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Unformatted text preview: Uterine Displacement 0. The round ligam ents norm ally hold the uteru s in antev ersion 1. Utero sacral ligam ents pull the cervix back ward and upwar d 2. Most comm on type of displa ceme nt is poste rior displa ceme nt or retrov ersion Tilted backwards... harder to get pgduring intercourse this hinders pg Uterine Prolapse Classification of Structural Disorders Risk Factors of Reproduction Prolapse 10. Firstdegre e uterin e prolap se 11. Secon ddegre e prolap se 12. Thirddegre e/com plete prolap se 0. The cervix and body of the uterus protrude through the vagina and the vagina is inverted First-degree Prolapse 13. Cervix is visible when perine um is depres sed Second-degree Prolapse 14. Cervix is visible 19. Con geni tal or acq uire d wea kne ss of pelv ic sup port stru ctur es (pel vic rela xati on) 20. Dela yed but dire ct resu lt of chil dbe arin g 21. Pelv ic trau ma 22. Stre ss and strai n Clinical Manifestatio ns 25. Pul lin g an d dra ggi ng se ns ati on s 26. Pre ss ure , pro tru sio ns 27. Fat igu e an d lo w ba ck ac he 28. Sy mp to ms wo rse n aft er 1. Pr olonged Uterine Prolapse Treatment 30. Estrog en thera py may be used in the older woma n to impro ve tissue tone 31. Depe nds on the degre e of prolap se 32. Kegel exerci ses, kneechest positi on Pessary Contrain dications 34. A c t i v e i n f e c t i o n s o f t h e p e l v i s o r v a g i n a 35. P a Complication s 38. I n c r e a s e d v a g i n a l d i s c h a r g e a n d o d o r 39. M i n i m i Patient Education 6. Mor e seri ous type of disp lace men t 7. Occ urs whe n the uter us sag s into the vagi na 8. Stru ctur es invo lved may incl ude uret hra, blad der, uter us, vagi na, culdesac, or 33.Pess aries may be useful in the treat ment of mild to mode rate uterin 42. Tea ch to rem ove the pes sary at nigh t, clea nse it, and repl ace in the mor ning 43. If the pes sary is alw ays left in plac e, reg ular dou chin g with com mer ciall y pre 1 Cystocele 0. Protrusion of bladder into the vagina 1. Caused by injured supporting structures 2. Over time the cystocele enlarges until is protrudes into the vagina 3. Complete emptying of the bladder is difficult Symptoms of Cystocele 4. Complaints of a bearingdown sensation 5. "Something is in my vagina" 6. Urinary frequency, retention, and/ or incontinence 7. Recurrent cystitis and urinary tract infections 8. Urinary continence is unaffected unless the bladder neck and urethra are damaged 9. Pelvic examination reveals a bulging of the anterior wall of the vagina as the woman bears down Cystocele Repair 10. Treatment for a cystocele includes use of vaginal pessary or surgical repair 11.Anterior repair (colporrhaphy) colporrhaphy) is usually done for large, symptomatic cystoceles 12. This provides better support for the bladder 13. An anterior repair is often combined with a vaginal hysterectomy Post surgically- important to teach not to lift anything above 5 lbs, exercise and no sex for 6 wks. Teach s/s of infection. Use lubricant when they do resume sex bc muscles are much shorter and tighter. Rectocele 14. Herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum 15. Appears as a large bulge that may be seen through the relaxed introitus Rectocele S/S 0. The sensation of "bearing down" 1. Sensation of the pelvic organs falling out 2. May be difficult to have a bowel movement 3. Some women report having to digitally reduce the rectocele to facilitate bowel movements Rectocele Repair 16. Small rectoceles may not require treatment. 17. Mild symptoms may be relieved with high-fiber diet, adequate fluid intake, stool softeners, and/ or mild laxatives 18. A posterior repair (colporrhaphy) is the usual procedure for large symptomatic rectoceles 19. Surgery is performed vaginally to provide better support for the rectum 20. Anterior and posterior repairs may be performed at the same time 21. May be done with vaginal hysterectomy Post surgical care similar to rectal surgery- low residue diet (don't want them to have many bowel movement) avoid straining. Sitz baths and pain meds.. Urinary Control Disturbances 22. Stress inconti nence, coughi ng or sneezi ng causes increas e in intraab domina l pressur e 23. Urge inconti Urinary Incontinence 25. 2534% of women betwee n ages 25 and 54 affecte d 26. Higher inciden ce in women who have given birth Vaginal Vault Repair Surgery 33. Do not take aspirin or any other blood thinnin g medica tions two (2) weeks prior to surgery 34. Do not eat or drink Vaginal Surgery 37. Proced ure done throug h the vagina 38. Sling proced ure may be done to correct stress urinary inconti nence 39. If so, Risks & Complications 41. Bleedin g and infectio n 42. Accide ntal injury to the bladder 43. Pain 44. Inabilit y to urinate (retenti on of urine) Post Surgical 52. Vaginal pack (preve nt bleedin g)usually pulled the next daysterile tampon packin g 53. Indwelli ng Postoperative Instructions 56. Vaginal dischar ge or drainag enormal for several weeks after surgery 57. Spasm s, pressur e, urgenc nence, caused by bladder or urethra disorde rs (urethri tis, cystitis) 24. Neurop athies (MS, diabete s) Kegels, medication, bladder training. increas anythin ing g after with 12 parity midnig 27. Involun ht the tary day urine before leaking surgery is main 35. Consu sign me 28. Leakin only g clear commo liquids n for one during day coughi prior to ng, surgery laughin 36. Expect g and a 23exercis hour e (short 29. Mild to stay) moder Any surgery they ate are going through urinary the vagina.. inconti nence can be decrea sed or relieve d by bladder training and pelvic muscle exercis small punctur e incision necess ary just above the hairline for suture placem ent 40. Incisio n is small, less discom fort, rapid healing 45. Recurr ent or worsen ing inconti nence 46. New or worse vaginal prolaps e 47. Urinary urgenc y 48. Ureter injury 49. Bowel injury (may require open surgica l fixation ) 50. Narrow ing of the vagina 51. Painful sexual interco urse cathete r 54. Normal pattern of urinatio n will return after swellin g lessen s (may need the cathete r for 510 days) 55. May resume a normal diet after surgery y are likely to occur 58. Antispa smodic s may be ordere d 59. May have constip ation or pain with BM 60. Showe ring and bathing shower after dressin g remove d 61. Resum e preoperati ve diet after n/ v has passed 62. Drink clear liquids as es 30. Insertio n of a bladder necksupport prosthe sis 31. Vaginal estroge n therapy 32. Surger y ordere d by physici an 63. Avoid lifting anythin g over 10lbs until OK with physici an (4-8 weeks) 64. Exercis emoder ate amount walking first 1-2 weeks 65. No high impact exercis e for 6 weeks post-op 66. No driving or operati ng machin ery for 3 weeks or while on pain meds 67. No sex for 6-8 weeks after surgery ...
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- Spring '08