DOCSLIB.ORG

Evidence Review No: 1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evidence Review No: 1 Local Policy Statement No 12 POLICY STATEMENT TITLE/TOPIC: Specific Obstetric and Gynaecology procedures ISSUE DATE: November 2011 1) INSERTION AND REMOVAL OF INTRA UTERINE CONTRACEPTIVE DEVICES (IUCD) DEFINITION An IUCD is a birth control device that is placed in the uterus by a doctor. Although they can come in different shapes and sizes, IUCDs are generally about 1 1/2 inches long, in the shape of a T, and have a copper coating. IUCDs have strings that extend from the device in the uterus, through the cervix and into the vagina. They can be felt to ensure that the IUCD is still in place, but they cannot be seen outside of the body There are two types of IUCDs: those that release progestin and those that do not. COMMISSIONING RECOMMENDATION: The insertion and removal of any IUCD should only be undertaken in a primary care setting, it is not commissioned as a secondary care service RISKS IUCDs do not protect against sexually transmitted diseases (STDs). Women who get an STD while using an IUCD are also more likely to develop pelvic inflammatory disease (PID). In 2 percent to 10 percent of cases, the uterus will push the IUCD out of the body. Fever and chills are other side effects. IUCDs cause cramps and backaches in some women. Heavier bleeding than normal and spotting are also common side effects, though this usually only lasts for the first few months. There is a greater risk of having an ectopic pregnancy with an IUCD than without one. 2) VAGINAL PESSARIES DEFINITION A vaginal pessary is a plastic device that fits into the vagina to help support the uterus (womb), vagina, bladder or rectum. 1 Version 1.0 prepared by Dr Sheila Will July 2011 Adopted November 2011 due for review November 2012 The pessary is most often used for prolapse of the uterus. Prolapse means that the uterus droops or sags into the vaginal canal because the muscles and ligaments that should support it are weak. This may occur after childbirth or pelvic surgery. Prolapse of the uterus is usually fixed with surgery but a vaginal pessary can be used to help keep the uterus in place. A pessary can also be used for a cystocele (when the bladder droops down into the vagina) or for a rectocele (when the wall of the rectum bulges into the bottom of the vagina). A pessary can also help many women who have stress urinary incontinence (the leaking of urine when you cough, strain or exercise). Pregnant women who have incontinence can also use a vaginal pessary. COMMISSIONING RECOMMENDATION: The insertion of vaginal pessaries should only be undertaken in a primary care setting, it is not commissioned as a secondary care service SIDE EFFECTS: Vaginal irritation and discharge 3) HYSTEROSCOPY DEFINITION A hysteroscopy is a procedure used to examine the inside of the uterus (womb). It is done using a hysteroscope, a narrow tube with a telescope at the end. Images are sent to a computer to give a close-up of the uterus A diagnostic hysteroscopy is used to look for abnormalities in the womb and find the cause of any symptoms. These can include: heavy or irregular periods pelvic pain unusual vaginal discharge repeated miscarriage infertility It can be performed with or without a local anaesthetic that numbs the area around the womb. 2 Version 1.0 prepared by Dr Sheila Will July 2011 Adopted November 2011 due for review November 2012 Operative hysteroscopy A hysteroscopy is described as operative when it involves an additional procedure such as a biopsy or treatment. If an abnormality is suspected when viewing the inside of the uterus a biopsy (a small sample of tissue) may be taken to be examined. If a medical condition is diagnosed straight away, such as a polyp (a projecting mass of overgrown tissue), it may be treated during the hysteroscopy. The most common treatments carried out during a hysteroscopy include the removal of: polyps adhesions and scar tissue in the womb fibroids (non-cancerous growths) in the womb a lost or stuck contraceptive device A contraceptive device can also be fitted during hysteroscopy. COMMISSIONING RECOMMENDATION: When appropriate, outpatient rather than inpatient ambulatory hysteroscopy will be considered CONTRAINDICATED Hysteroscopy is contraindicated during pregnancy or where the patient has a vaginal or urinary tract infection or a cancer of the womb. 4) DIAGNOSTIC DILATATION AND CURETTAGE FOR WOMEN UNDER 40 YEARS DEFINITION Dilatation and curettage (D&C) is a procedure where tissue is removed from the endometrium (the lining of the womb (uterus) (by dilating the cervix (Dilatation) and scraping out the lining of the womb (Curettage)). COMMISSIONING RECOMMENDATION: Effective Health Care Bulletin 9 recommended that diagnostic D&C should not be performed routinely on women aged under 40 since the risks of anaesthesia, uterine perforation and cervical laceration outweigh the minimal potential benefit. Newer methods of endometrial sampling appear to be at least as accurate as D&C with high levels of acceptability and lower complication rates. For women 3 Version 1.0 prepared by Dr Sheila Will July 2011 Adopted November 2011 due for review November 2012 with dysfunctional uterine bleeding, a range of medical interventions is available (e.g. mefenamic acid with norethisterone etc). In the investigation of dysfunctional uterine bleeding, hysteroscopy with selected biopsy and curettage is preferable. D&C alone should not be used as a diagnostic tool or as a therapeutic treatment. If appropriate, a biopsy should be taken to exclude endometrial cancer or atypical hyperplasia. Indications for a biopsy include persistent inter-menstrual bleeding, and in women aged 45 and over treatment failure or ineffective treatment. Ultrasound is the first line diagnostic tool for identifying structural abnormalities. Hysteroscopy should be used as a diagnostic tool only when ultrasound results are inconclusive, for example, to determine the exact location of a fibroid or the exact nature of the abnormality. NICE Guidance CG44 5) HYSTERECTOMY (ABDOMINAL AND VAGINAL) DEFINITION Hysterectomy is an operation to remove the uterus (womb). A hysterectomy is used to treat conditions that affect the female reproductive system. A hysterectomy is a major operation with a long recovery time. It is usually only considered after alternative, less invasive treatments have been tried. Types of hysterectomy Total hysterectomy: this is the most commonly performed operation. The uterus and cervix (neck of the womb) are removed. Subtotal hysterectomy: the main body of the uterus is removed leaving the cervix in place. Total hysterectomy with bilateral salpingo-oophorectomy: the uterus, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed. Radical hysterectomy: the uterus and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue. 4 Version 1.0 prepared by Dr Sheila Will July 2011 Adopted November 2011 due for review November 2012 There are three ways to perform a hysterectomy: Vaginal hysterectomy: the uterus is removed through a cut in the top of the vagina. Abdominal hysterectomy: the uterus is removed through a cut in the lower abdomen. Laparoscopic hysterectomy (keyhole surgery): the uterus is removed through a number of small cuts in the abdomen. COMMISSIONING RECOMMENDATION: Hysterectomy should not be used as a first-line treatment solely for heavy menstrual bleeding. Hysterectomy should only be undertaken if patients have followed the Map of Medicine pathway, or are on a cancer referral pathway See NICE Guidance CG44 6 Version 1.0 prepared by Dr Sheila Will July 2011 Adopted November 2011 due for review November 2012 .
Load more

Recommended publications
  • Prevalence of Malignant Uterine Pathology in Utero-Vaginal Prolapse After Vaginal Hysterectomy
    Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology PelviperineologyORIGINAL Pelviperineology ARTICLE Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology Pelviperineology DOI: 10.34057/PPj.2020.39.04.006 Pelviperineology 2020;39(4):137-141 Prevalence of malignant uterine pathology in utero-vaginal prolapse after vaginal hysterectomy EDGARDO CASTILLO-PINO1, VALENTINA ACEVEDO1, NATALIA BENAVIDES1, VALERIA ALONSO1, WASHIGNTON LAURÍA2 1Department of Obstetrics and Gynaecology, Urogynaecology and Pelvic Floor Unit, School of Medicine, University of the Republic, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay 2Department of Obstetrics and Gynaecology, School of Medicine, University of the Republic, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay ABSTRACT Objective: The aim of this study was to establish the prevalence of malignant uterine pathology after vaginal
    [Show full text]
  • Female Pelvic Relaxation
