GU: Pathologies

Question 1

What is Endometriosis?

Answer 1

This is the development of endometrial tissue, which normally lines the uterus, in extrauterine locations within the abdomen and pelvis.

• The most common locations of extrauterine endometial tissue growth occurs at the uteroscaral ligaments
• The level of pain does not always correlate with the severity of extrauterine tissue growth

Question 2

What is the Etiology Endometriosis?

Answer 2

Unknown

• During each menstral cycle the endometrial tissue bleeds causing subsequent scarring and adhesions

Question 3

What are the S/S of Endometriosis?

Answer 3

Sx can vary, but typically include moderate to lower abdominal, pelvic or low back pain before or during menstration, irregular menstral cycles, premenstrual spotting, dyspareunia, pain during defectation, and infertility

Question 4

What can be done for treatment for Endometriosis?

Answer 4

PT may include manual techniques such as myofascial release, visceral mobilization and soft and deep tissue masssage to break up scar tissue and adhesions. Mobility exercises are performed to sustain elongation of tissues

• Relaxation exercises such as breathing routines and restortative poses are performed to regulate the pain cycle
• TENS is also indicated
• Pharmcological intervention may be indicated to alter hormonal balance using oral contraceptives and antigonadotrophins
• Surgery to remove extrauterine endometrial tissue, scarring and adhesion; and a total hysterecetomy may be recommended whan pregnancy is no longer desired

Question 5

What is a Uterine Prolapse?

Answer 5

This is the descent of the uterus and cervix into the vagina. The Baden-Walker System is the most widespread classification of prolapse using a five-point grading system ranging from no prolapse to maximum descent of vaginal tissue outside of the body

Question 6

What is the Etiology of Uterine Prolapse?

Answer 6

The etiology typcially consist of genetics, denervation or direct muscle trauma (i.e., labor and delivery)

Question 7

What are the S/S of Uterine Prolapse?

Answer 7

Primary symptoms vary, but can include pelvic pressure that increases the exertion, urgency, frequency, urinary incontinence, incomplete bladder emptying, discomfort, vaginal dryness or irritation, dyspareunia, and lower back pain that is relieved by lying down

Question 8

What can be done for treatment for Uterine Prolapse?

Answer 8

PT treament may include pelvic floor muscle training using biofeedback, Kegel exercises, core strengthening exercises, body mechanic, and symptom dependent lifestyle modifications.

• In more severe cases, an intravaginal mechanical support device called a pessary may be indicated.
• The patient may require reconstructive or obliterative surgery, if conservative treatment fails

Question 9

What is Prostatitis?

Answer 9

This is inflammation of the prostate gland

Question 10

What is the Etiology of Prostatitis?

Answer 10

The most common etiology include bacterial infection or the backup of prostate secretions within the gland.

Classifications of Prostatitis include:
1) Acute Bacterial prostatitis
2) Chronic Bacterial prostatitis
3) Chronic Pelvic pain syndrome
4) Asymptomatic inflammatory porstatitis

Question 11

What are the S/S of Prostatitis?

Answer 11

Common symptoms include watery urethral discharge, urgency, frequency, discomfort with urination, and pain with ejaculation.

• Chronic Pelvic pain syndrome manifests as pain in the perineum, rectum, prostate, penis, testicle, and abdomen
• Asymptomatic inflammation prostatitis is characterized by prostate inflammation in the absence of genitourinary tract symptoms

Question 12

What can be done for treatment for Prostatitis?

Answer 12

Management includes lifestyle modifications, biofeedback training, stretching exercises, myofascial techniques, and bladder retraining,

• Pharm intervention such as antibiotics, alpha blockers or nonsterodial anti-inflammatory medications for pain may be indicated

Question 13

What is Erectile Dysfunction (ED)?

Answer 13

Also known as Impotence, is more prevalent in men with diabetes when compared to the general population.

• Onset of ED in individuals with diabetes usually occurs 10-15 years earlier than in men without diabetes

Question 14

What is the Etiology of Erectile Dysfunction (ED)?

Answer 14

There are various causative factors for ED.

• Diabetes is a primary etiology, while other risk factors include coronary heart disease, hypertension, hypothyroidism, hypopituitarism, multiple sclerosis, psychiatric disorders, excessive alcohol consumption, smoking, vessel disease, kidney disease, pharm side effects, and hormonal disturbances

Question 15

What are the S/S of Erectile Dysfunction (ED)?

