Screening the Genitourinary System Flashcards
Principles of PT ethics
Physical therapists shall respect the inherent dignity and rights of all
individuals.
Physical therapists shall be trustworthy and compassionate in addressing
the rights and needs of patients/clients.
Urinary system checklist
color
flow
incontinence
reproductive system checklist
discharge dysfunction pain menstruation obstetric history
urinary tract colors
Dark-brown
► Hepatic or biliary obstructive disease
► Rhabdomyolysis
Reddish
► Occurs with many GI diseases
► Vegetable dyes, beets
► Medications (Pyridium)
Dark yellow, amber
► Dehydration
questions for urine color
► First, may want to start with general question:
Do you have any trouble with urination?
Any trouble when you go to the bathroom?
► Reference hematuria or colored urine:
• How long have you noticed the red urine?
• Do you have a history of bleeding problems?
• What medications are you currently taking?
• Do you currently/recently have upper respiratory tract infection or sore throat?
• Have you noticed whether the urine starts red and then clears, starts clear and
then turns red, or is red throughout?
• Do you have any associated symptoms, such as fever, weight loss, fatigue, or
flank or abdominal pain?
Urinary Flow
Frequency or urgency timing and “warning”
► Nocturia=increased frequency at night
► Urgency is hallmark symptoms of urinary tract infection (UTI)
Output/amount….increased polyuria (diabetes)
Retention is inability to completely empty the bladder
► Obstructive disorders, e.g. benign prostatic hyperplasia (BPH)
► Cauda equina syndrome (usually with LBP, saddle anesthesia)
Dysuria is pain or discomfort when urinating
► Commonly due to bacterial infections of urinary tract
► Cystitis or bladder infection, if lower in tract
Force of stream, difficulty initiating
► BPH
► Renal failure
Urine flow screening questions
• Changes occurred quickly or over a long period of time?
• Drinking more fluids than usual lately? Excessive thirst?
• What medications are you taking? Any new/increased
diuretics?
• Have you noticed that, despite the urge to urinate, you cannot
start urination?
• After urine flow has stopped, do you still feel the need to
urinate?
• Do you have any associated symptoms, such as headaches
or visual problems (possibly diabetes-related) or fever,
nausea, and weight loss?
• Any prostrate issues identified?
Urinary incontinence
Very common disorder in adult population
Many patients receive PT services to address issues
Four types
► Stress – increased pressure (cough, sneeze, laugh, exercise)
► Urge – strong desire to void with involuntary loss (triggers)
► Mixed – combination of stress and urge
► Overflow – overdistension of the bladder, obstruction by prostrate
hyperplasia or urethral or genital prolapse
Onset of cx-spine pain concurrent=potential red flag
► Possible compression on spinal cord
► Evaluate/treat for cervical disk protrusion
Incontinence questions
• How much are you bothered by frequent urination?
• Do you have trouble with leakage related to feeling of urgency, physical
activity, coughing, or sneezing?
• Do you have history of infections, endocrine disorders, bowel impaction?
• Any changes in medications or increased intake of alcohol or caffeine?
• Has urine leakage affected your ability to do household chores, such as
cooking, housecleaning, laundry?
• Does it keep you from physical recreation such as walking, swimming, or other
exercise or other fun events, like movies?
• Are you able to travel by car or bus more than 30 minutes from home?
• Do you participate in community social activities?
• How are you coping, emotionally? Are you nervous, anxious, depressed,
frustrated?
Reproductive tract: discharge
From penis or vagina = possible infection (UTI)
Possible STD/STI = needs to be diagnosed and treated to
protect overall health and fertility
Discharge screening questions
What is the frequency?
Is it a continuous flow, spotting, or sporadic episodes?
What is the color of the discharge? Accompanied by an odor?
Are there associated symptoms, such as pruritus (itching),
local pain or inflammation, fever, nausea, or dyspareunia?
Reproductive tract: dysfunction, pain
Dyspareunia = pain during or after intercourse
May also report mechanical low back/SI/hip pain
Differentiate by pain pattern
Mechanical – associated with specific intercourse positions
Pelvic organ/floor – regardless of position
May also present with erectile dysfunction
Can be neurologic in origin (SCI, HNP)
Due to postsurgical complications or medications
Psychogenic or other medical hx (DM)
Screening questions for dysfunction/pain
How long as the condition been present? Constant/intermittent?
Difficulties with B/B function, any numbness or weakness?
Reproductive tract: menstruation
Screening is to identify a change from usual pattern
Assess frequency and length of periods
Dysmenorrhea-associated pain
Primary-due to cycle
Secondary-reproductive organ cause (endometriosis, pelvic inflammatory disease,
fibroids, decreased estrogen)
Amenorrhea – cessation of cycle
Athletes, anorexia, endocrine disorders, pregnancy
screening questions for menstruation
When was your last period?
Was it normal for you (compared pain pattern, blood flow)?
Experienced any vaginal bleeding between periods?
