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Endo/Repro II Test 1 > pelvic relaxation and incontinence > Flashcards

Flashcards in pelvic relaxation and incontinence Deck (19)
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1
Q

What is another name for when the bladder prolapses into the vagina?

A

Anterior vaginal prolapse (aka Cystocele)

2
Q

What is a pathognomonic sign that a patient has a lower posterior vaginal prolapse (aka _____)?

A

Lower posterior vaginal prolapse = rectocele

Pt has to “splint to have a poop

3
Q

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?

A

Apical vaginal/uterine prolapse

4
Q

What type of pelvic floor prolapse is commonly seen post-hysterectomy?

A

Vaginal vault prolapse => sagging uterovaginal canal

5
Q

What ar 4 treatment options for an anterior vaginal prolapse (cystocele)?

A
  1. Do nothing
  2. Pelvic floor physical therapy
  3. Pessary (ring w support or Gehrung)
  4. Surgical correction = anterior colporrhaphy (pubocervical fascia is sutured in the midline and laterally to the arcus tendinous fascia)
6
Q

What are 3 treatment options for a uterine prolapse?

A
  1. Pessary (space-filling = gelhorn, donut, cube)
  2. Hysterectomy
  3. Colpocleisis
7
Q

What are some ways to diagnose stress incontinence?

A
  1. - Physical exam
  2. - Q tip test –> tests for ↑ mobility of urethra seen in incontinence: > 30 degree change with valsalva
    • Urodynamics => measures abdominal and pelvic pressure
  3. - Postvoid residual (<50 mL is normal)
8
Q

List 4 treatment options for stress incontinence?

A
  1. Topical estrogen
  2. Pelvic floor PT/kegals
  3. Pessary
  4. Surgery –> suburethral sling (transvaginal tape or trans-obturator tape for vaginal approach)
9
Q

What is the best treatment option for patient with a rectocele?

A

Surgery

10
Q

What type of bladder incontinence is caused by detrusor m. hyperactivity?

A

Urge incontinence/overactive bladder

11
Q

Understand RFs for pelvic floor disorders (7)

A
  1. Parity—1 or more vaginal births
  2. Menopause
  3. Advancing age
  4. Increase intraabdominal pressure (obesity, chronic constipation)​
  5. CT disorders
  6. Prior pelvic surgery
  7. Genetic predisposition
12
Q

What supports the vagina?

A

Arcus tendinous fascia pelvis

13
Q

What provides apical support for cervix?

A

Uterosacral and cardinal ligaments

14
Q

Understand signs and sx of pelvic floor disorders

A
  1. Vaginal pressure/heaviness
  2. Vaginal/perineal pain or discomfort
  3. Abdominal/low back pain
  4. Mass sensation
  5. Urinary or fecal loss or retention
15
Q

25% of women will have what type of incontinence in the first 4-6 months after vaginal delivery.

A

Ambulatory stress incontinence (MC) that occurs when you sneeze, cough, laugh, jump.

16
Q

Pt has to rush to the bathroom. what type of incontinence is this?

How is it diagnosed?

A

Urge incontinence => overactivity of the detrusor muscle caues increase urge and frequency

  • Dx:
      1. PE
      1. Urinalysis to check for infection
17
Q

Treatment of urge incontinence/overactive bladder

A

Behavior modification

  1. Decrease caffeine
  2. Limit fluids after 7 PM
  3. Bladder training

Antispasmadic

  1. Oxybutynin
  2. Tolterodine
18
Q

Pt has pelvic pressure and bulging cessation with prolonged standing. Denies urinary or bowel complaints

What could they have?

A

Anterior vaginal prolapse

19
Q

Know the steps in evaluation of pelvic floor disorders

A

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