Answer 15

The primary symptom is the consistent inability to maintain an erection adequate for sexual intercourse

Question 16

What can be done for treatment for Erectile Dysfunction (ED)?

Answer 16

Treatment varies and includes pharm intervention, surgical intervention, injections directly to the penis, and Kegel exercises

Question 17

What is Renal Failure?

Answer 17

This is a condition where the kidneys experience a decrease in glomerular filtration rate and fail to adequately filter toxins and waste from the blood.
- There are two forms: Acute and Chronic Renal Failure

Question 18

What is the Etiology of Renal Failure?

Answer 18

This typically occurs secondary to diabetes mellitus or hypertension, but can also occur from poison, trauma, and genetics. The nephrons are usually damaged and they lose their ability to filter blood.

Renal Failure can be classified as:
- Acute (Damage occurs quickly)
- Chronic (Damage occurs slowly)
- End-Stage (Nearly total or total renal failure, dialysis required)

Question 19

What are the characteristics of Acute Renal Failure?

Answer 19

• Sudden decline in renal function
• Increase in BUN and cretinine
• Oliguria, hyperkalemia, sodium retention
• Prenatal etiology is secondary to a decrease in blood flow typically due to shock, hemorrhage, burn or pulmonary embolism
• Postrenal etiology is secondary to obstruction distal to the kidney due to neoplasm, kidney stone or prostate hypertrophy
• Intrarenal etiology is secondary to primary damage of renal tissue due to toxins, intrarenal ischemia or vascular disorders

Question 20

What are the characteristics of Chronic Renal Failure?

Answer 20

• Progressive deterioration in renal function
• Diabetes mellitus
• Severe hypertension
• Glomerulopathies
• Obstructive uropathy
• Interstitial nephritis
• Polycystic kidney disease

Question 21

What is Stage 1 Kidney Disease?

Answer 21

Kidney damage with normal GFR (90 or greater)

Question 22

What is Stage 2 Kidney Disease?

Answer 22

Mild decrease in GFR (60-89)

Question 23

What is Stage 3 Kidney Disease?

Answer 23

Moderate decrease in GFR (30-59)

Question 24

What is Stage 4 Kidney Disease?

Answer 24

Severe reduction in GFR (15-29)

Question 25

What is Stage 5 Kidney Disease?

Answer 25

Kidney failure (GFR < 15)

Question 26

What are the S/S of Renal Failure?

Answer 26

Symptoms of renal failure vary based on severity of the condition and can include nausea, vomiting, lethargy, weakness, hiccups, anorexia, ulceration within the GI tract, sleep disorders, headache, peripheral neuropathy, anemia, pruritus, osteomalacia, ecchymosis, pulmonary edema, seizures, and coma

Question 27

What can be done for treatment for Renal Failure?

Answer 27

- Treatment of Acute Renal Failure includes management of primary etiology, pharm intervention, diuretics, nutritional support, hydration, hemodialysis and/or transfusion if applicable. - Treatment of Chronic Renal Failure inludes conservative management and renal replacement therapy. Conservative management assists with slowing the process and assisting the body in its compensation. Nutritional support, hydration, avoidance of protein, and pharm intervention are usually the primary basis of intervention. - Renal replacement therapy includes some form of hemodialysis and/or organ transplant. Peritoneal dialysis is a form of renal replacement therapy that uses the peritoneal cavity as a semi-permeable membrane between the dialysate fluid and blood vessels of the abdominal cavity

Question 28

With Kidney failure, what is Hemodialysis?

Answer 28

This is a treatment process for patients with advanced and permanent kidney failure. Kidney failure creates excess toxic waste, increased blood pressure, retention of excess body fluids, and a decrease in red blood cell production. - Hemodialysis removes the blood from the body along with waste, excess sodium, and fluids. The process cleanses the blood and returns it to the body. - A patient requires 3 to 5 hours to complete the treatment - Side effects that may be associated with dialysis include anemia, renal osteodystrophy, pruritus (itching), sleep disorders ("restless legs"), and dialysis-related amyloidosis

Question 29

What are the Rehabilitation Considerations for patients with Renal Failure/Dialysis?

