Professional Documents
Culture Documents
1-stress incontinence :
Caused by laxity of pelvic floor muscles; allows proximal urethra to drop
below the pelvic floor so the pelvic floor muscles is not aroud the urethra
anymore
Decreased urethral/vesicle angle allows bladder pressure to exceed
urethral pressure briefly at times of strain
Associated with:
-cystocele (-Bulging of bladder wall into the upper anterior vaginal wall) ,as
the UB become in straight line with the urethra.
-History of vaginal child birth (multiparous women) and Pelvic surgery
-Decreased estrogen level , lowered estrogen levels may lead to lower muscular
pressure around the urethra (this type mainly occurs in women
postmenopause)
-Presentation: Small volume leak with elevated intra-abdominal pressure
as: cough or laughing , sneezing , lifting heavy weight , NOT present in
supine position
-Treatment:
Topical vaginal estrogen
Kegel exercises to strengthen pelvic floor muscles
Alpha-agonists to increase muscle tone of bladder neck
Surgical procedures available as a FINAL option
3-Functional incontinence:
Patient cant reach toilet in time, he is normally continent but has large
volume of urine that he cant contain:
Caused by increased urinary volume, secondary to large volume intake or
using diuretics , or excessive caffeinated drinks
Patients are continent without the increased urinary volume
4-Overflow incontinence:
Caused by urinary retention secondary to obstruction (eg BPH) or bladder
atony (eg. Diabetes autonomic neuropathy or parasympathetic denervation
of UB)
Presentation:
History of chronic urine retention:
Dribbling urine, Small volume voids, increased urinary frequency
Treatment:
1- cholinergic agonists to increase detrusor muscle tone (for bladder
atony)
2-alpha-adrenergic antagonists to decrease tone of bladder neck in
case of obstructive lesion as BPH
3- urinary catheter for timed voiding
5-Total Incontinence:
Urinary loss in ALL times in ALL positions due to complete damage of the
sphincter by Cancer , Surgery . OR due to fistula between
bladder/Urethra and skin or vesico vaginal fistula
Treatment is SURGERY
Kegel exercise
repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now
sometimes colloquially referred to as the "Kegel muscles"
The aim of Kegel exercises is to improve muscle tone by strengthening
the pubococcygeus muscles of the pelvic floor.
It is now known that the components of
Pelvic prolapse
Sexual function
In 1952, Dr. Kegel published a report in which he claimed that the
women doing his exercises were orgasming more easily, more
frequently and more intensely , A paper found that pelvic floor exercises
could help restore erectile function in men with erectile dysfunction.
relation to their menstrual cycle. If a woman is not sure the anomaly she has found on her
cervix is a nabothian cyst, a visit to a doctor is recommended to rule out other conditions.[2]
Rarely, nabothian cysts have a correlation with chronic cervicitis, an inflammatory
infection of the cervix.
Nabothian cysts are not considered problematic unless they grow very large and present
secondary symptoms. A physician may wish to perform a colposcopy orbiopsy on a
nabothian cyst to check for cancer or other problems. Two methods for removing these cysts
include electrocautery and cryofreezing, although new cysts may form after the procedure.
postpartum thyroiditis
The exact cause is not known but it is believed to be an autoimmune disease very similar
to Hashimotos thyroiditis. In fact, these two disorders cannot be distinguished from one
another on pathology specimens. As in Hashimotos thyroiditis, postpartum thyroiditis is
associated with the development of anti-thyroid (anti-thyroid peroxidase, antithyroglobulin) antibodies. Women with positive antithyroid antibodies are at a much higher
risk of developing postpartum thyroiditis than women who do not have have positive
antibodies. It is believed that women who develop postpartum thyroiditis have an underlying
asymptomatic autoimmune thyroiditis that flares in the postpartum period when there are
fluctuations in immune function. The classic description of postpartum thyroiditis
includes thyrotoxicosis followed by hypothyroidism