Pelvic health Flashcards
(43 cards)
1
Q
Why you need to know it
A
- The pelvic floor is a sling between the innominates the pubis and the sacrum/coccyx
2
Q
Pelvic floor importance
A
- Maintains intraabdominal pressure
- Maintains organ position
- Assists in balance
- Plastic in regards to the birthing process
3
Q
Difference between male and female pelvis
A
- Male long sacrum with inward coccyx
- Female shorter sacrum with straight or slight outward coccyx
- Male angle between rami
- Female wider angle (up to double) between rami
- Male pubic outlet round
- Female pubic outlet more oval
4
Q
Pelvic Triangles
A
-
Urogenital
- Muscular border reinforced with Ischiopubic ramus
- Infant passes through this triangle for birthing
-
Anal
- Structurally identical in men and women
-
Musculature
- You need to know and understand the function of each muscle of the pelvic floor
- Both for men and women
5
Q
UI:
A
urinary incontinence
6
Q
Gravida:
A
to have been pregnant
7
Q
Parous (Para):
A
to have delivered an infant
8
Q
Nulliparous:
A
never having given birth
9
Q
Incontinence- Prevalence
A
- 17 million community dwelling Americans
- 34 million have overactive bladder syndrome
- 2.9 million of which have periods of incontinence
- An additional 1.5 million long-term care
10
Q
Women vs Men
A
-
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
11
Q
Nocturia:
A
getting up at least once in the night to urinate
12
Q
Micturition:
A
emptying of the bladder
13
Q
Post Void Residual (PVR):
A
amount of urine left in bladder after urination
14
Q
Urgency:
A
a sudden compelling desire to urinate that can’t be deferred
15
Q
Hesitancy:
A
Delay in initiating urination
16
Q
Risk Factors
A
-
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
17
Q
CO$T
A
- 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
***While more money is still spent on baby diapers, sales of baby diapers have decreased 8 percent while adult diapers have increased 20 %
18
Q
Types of UI
A
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
19
Q
Stress Incontinence
A
-
Cause
- Weak pelvic floor muscles
- Occurs with abdominal pressure exceeds urethral pressure
20
Q
What are types of stress than can cause stress incontinence?
A
Sneeze and a dribble
21
Q
OAB Syndrome
A
-
Cause
- Detrusor over activity
- Associated with involuntary bladder muscle contraction during filling phase
- Does not always result in an incontinent episode
22
Q
UUI
A
-
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
23
Q
Etiology (non-neurologic)
A
- Functional
- Weak pelvic floor
- OAB
- Medications
- Retention
- Over distension
- Fluid intake
24
Q
Functional
A
- Inability to undress in a timely fashion
- Inability to navigate to the restroom quickly
-
Examples
- Post CVA pt trying to pull pants and undergarment down with one arm
- Trying to walk to restroom with walker and due to obstacles can’t make it in time
25
Weak pelvic floor
* Hysterectomy
* Prolapse
* Straining with constipation
* Poor biomechanics with lifting
* Shift of the pelvis affecting muscle length
* Scaring in the perineal and pelvic area
26
OAB and UUI specifically
* OAB and UUI specifically
* UTIs
* Irritation of the lining of the bladder
* Neoplasia
* Cancers or other abnormal tissue growth
* Poster surgery status
* Bladder outlet obstruction
* Enlarged prostate
* Anxiety
* Poor toileting habits
27
Retention
* Enlarged prostate
* Increased difficulty in passing urine due to decreased diameter of urethra
* Hyper active pelvic floor syndrome
* Inability to relax pelvic floor
* Can cause pelvic pain syndrome and painful bladder syndrome
* Poor toileting habits
28
Medications
* **Anticholinergic meds**
* **Antiscychotic meds**
* Sedation
* Rigid pelvic floor
* **Diuretics**
* Worsen many forms of UI
29
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
30
Fluid Intake
* Both too much and too little
* Too much
* Over distention of the bladder
* Too little
* Concentrated urine
* Increased infection
* Intake of bladder irritating fluids
* Spicy foods
* Caffeine
* Sugary drinks
* Carbonation
* Acidic foods/drinks
31
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
32
Prolapse
* POP: pelvic organ prolapse
* Occurs
* Women and Men
33
Prolapse- symptoms
* **Symptoms**
* Discomfort
* Bleeding
* Urinary symptoms
* Leakage
* Frequency
* Increased infection
* Hesitancy
* Difficult bowel movements
* Bulging near pelvic opening/s
* Sensation of pressure in pelvic region or lower abdomen
34
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
35
Prolapse-Causes and Risk Factors
* Increased age (risk factor not cause)
* Childbirth
* Multiple births, long labors, large infants
* Chronic straining
* During bowel movements or micturition
* Obesity
* Increased weight of organs and strain on pelvic floor
* Hysterectomy
* Uterus supports other structures
* Prior pelvic surgeries
* Poor lifting mechanics over time
36
Stages of Prolapse
**Stage 0** (1) no prolapse
**Stage 1** (2) 1 cm or more above hymen
**Stage 2** (3) 1 cm or less above or below hymen
**Stage 3** (4) greater than 1 cm below hymen
**Stage 4** (5) full eversion of organ
37
Types of prolapse
* **Cystocele**
* bladder prolapse
* Urethrocele
* Urethra prolapse
* Occurs in conjunction with cystocele
* Combined called a cystourethrocele
* **Enterocele**
* small bowel prolapse
* **Rectocele**
* rectum prolapse
* **Uterine prolapse**
* AKA uterocele
* prolapse of the uterus
* **Vaginal vault prolapse**
38
Cystocele
* Front of vaginal wall is weak
* Bladder herniates into vaginal vault
* Herniation leads to alteration of urethral angle
* Causes stress incontinence
* Can cause urinary retention
39
Enterocele
* 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
40
Rectocele
* Posterior wall of vagina weakens
* Rectum presses against vaginal wall
* Posterior wall of vagina separates
* Rectum herniates into vagina
* Generally most obvious as a bulge when having a bowel movement
* Pts feel need to ‘push stool out’
41
Vaginal Vault Prolapse
* Removal of uterus
* 10% of women post hysterectomy
* Vaginal vault prolapses into vaginal canal
* Telescoping action
* Often occurs with enterocele
42
Rectal Prolapse
* Rectum prolapses into our out of anus
* Occurs more in men
* Generally young active men
* Or those with predisposition (congenital abnormality)
43
Types of rectal prolapse
* External (complete) rectal prolapse: is a full thickness, circumferential, telescoping of the rectal wall which protrudes from the anus and is visible externally.
* Internal rectal prolapse: a funnel shaped infolding of the upper rectal wall that can occur during defecation
* Mucosal prolapse: loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall ---ie: hemorrhoids (piles)
* Internal mucosal prolapse: refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally --ie: internal hemorrhoids
\*Other types: some described in literature but not accepted as true prolapses