Answer 29

- Modify treatment plan based on fluid and electrolyte status - Standard precautions should be followed at all times for protection - Recognize patients abilities post-dialysis and potential for dehydration and hypotension - Monitor vital signs closely, however, avoid placement of the blood pressure cuff over the fistula - Avoid mobilization activities as they are contraindicated during dialysis - Energy conservation techniques and pacing skills should be incorporated into therapy

Question 30

What is a Neurogenic Bladder?

Answer 30

This is a dysfunction where there is damage to the cerebral control that allows for urinary dysfunction - If the urine cannot be properly released, there may be an increase in urinary tract infections and kidney damage

Question 31

What is the Etiology of Neurogenic Bladder?

Answer 31

The etiology can include diabetes, diminished bladder capacity, hyperactive detrusor muscle, CVA, other disease processes, infection, and nerve damage

Question 32

What are the S/S of Neurogenic Bladder?

Answer 32

Sx's include frequent UTI's, leakage of urine, inability to empty the bladder or loss of the urge to urinate when the bladder is full. - Diagnosis should include an evaluation by a physician, X-ray, and urodynamics to assist with diagnosis.

Question 33

What can be done for treatment for Neurogenic Bladder?

Answer 33

Management is dependent on the actual etiology with a goal of preventing bladder overdistention, UTI's, and renal damage. Patient education, bladder technqiues, lower abdominal massage, temporary catheterization, pharm intervention, and a timed urination program may be indicated

Question 34

What is Urinary Incontinence?

Answer 34

This is an involuntary loss of urine that is great enough to be problematic for the person and typically occurs when bladder pressure exceeds sphincter resistance. - General treatment includes pelvic floor muscle training using feedback, lifestyle modifications, bladder re-training, prompted voiding programs, urge suppresion strategies, myofascial release, visceral mobilization, body mechanics, abdominal strengthening, and stretching exercises of surrounding muscles. - Pharm intervention to address urgency, injection therapy of a "bulking" agent, and surgical intervention for urethral and bladder positioning may also be indicated. *These interventions do not apply to all types of urinary incontinence and should be determined on a per patient basis*

Question 35

What is Stress Urinary Incontinence (SUI)?

Answer 35

This is the loss of urine due to activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, running, and jumping

Question 36

What is Urge Urinary Incontinence (UUI)?

Answer 36

This is the loss of urine after a sudden, intensive urse to void due to the detrusor muscle of the bladder involuntarily contracting during bladder filling. - UUI is the most common incontinence in the geriatic population and among residents in long-term care facilities

Question 37

What is the Etiology of Urge Urinary Incontinence (UUI)?

Answer 37

The most common etiologies are detrusor muscle overactivity, overactive bladder also known as "urgency-frequency" syndrome, changes in the smooth muscle of the bladder, increased afferent activity, increased sensitivity of the detrusor to acetylcholine, and idiopathic - There is also association with the following neuroloical disorders: MS, SCI, CVA, and PD

Question 38

What are the S/S of Urge Urinary Incontinence (UUI)?

Answer 38

For many people, UUT is triggered by certain events due to a conditioned reflex. Two of the most common triggers are "Key-in-the-lock" when arriving home and running water.

Question 39

What can be done for treatment for Urge Urinary Incontinence (UUI)?

Answer 39

Behavior modification is the primary goal of treatment for this condition. Biofeedback, pelvic floor strengthening, and bladder retraining (scheduled voiding) are key components in resolving UUI. Pharm intervention may also be warrented

Question 40

What is Overflow Urinary Incontinence (OUI)?

Answer 40

OUI is the loss of urine when the intra-bladder pressure exceeds the urethra's capacity to remain closed due to urinary retention

Question 41

What is the Etiology of Overflow Urinary Incontinence (OUI)?

Answer 41

This condition is caused by outflow obstruction secondary to a narrowed or obstructed urethra that results from a prolapsed pelvic organ, a stricture, an elarged prostate, chronic constipation or neurological disease

Question 42

What are the S/S of Overflow Urinary Incontinence (OUI)?

Answer 42

Individuals who present with OUI may also experience difficulty initiating the urine stream. Once the stream is initiated, it is weak and presents with Post-void dribble.

Question 43

What can be done for treatment for Overflow Urinary Incontinence (OUI)?

