Pelvic Relaxation and Incontinence - Wootton Flashcards Preview

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Flashcards in Pelvic Relaxation and Incontinence - Wootton Deck (10)
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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)

Cystocele

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

2

2 good types of Pessary for cystocele

- Ring w/ support
- Gehrung (C-shape thing)

3

What is an anterior colpoprrhaphy?

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

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)

Uterine prolapse

- Pessary
- Hysterectomy
- Colpocleisis

5

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

Space-filling ones
- Gelhorn
- Donut
- Cube

6

What is colpocleisis?

Suturing of vaginal walls together, prevents future prolapse

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)

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)

8

Best kind of pessary for stress incontinence?

Ring w/ thick portion to block/close urethra

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?

Rectocele

Surgery (posterior colpocleisis)

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)

Urge incontinence (overactive bladder)

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