Pelvic gu pathology or weak sphincter tone knack

This preview shows page 25 - 27 out of 59 pages.

Pelvic GU pathology or weak sphincter tone Knack- pelvic muscle contraction timed to intra-urethral pressure before/during event causing leakage Diagnostics - Voiding diary 2-3 days’ (when incontinence occurs), UA, PSA, post-void Cystourethrogram or uroflowmeter (obstruction?), cough stress test Leak point pressure test - catheter in bladder, measure intra-abdominal pressure Prevention - Kegel, treatment of prostatic hyperplasia Non Rx- treat underlying, voiding diary 3 days, perineal hygiene, regular emptying, Kegel Intermittent cath for retention, incontinence pads (cones), Caffeine/Etoh Biofeedback, Surgery (TURP, bladder sling), treat constipation, nerve stimulation Bladder training- URGE UI- Urgency and Frequency Tampons- do not absorb, but provide gentle pressure to support urethra Refer - refractory incontinence to Rx or lifestyle, gross/microscopic hematuria (malignancy) Botox injections in detrusor muscle if 1 st line fails Cystocele (Pelvic Organ Prolapse) Herniation of pelvic organs to or beyond vaginal walls Enterocele- hernia of intestines to or through the vaginal wall Rectocele- descent of the rectum Cystocele- anterior compartment prolapse Pathogenesis - Levator ani muscle provides primary support to pelvic organs Endopelvic fascial attachments (uterosacral and cardinal ligaments)- stabilize pelvis S2, S3, S4 segments innervate pelvic region Risk - advancing age, parity ( w/ vaginal births), obesity, hysterectomy, chronic constipation AA have lower prevalence Assessment Asymptomatic, bulge or pressure in vagina or pelvis (“something falling out”)
Urinary- stress incontinence/difficulty voiding/retention Defecation- constipation and incomplete emptying (most common symptoms) Fecal urgency/incontinence, obstructive (straining); fecal during sex Diagnosis - Pelvic examination; POPQ- Stage 2 to Introitus Management - Treatment indicated- urinary/bowel/sex dysfunction; Hydronephrosis- ureteral kinking Started regardless of degree of prolapse and not indicated in asymptomatic Expectant management- watch and wait for those who prefer to avoid treatment Conservative- 1 st line- lifestyle modifications/ pelvic muscle training/ pessary (mainstay) Estrogen therapy (no data to suggest as a primary treatment) Surgical- Colpocleisis, hysterectomy, Mesh Pregnant - conservative management- pelvic floor exercises and pessary management Interstitial Cystitis (Bladder Pain Syndrome) Characterized by pain w/ bladder filling that is relieved by emptying Often associated w/ urgency & frequency Etiology - Unknown, most likely not a single disease but several diseases w/ similar sx Severe allergies, IBS, IBD Assessment- Dyspareunia Pain w/ bladder filling relieved w/ urination Urgency, frequency, and nocturia are most common Has there been pelvic radiation exposure or treatment w/ cyclophosphamide Check for genital herpes, vaginitis, urethral diverticulum Diagnostics - Diagnosis of Exclusion UA w/ Culture Urodynamic testing- bladder sensation and compliance This is to exclude Detrusor Instability

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture