pelvic floor Flashcards
(32 cards)
PF Anatomy sling between two whats of the pubis?
innominates
What is the importance of the pelvic floor?
Maintains intraabdominal pressure
Maintains organ position
Assists in balance
Plastic in regards to the birthing process
Male/female pubic angle
50-80
90-100
important muscles of pelvic floor
Ischiocavernosus– more anterior
Transverese perinei superficialis- posterior
Vocab
Gravida meaning?
Parous Meaning?
Nulliparous-?
Gravida: to have been pregnant
Parous (Para): to have delivered an infant
Nulliparous: never having given birth
Examples
Gravida 1: Para 1=one pregnancy and one birth
Gravida 2: Para 1=two pregnancies and one birth
Men vs Women UTI
Women
Over 60 twice the prevalence of UI as men of the same age
Most women with UI are parous
~1/3 women have UI
Men
~30% of men over 60 report increased daytime frequency
27% reported increased urgency or over active bladder
nulliparous athlete
high impact sport athletes are more likely to have UI
17% of boys age 5014 are incontinent
Nocturia meaning? Micturition? Post void residual? Urgency? Hesitancy?
Nocturia: getting up at least once in the night to urinate
Micturition: emptying of the bladder
Post Void Residual (PVR): amount of urine left in bladder after urination
Urgency: a sudden compelling desire to urinate that can’t be deferred
Hesitancy: Delay in initiating urination
Risk factors
Obesity:
increased pressure on pelvic floor
Smoking
Decreased collagen synthesis
Anatomical and neuro changes to bladder=decreased functionality
Increased coughing causes increased strain on the pelvic floor
Diabetes
Decreased sensitivity in bladder
Larger bladder capacity with larger post void residuals
UI one of the most prevalent chronic disease
One of the most prevalent chronic diseases
Only ¼ to ½ of those affected seek medical intervention
In 2000
$19.5 billion spent on UI
$12.6 billion spent on OAB
SUI (~35% of those with UI)
More per pt cost as surgery is often used for treatment
ratio of women with UI
1/3 women are affected by UI in UK
Stress UI
urge UI
OAB Syndrome:
Mixed UI
Stress UI (SUI): loss of urine associated with strain on pelvic floor
Urge UI (UUI) loss of urine associated with urge to urinate
OAB Syndrome: urinary urgency with increased frequency and nocturia without UTI
Mixed UI: loss of urine associated with both stress and urge
Stress UI
Cause
Weak pelvic floor muscles
Occurs with abdominal pressure exceeds urethral pressure
OAB Syndrome Cause
Cause
Detrusor over activity
Associated with involuntary bladder muscle contraction during filling phase
Does not always result in an incontinent episode
Urge UI
Cause
Detrusor instability
A contraction of the bladder before it is full
Associated with an undeniable urge to urinate
Urge can be so strong voiding can occur prior to reaching bathroom
Etiology (non-neurologic)
Functional Weak pelvic floor OAB Medications Retention Over distension Fluid intake
Medications
Anticholinergic meds See image to right Antiscychotic meds Sedation Rigid pelvic floor Diuretics Worsen many forms of UI
meds->retention-> overflow-> Urgency->frequency
over distended bladder
Overflow incontinence Results Constant or intermittent dribbling General patient presentation High post void residuals Can feel that their bladder isn’t completely emptied Can also have sensory problems Can’t feel bladder filling
fluid intake
to much to little?
Both too much and too little Too much Over distention of the bladder Too little Concentrated urine Increased infection
Pregnancy and UI
Associated with weakened pelvic floor musculature
Over stretching
Injury to ligaments
Damage to pudendal nerve
Pressure on pelvic floor from weight of fetus
Can occur during and after pregnancy
Symptoms of severe prolapse
Heavy sensation in the pelvis
Sensation of “sitting on a ball”
Needing to push stool out
Placing fingers in vagina to physically push stool out
Hesitation with weak stream or spraying of urine
Increased frequency and constant sensation of full bladder
Low back pain
Need to lift up a ‘bulge’ to start urination
Prolapse causes and risk factors
Childbirth Multiple births, long labors, large infants Chronic straining During bowel movements or micturition Obesity Increased weight of organs and strain on pelvic floor Increased age (risk factor not cause) Hysterectomy Uterus supports other structures Prior pelvic surgeries Poor lifting mechanics over time
Stages of prolapse
Stage 0- none Stage 1- 1cm or more above hymen stage2- 1cm or less above or below hymen stage 3- 1cm below hymen disstance 2 cm less total genital tract Stage 4- complete lower genital tract
enterocoele
Front and or back of vaginal walls weakens
Small bowel presses against vaginal walls
Front and or back of vaginal walls separate
Small bowel herniates into vagina
Most common after hysterectomy
Uterus no longer present
Can’t hold other abdominal organs back