    FEMALE PELVIC RELAXATION A Primer for Women with Pelvic Organ Prolapse Written by: ANDREW SIEGEL, M.D. An educational service provided by: BERGEN UROLOGICAL ASSOCIATES N.J. CENTER FOR PROSTATE CANCER & UROLOGY Andrew Siegel, M.D. • Martin Goldstein, M.D. Vincent Lanteri, M.D. • Michael Esposito, M.D. • Mutahar Ahmed, M.D. Gregory Lovallo, M.D. • Thomas Christiano, M.D. 255 Spring Valley Avenue Maywood, N.J. 07607 www.bergenurological.com www.roboticurology.com Table of Contents INTRODUCTION .................................................................1 WHY A UROLOGIST? ..........................................................2 PELVIC ANATOMY ..............................................................4 PROLAPSE URETHRA ....................................................................7 BLADDER .....................................................................7 RECTUM ......................................................................8 PERINEUM ..................................................................9 SMALL INTESTINE .....................................................9 VAGINAL VAULT .......................................................10 UTERUS .....................................................................11 EVALUATION OF PROLAPSE ............................................11 SURGICAL REPAIR OF PELVIC PROLAPSE .....................15 STRESS INCONTINENCE .........................................16 CYSTOCELE ..............................................................18 RECTOCELE/PERINEAL LAXITY .............................19
    [Show full text]
  • Legacy Health
    Legacy Health Co-Management and Referral Guidelines Management of Pelvic Floor Dysfunction Phone: 503-413-3707 Legacy Physical Therapy Fax: 503-413-1504 Introduction After appropriate evaluation by your care providers, patients may be referred to pelvic floor physical therapy for management of pelvic floor muscle dysfunctions/pain, incontinence of urine or fecal matter, pelvic floor/girdle physical therapy. • Hypertonic pelvic floor dysfunction — vaginismus, dyspareunia, levator ani syndrome • Hypotonic pelvic floor muscles — organ prolapse, rectus diastasis • Continence issues after abdominal surgeries in male and female (prostate or hysterectomies), overactive bladder • Endometriosis, pelvic pain • Chronic constipation Evaluation Evaluation and A careful history and evaluation/physical exam will be performed to assess the origin and functional Management limitations of the patient. Muscle tone assessment, organ mobility, scar tissue mobility, bladder and/or bowel diary Treatment Strengthening or down-training PF muscles, with or without biofeedback, manual therapy, scar tissue release, electrical stimulation, trigger point release, visceral and myofascial mobilization, body mechanics and core stabilization. Duration One to six 60-minute visits with the physical therapist When to refer Refer when pain is limiting normal activities of daily living, if patient is not able to get to the bathroom dry, if sexual activity is painful (although dyspareunia alone is often not covered by insurance) Commonly referred ICD10 codes and descriptors for PT diagnoses R10.9 Abdominal pain K59.4 Anal spasm/proctalgia fugax R39.89 Bladder pain M53.3 Coccygodynia K59.00 Constipation, unspecified N81.10 Cystocele, unspecified (prolapse of anterior vaginal wall NOS) M62.0 Diastasis rectus post-partum N94.1 Dyspareunia — excludes psychogenic dyspareunia (F52.6).
    [Show full text]
  • Pelvic Floor Ultrasound in Prolapse: What's in It for the Surgeon?
    Int Urogynecol J (2011) 22:1221–1232 DOI 10.1007/s00192-011-1459-3 REVIEW ARTICLE Pelvic floor ultrasound in prolapse: what’s in it for the surgeon? Hans Peter Dietz Received: 1 March 2011 /Accepted: 10 May 2011 /Published online: 9 June 2011 # The International Urogynecological Association 2011 Abstract Pelvic reconstructive surgeons have suspected technique became an obvious alternative, whether via the for over a century that childbirth-related trauma plays a transperineal [4, 5] (see Fig. 1) or the vaginal route [6]. major role in the aetiology of female pelvic organ prolapse. More recently, magnetic resonance imaging has also Modern imaging has recently allowed us to define and developed as an option [7], although the difficulty of reliably diagnose some of this trauma. As a result, imaging obtaining functional information, and cost and access is becoming increasingly important, since it allows us to problems, have hampered its general acceptance. identify patients at high risk of recurrence, and to define Clinical examination techniques, in particular if the underlying problems rather than just surface anatomy. examiner is insufficiently aware of their inherent short- Ultrasound is the most appropriate form of imaging in comings, are rather inadequate tools with which to assess urogynecology for reasons of cost, access and performance, pelvic floor function and anatomy. This is true even if one and due to the fact that it provides information in real time. uses the most sophisticated system currently available, the I will outline the main uses of this technology in pelvic prolapse quantification system of the International Conti- reconstructive surgery and focus on areas in which the nence Society (ICS Pelvic Organ Prolapse Quantification benefit to patients and clinicians is most evident.
    [Show full text]
  • Uro 2018-159 Issue Date: 02/2015 Review Date: 03/2021 © Liverpool Women’S NHS Foundation Trust
    Vaginal Pessary Information Leaflet What Is A Pessary? A pessary is a plastic or silicone device that fits into your vagina to support a prolapsed bladder, rectum or uterus (womb). There are different types but the most commonly used are either a ring or a shelf pessary. 71%- 90% of women are successfully fitted with a pessary. What Is A Prolapse? A prolapse means that your uterus, bladder or rectum is bulging or leaning into the vagina, because the muscular walls of the vagina have become weakened. This can sometimes be felt as a lump in the vagina. If the prolapse is large it may also cause difficulty when emptying the bladder or bowel. It is possible for women to have more than one type of prolapse. 50% of women can get a prolapse. Patients can have varying symptoms such as vaginal heaviness, pelvic pressure bulging into the vagina and backache. What Are The Different Types Of Prolapse? Cystocele A cystocele occurs when the vaginal wall that is next to the bladder becomes weakened. This causes the bladder to lean (or prolapse) into the vagina, where it may then be felt as a lump (See Figure 1) Cystocele Figure 1 Rectocele A rectocele occurs when the vaginal wall next to the rectum becomes weakened. This causes the rectum to lean (or prolapse) into the vagina, where it may then be felt as a lump. This type of prolapse may cause difficulty when opening your bowels. (See Figure 2) Figure 2 Uterine prolapse A Uterine prolapse occurs when the structures that support the womb weaken.
    [Show full text]
  • About Your Enterocele Or Rectocele Repair
    PATIENT & CAREGIVER EDUCATION About Your Enterocele or Rectocele Repair This information describes enteroceles and rectoceles and how they are repaired. About Enteroceles An enterocele (en-tuh-roh-seal), also called small bowel prolapse, occurs when the small intestine moves down and pushes at the top part of the vagina. This creates a bulge (see Figure 1). Figure 1. Female anatomy with and without a enterocele About Your Enterocele or Rectocele Repair 1/5 An enterocele happens when the roof of your vagina weakens. This can be caused by: Aging Vaginal deliveries of heavy babies Menopause A hysterectomy (surgery to remove your uterus) or other gynecologic surgery About Rectoceles A rectocele (rek-tuh-seal), also called a posterior prolapse, is when your rectum bulges into the back wall of your vagina (see Figure 2). Figure 2. Female anatomy with and without a rectocele A rectocele happens when the muscles in your vaginal wall weaken. This can be caused by: Aging Vaginal deliveries of heavy babies About Your Enterocele or Rectocele Repair 2/5 Menopause Treatment for Enteroceles or Rectoceles You will have a repair surgery. A repair surgery will strengthen the wall of your vagina with sutures (stitches). An enterocele repair stops the small intestine from bulging into your vagina. A rectocele repair stops the rectum from bulging into the vagina. Risks of having repair surgery Most people who have enterocele or rectocele repair surgery don’t have problems after their surgery. After your surgery, you may experience: Pain Vaginal bleeding Infection Injury to the bladder or ureters (tubes that take urine from the kidneys to the bladder) Incontinence (urinary leakage) Long-term or permanent problems urinating You may have to insert a catheter (thin, flexible tube) into your bladder to drain your urine.
    [Show full text]
  • Anterior Rectocele
    Saint Mary’s Hospital Gynaecology Service - Warrell Unit Information for Patients Anterior Rectocele What is an anterior rectocele? An anterior rectocele is the name given to a pocket or bulge in the part of the bowel lying under the back wall of the vagina. It is a type of prolapse. Between the vagina and the rectum, there is a sheet of strong connective tissue which helps to support the vagina and rectum and stop one from bulging into the other. Weakness of this tissue allows the rectum to bulge forwards into the vagina during straining or having the bowels opened. This bulge is called an anterior rectocele. Some women have an anterior rectocele and are not bothered by it at all. For some women, it causes a bulge or lump in the vagina. Sometimes it can cause a sensation of needing to empty the bowels during intercourse. It can cause difficulty in getting a bowel movement to come out. Women may have a feeling that the stool is going forward into the vagina rather than coming out. They may need to put a finger into the vagina to help the bowels to empty and may have to return to the toilet several times because they are not able to fully empty the bowel all at once. How common is prolapse and anterior rectocele? Prolapse is very common. Most women who have had a baby will have small amounts of prolapse. Anterior rectoceles are also very common. About 10% of women (1 in 10) have prolapse that causes bothersome symptoms. What causes an anterior rectocele? We do not understand yet why some women get an anterior rectocele and others do not.
