Pelvic Support Issues ppt
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Questions and Answers

Which ligaments play a key role in suspending the upper and proximal vagina?

  • Perineal body ligaments
  • Arcus tendineus fascia pelvis
  • Cardinal and uterosacral ligaments (correct)
  • Levator ani and coccygeus muscles
  • What characterizes a rectocele?

  • Descent of the uterus into the vaginal cavity
  • Herniation of the bladder into the anterior vaginal wall
  • Herniation of intestines into the lateral vaginal wall
  • Prolapse of the rectum into the posterior vaginal wall (correct)
  • Which of the following describes a potential outcome if the vaginal angle becomes more vertical?

  • Increased risk of pelvic organ prolapse (correct)
  • Rejuvenation of pelvic floor muscles
  • Strengthened uterine positioning
  • Improved pelvic organ support
  • At what age range does the peak incidence of pelvic organ prolapse occur?

    <p>70-79 years</p> Signup and view all the answers

    What structures comprise Level 2 support of the vagina?

    <p>Arcus tendineus fascia pelvis along the mid-vagina</p> Signup and view all the answers

    What is a common symptom associated with pelvic organ prolapse?

    <p>Sensation of vaginal bulging</p> Signup and view all the answers

    Which of the following factors is NOT associated with an increased risk of pelvic organ prolapse?

    <p>High physical activity levels</p> Signup and view all the answers

    Which statement about the POP-Q staging system is correct?

    <p>Stage I indicates that the most distal prolapse is more than 1 cm above the hymen.</p> Signup and view all the answers

    What is a potential complication of pessary use?

    <p>Vaginal erosion</p> Signup and view all the answers

    How can pelvic floor physical therapy assist patients with pelvic organ prolapse?

    <p>It strengthens pelvic floor muscles.</p> Signup and view all the answers

    In which scenario is surgical intervention for pelvic organ prolapse generally recommended?

    <p>Patients desiring to improve quality of life</p> Signup and view all the answers

    What role do Kegel exercises play in the management of pelvic organ prolapse?

    <p>They strengthen the pelvic floor muscles.</p> Signup and view all the answers

    What is one reason for performing a bimanual exam in the physical evaluation of pelvic organ prolapse?

    <p>To evaluate pelvic organs and pelvic floor tone</p> Signup and view all the answers

    What influence does estrogen deficiency have on pelvic organ prolapse?

    <p>It diminishes the quality and quantity of collagen.</p> Signup and view all the answers

    What is the significance of performing a speculum exam in a patient suspected of having POP?

    <p>To visualize the anterior and posterior vaginal walls</p> Signup and view all the answers

    What factor should be considered when planning surgical management for pelvic organ prolapse?

    <p>Patient's surgical preferences and goals</p> Signup and view all the answers

    What does a manual reduction of prolapse imply for urinary symptoms?

    <p>It helps in starting or completing voiding.</p> Signup and view all the answers

    What is a characteristic of Stage IV pelvic organ prolapse according to the POP-Q system?

    <p>The organ protrudes out of the body completely.</p> Signup and view all the answers

    What anatomical structure is primarily responsible for anchoring the upper and proximal vagina?

    <p>Cardinal and uterosacral ligaments</p> Signup and view all the answers

    In which situation would pelvic organ prolapse most likely occur?

    <p>When the vaginal angle becomes more vertical</p> Signup and view all the answers

    Which type of pelvic organ prolapse involves the bladder?

    <p>Cystocele</p> Signup and view all the answers

    What is the estimated percentage of women in the US who report symptoms of vaginal bulging related to pelvic organ prolapse?

    <p>3-6%</p> Signup and view all the answers

    Which layer comprises the primary support at Level 3 of vaginal support anatomy?

    <p>Fibromuscular connective tissue</p> Signup and view all the answers

    What primarily contributes to the resistance of increased bladder pressure in an ideally supported urogenital tract?

    <p>Support from levator ani and vaginal connective tissue</p> Signup and view all the answers

    Which type of urinary incontinence is characterized by leakage due to sudden urges to void?

    <p>Urge Urinary Incontinence</p> Signup and view all the answers

    Which of the following factors is least likely to be a risk factor for urinary incontinence?

    <p>High-impact aerobic exercise</p> Signup and view all the answers

    During what process does the bladder contract while the urethra relaxes to permit urine flow?

    <p>Voiding Phase</p> Signup and view all the answers

    What mechanism do the deep folds of the urethral mucosa facilitate to help maintain continence?

    <p>Urethral mucosal coaptation</p> Signup and view all the answers

    Which symptom is NOT typically associated with Overactive Bladder (OAB)?

    <p>Leakage of urine after a sneeze</p> Signup and view all the answers

    What is a common physiological effect of compromised support from the levator ani during increases in intraabdominal pressure?

    <p>Urinary leakage</p> Signup and view all the answers

    Which symptom would likely indicate Mixed Urinary Incontinence?

    <p>A combination of stress and urge symptoms</p> Signup and view all the answers

    What is a common neurological condition associated with neurogenic detrusor overactivity?

    <p>Spinal cord injury</p> Signup and view all the answers

    Which of the following is a treatment modality for urge incontinence?

    <p>Pelvic floor muscle training</p> Signup and view all the answers

    What is the purpose of a Q-tip test in the evaluation of urinary incontinence?

    <p>To evaluate urethral hypermobility</p> Signup and view all the answers

    Which medication is categorized as an anticholinergic/antimuscarinic used for urge incontinence?

    <p>Oxybutynin</p> Signup and view all the answers

    What is a key feature in taking a history for female urinary incontinence?

    <p>Documenting the patient's surgical history</p> Signup and view all the answers

    What can cause changes in the vascular plexus leading to urinary incontinence?

