is the innervation to levator ani?

Pudendal nerve

 

And also anterior roots of S2, S3, S4

 

Thank you @Alba!

14

What kind of incontinence is likely to occur due to a CNS injury?

Urgency urinary incontinence

  • When pressure in the bladder is sensed, there is a problem with the central pathways that are supposed to prevent detrusor contraction and increase sympathetic tone (these things help us hold our pee)
  • Result is spontaneous detrusor contraction

 

Sx = not enough warning between feeling like you have to go and then going

15

What is the first line treatment for functional fecal incontenence?

Change stool consistency

Psyllium husk fiber or low-dose loperamide