    [Show full text]
  • Female Chronic Pelvic Pain Syndromes 1 Standard of Care
    BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Female Chronic Pelvic Pain Syndromes ICD 9 Codes: 719.45 Pain in the pelvic region 625.9 Vulvar/pelvic pain/vulvodynia/vestibulodynia (localized provoked vestibulodynia or unprovoked) 625.0 Dyspareunia 595.1 Interstitial cystitis/painful bladder syndrome 739.5 Pelvic floor dysfunction 569.42 Anal/rectal pain 564.6 Proctalgia fugax/spasm anal sphincter 724.79 Coccygodynia 781.3 Muscular incoordination (other possible pain diagnoses: prolapse 618.0) Case Type/Diagnosis: Chronic pelvic pain (CPP) can be defined as: “non-malignant pain perceived in structures related to the pelvis, in the anterior abdominal wall below the level of the umbilicus, the spine from T10 (ovarian nerve supply) or T12 (nerve supply to pelvic musculoskeletal structures) to S5, the perineum, and all external and internal tissues within these reference zones”. 1 Specifically, pelvic pain syndrome has been further defined as: “the occurrence of persistent or recurrent episodic pelvic pain associated with symptoms suggestive of lower urinary tract, sexual, bowel or gynecological dysfunction with no proven infection or other obvious pathology”.1 Generally, female pelvic pain has been defined as pain and dysfunction in and around the pelvic outlet, specifically the suprapubic, vulvar, and anal regions. A plethora of various terms/diagnoses encompass pelvic pain as a symptom, including but not limited to: chronic pelvic pain (CPP), vulvar pain, vulvodynia, vestibulitis/vestibulodynia (localized provoked vestibulodynia or unprovoked vestibulodynia), vaginismus, dyspareunia, interstitial cystitis (IC)/painful bladder syndrome (PBS), proctalgia fugax, levator ani syndrome, pelvic floor dysfunction, vulvodynia, vestibulitis/vestibulodynia dyspareunia, vaginismus, coccygodynia, levator ani syndrome, tension myaglia of the pelvic floor, shortened pelvic floor, and muscular incoordination of the pelvic floor muscles.
    [Show full text]
  • Posterior Repair with Perineoplasty
    501 19th Street, Trustee Towers FORT SANDERS WOMEN’S SPECIALISTS 1924 Pinnacle Point Way Suite 401, Knoxville Tn 37916 P# 865-331-1122 F# 865-331-1976 Suite 200, Knoxville Tn 37922 Dr. Curtis Elam, M.D., FACOG, AIMIS, Dr. David Owen, M.D., FACOG, Dr. Steven Pierce M.D. Dr. Dean Turner M.D., FACOG, ASCCP, Dr. F. Robert McKeown III, M.D., FACOG, AIMIS Dr. Brooke Foulk, M.D., FACOG, Dr. G. Walton Smith, M.D., FACOG, Dr. Susan Robertson M.D., FACOG POSTERIOR REPAIR WITH PERINEOPLASTY Please read and sign the following consent form when you feel that you completely understand the surgical procedure that is to be performed and after you have asked all of your questions. If you have any further questions or concerns, please contact our office prior to your procedure so that we may clarify any pertinent issues. Definition: Posterior repair is a surgical procedure to correct a rectocele. A rectocele occurs when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the rectum to bulge into the back wall of the vagina. A posterior repair returns the rectum back into its normal position and strengthens the wall between the rectum and the vagina. A perineoplasty is the reconstruction of the opening of the vagina (introitus) and the area between the anus and the vagina (perineum). These procedures are performed completely through the vagina, no abdominal incisions are made. Procedure: After sedation from general anesthesia is achieved; the surgeon will begin by placing a catheter in the bladder to keep it empty during the procedure.