    <p>Hypoestrogenism</p> Signup and view all the answers

    Which condition is NOT typically associated with increased risk of stress urinary incontinence?

    <p>Hyperthyroidism</p> Signup and view all the answers

    What urinary volume indicates a normal post void residual (PVR)?

    <p>Less than 100mL</p> Signup and view all the answers

    What is a potential outcome of inadequate contraction of surrounding musculature in the urethral system?

    <p>Stress urinary incontinence</p> Signup and view all the answers

    Which feature is crucial in the treatment of stress urinary incontinence with pelvic floor muscle training?

    <p>Practice of Kegel exercises</p> Signup and view all the answers

    Study Notes

    Female Pelvic Anatomy

    • Pelvic organ support relies on interactions between pelvic floor muscles, connective tissue, and vaginal walls.
    • Key structures include uterosacral ligaments, arcus tendineus fascia pelvis, levator ani muscles, pelvic diaphragm, levator ani and coccygeus muscles, perineal body, and levator hiatus.
    • The levator hiatus is a U-shaped opening in the pelvic floor allowing passage of urethra, vagina, and rectum.

    Vaginal Support Levels

    • Level 1: Supports the upper proximal vagina via cardinal and uterosacral ligaments attached to cervix and upper vagina.
    • Level 2: Attaches mid-vagina to arcus tendineus fascia pelvis.
    • Level 3: Involves perineal body, superficial/deep perineal muscles, and fibromuscular connective tissue.

    Functional Pelvic Support

    • Vertical vaginal angle, versus horizontal, can lead to pelvic organ prolapse (POP).
    • Levator ani muscle tone changes can be observed.

    Pelvic Organ Prolapse (POP)

    • Definition: Descent of vaginal and uterine components, potentially causing nearby organs to herniate.
    • Types:
      • Anterior vaginal wall: Cystocele (bladder)
      • Posterior vaginal wall: Rectocele (rectum)
      • Uterus/cervix: Apical prolapse
      • Lateral/superior posterior vaginal wall: Enterocele (intestines)

    POP Epidemiology

    • Highest incidence in 70-79 year old women.
    • ~3-6% US women report vaginal bulging symptoms.
    • Exam prevalence of POP: 40-50%.
    • Limited research on natural progression of POP.

    POP Pathophysiology

    • Loss of levator ani muscle tone.
    • Connective tissue support damage/change in the pelvis.
    • Uterosacral ligament smooth muscle loss.
    • Arcus tendineus fascia pelvis stretching/tearing.
    • Estrogen decline (menopause) negatively impacts collagen and muscle quality.
    • Vaginal wall fibromuscular layer damage/loss.

    POP Symptoms

    • Bulge symptoms: Sensation/feeling of vaginal bulging, pressure, heaviness.
    • Urinary symptoms: Incontinence, frequency, urgency, hesitancy, incomplete emptying, need for postural changes to urinate.
    • Bowel symptoms: Incontinence (flatus, liquid/solid stool), urgency, straining, incomplete emptying, digital evacuation, splinting.
    • Sexual symptoms: Dyspareunia, decreased lubrication.
    • Pain: Vaginal, bladder, rectal, pelvic, and low back pain.

    POP Risk Factors

    • Parity (pregnancy, vaginal delivery), aging, obesity, connective tissue disorders, menopause, chronic increased intra-abdominal pressure (e.g., constipation, COPD), pelvic floor trauma.

    POP Physical Exam

    • Patient in dorsal lithotomy position.
    • Vulva/perineum exam for signs of atrophy.
    • Valsalva maneuver to observe prolapse degree.
    • Speculum exam.
    • Split speculum exam (viewing anterior and posterior vaginal walls with and without Valsalva).
    • Bimanual exam for pelvic organ/floor tone evaluation.

    POP Quantification (POP-Q)

    • System for staging POP severity.
    • Stages 0-IV (0: no prolapse; I-IV: increasing prolapse severity, with Stage IV representing complete eversion).
    • Measures site-specific pelvic support relative to hymen.

    POP Treatment

    • Expectant management: May be appropriate for asymptomatic/mildly symptomatic patients .
    • Treatment decisions based on symptoms, severity, age, comorbidities, recurrence factors, and desire for sexual/fertility function.
    • Treat modifiable risk factors (constipation, cough).

    Nonsurgical Options

    • Kegel exercises.
    • Pelvic floor physical therapy.
    • Pessary.

    Pessary

    • Silicone/plastic device to reduce prolapse, often used long-term.
    • Aids in diagnosis/treatment prognosis.
    • Trial use to assess symptom improvement or resolution.
    • May be used prior to surgery to assess incontinence risk.
    • Separate fitting appointment to determine best size/shape.
    • Often used with vaginal estrogen cream.
    • Self-managed or managed by provider with appointments (every 2-3 months).
    • Potential complications: vaginal erosion, bleeding.

    Surgical Management

    • Individualized approach based on anatomy, goals, and health characteristics.
    • Reconstructive repair addressing different vaginal compartments.
    • Primarily vaginal approach, with some laparoscopic/robotic procedures available.

    POP Surgery and Incontinence

    • Pre-surgical evaluation for stress urinary incontinence.
    • Concurrent stress incontinence procedures recommended if symptoms present.
    • Latent incontinence may appear post-repair.
    • Individualized decisions about anti-incontinence surgeries.

    Healthcare Team

    • Patient, support persons, primary care provider, gynecologist/urogynecologist, physical therapist, operating room team.

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    Description

    Explore the intricate anatomy of the female pelvic region, focusing on the pelvic floor muscles and their role in organ support. This quiz addresses the key structures involved in pelvic support and the levels of vaginal support, culminating in a discussion on pelvic organ prolapse. Test your knowledge on these vital concepts in women's health.

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