    [Show full text]
  • SURGICAL TUTORIAL 1: Before, During and After- Comprehensive Team Approach to Laparoscopic Management of Severe Endometriosis
    SYLLABUS SURGICAL TUTORIAL 1: Before, During and After- Comprehensive Team Approach to Laparoscopic Management of Severe Endometriosis Be a Surgical “Multiplier” in MIGS Inspire Brilliance Through Teamwork Scientific Program Chair Honorary Chair President Jubilee Brown, MD Barbara S. Levy, MD Marie Fidela R. Paraiso, MD Professional Education Information Target Audience This educational activity is developed to meet the needs of surgical gynecologists in practice and in training, as well as other healthcare professionals in the field of gynecology. Accreditation AAGL is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAGL designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure of Relevant Financial Relationships As a provider accredited by the Accreditation Council for Continuing Medical Education, AAGL must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course chairs, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity.
    [Show full text]
  • SOME GYNECOLOGICAL PROBLEMS in the Agedt
    SOME GYNECOLOGICAL PROBLEMS IN THE AGEDt Gerald W. Korn, M. I have selected just three topics for this dis- However, carcinoma of the vulva and the vagina have cussion and try to give some practical tips as to the a higher incidence in the aged. management of some of the problems that fall under Where there has been a definite blood loss, it is these headings. For the purpose of this discussion, I mandatory to perform a comprehensive examination am using the age of seventy as the lower limit of of the pelvic organs. This should include (1) a care- the aged female, although, or course, many of the ful inspection of the external genitalia (2) a speculum problems that I will mention can occur in women examination (3) a bimanual examination (4) a cer- much younger than that. However, I am trying to vical and posterior vaginal wall smear (5) a curet- avoid getting into the perimenopausal era, which has tage in almost all cases (6) a biopsy of any lesions its own particular problems. suspected as being the site of the bleeding. Postmenopausal bleeding is my first large group Even where one has found an obvious vaginal, of problems and, as you are well aware, there is a urethral or cervical lesion, a curettage should be per- long list of causes of this symptom. However, in the formed where the bleeding has been of significance. aged, the number of likely causes can be reduced to Perhaps the only exclusions should be where there a small list-others being of considerable rarity.
    [Show full text]
  • Understanding, Preventing and Managing Pelvic Floor Dysfunction
    EDNF 2012 Conference August 2012 Women: Understanding, Preventing, and Managing Pelvic Floor Dysfunction KATHLEEN ZONARICH, PT What is Pelvic Floor Dysfunction? Pelvic floor dysfunction refers to a wide range of problems that result when pelvic floor muscles are: ¡ Weak; ¡ Tight; and/or ¡ Impaired sacroiliac joint, low back, coccyx and/or hip joint. Tissues surrounding the pelvic organs may have: ¡ Increased or decreased sensitivity; and/or ¡ Irritation resulting in pelvic pain. Pelvic Floor Dysfunction Facts Many times the underlying cause of pelvic pain is difficult to determine Pelvic floor dysfunction can cause: ¡ Incoordination in the contraction; and ¡ Relaxation of the pelvic floor muscles that assist in controlling bladder and bowel function. Pelvic floor dysfunction is not a normal course of aging All rights reserved. 1 EDNF 2012 Conference August 2012 Statistics An estimated 1/3 of all U.S. women are affected by some type of pelvic floor disorder 1 in 11 women will have pelvic floor surgery 13 million Americans are effected by incontinence ¡ Stress incontinence is most common for women ¡ Adolescent girls suffer from stress incontinence with sports Pelvic floor dysfunction occurs in women that have not given birth Structures in and around the Pelvic Floor Bones - pelvis, tailbone and sacrum Muscles Ligaments Tendons Nerves (pudendal nerve) Anatomy of the Pelvic Floor and Surrounding Structures The pelvic floor acts as a sling to: ¡ Support: ÷ Bladder ÷ Uterus ÷ Rectum ¡ Surround: ÷ Urethra ÷ Vagina ¡ Assist: ÷ With urination and defecation All rights reserved. 2 EDNF 2012 Conference August 2012 Types of Pelvic Floor Dysfunction Supportive Dysfunction ¡ A result of the loss of nerve, muscle, ligament, or fascial integrity of the pelvic floor muscles causing weakness and laxity ¡ Could be caused by injury incurred during childbearing or gynecologic surgery, chronic constipation, chronic coughing, obesity, or hormonal changes Hypertonus Dysfunction ¡ Symptoms of pain in the abdominal area, back, or vulvar region.
    [Show full text]