Answer 43

- Treatment will likely include surgical intervention if there is an obstruction. - If there is weakness of the detrusor muscles, double voiding is recommended for these patients as well as other strengthening measures - Failed intervention may result in intermittent catheterization

Question 44

What is Functional Urinary Incontinence (FUI)?

Answer 44

This is the loss of urine due to the inability or unwillingness of a person to use the bathroom facilities prior to involuntary bladder release

Question 45

What is the Etiology of Functional Urinary Incontinence (FUI)?

Answer 45

A decreased level of mental awareness or a decreased in mobility are the two primary causative factors for FUI. - FUI is rarely seen without another bladder issue or neurological involvement

Question 46

What are the S/S of Functional Urinary Incontinence (FUI)?

Answer 46

These patients will typically present with impaired cognition and/or mobility and will experience incontinence secondary to the inability to successfully use a bathroom to void

Question 47

What can be done for treatment for Functional Urinary Incontinence (FUI)?

Answer 47

Since there is typically no urologic pathology associated with functional incontinence, treatment should be directed to alleviate the underlying issue. - Improving mobility, modifying clothing style, increasing independence with ambulation and with function will assist with decreasing functional incontinence - Patients may also require a behavioral toileteing schedule or program to decrease incontinence

Question 48

# Spotlight on safety When working with those patients in Acute care, Long-term care or Home care settings, what are factors that contribute to Functional Urinary Incontinence (FUI)?

Answer 48

**Restricted Mobility or Dexterity**: - Pts may have difficulty or the inability to get to the bathroom in a timely fashion due to underlying physical disabilities or limitations such as a spinal cord injury, rheumatoid arthritis or acute illness **Environmental Barriers**: - Pts may not be able to reach the restroom or toilet due to stairs, lack of handrails or narrow doorways that do not accommodate wheelchairs or walkers **Mental and Psychosocial disability**: - Pts may not realize they have to urinate or may be confused over the location of the restroom **Pharmacological intervention**: - Pts may take medications that affect awareness, mobility, and dexterity

Question 49

What are lifestyle modifications to address bladder symptoms?

Answer 49

- Daily fluid intake should be 2,500 mL, or 10 cups, to regulate excessively high or low fluid intake - Reduce bladder irritant including carbonated, caffeinated, and alcoholic beverages, spicey foods, citrus juices, and artificial sweeteners. Caffeine reduction should be tapered slowely to avoid severe headaches - Schedule voiding for every 3-4 hours to reduce bladder distention. An average person voids 6-8 times in a 24 hour period. A bladder diary assist with baseline measurements and goal setting - Regulate bowel function to prevent constipation and straining during bowel movements by monitoring dietary fiber, fluid intake, and exercise - Avoid fluid intake 2-3 hours prior to bedtime to reduce nocturia - A smoking cessation program may decrease the occurance of coughing and subsequent bladder leakage - A weight loss program, if moderately obese, may decrease pressure on the pelvic tissues and organs

Question 50

What are Urinary Tract Infections (UTI)?

Answer 50

These are very common and occur within the general population, however, there is a higher incidence in women and the geriatric population. - UTI's can be classified as uncomplicated, complicated, recurrent or chronic

Question 51

What is the Etiology Urinary Tract Infections (UTI)?

Answer 51

UTI's occur when bacteria infiltrate the urethra (termed urethritis) or further into the bladder itself (cystitis) - Untreated, this type of infection can spead and cause a kidney infection (pyelonephritis) - Diagnosis is confirmed with urinalysis - Frequent UTI's may require ultrasound, intravenous pyelogram, and cystoscopy to further assess the function of the bladder

Question 52

What are the S/S of Urinary Tract Infections (UTI)?

Answer 52

Sx's of a UTI include increased frequency of urination, pain and/or burning with urination, cloudy urine, pressure, above the pubic bone in women, shakiness, fever, back pain, and fatigue

Question 53

What can be done for treatment for Urinary Tract Infections (UTI)?

Answer 53

Early treatment has the best results; delay in treatment may allow for serious infection to occur. - Pharmacological treatment includes bacteria-specific antibiotics based on the bacteria found in the bladder. - Patients are also encouraged to drink an excess of fluids to assist with treatment of the infection

Question 54

With those patient with pelvic floor dysfunctions, what are some advance physical therapy interventions that can be done?

Answer 54

- Perineal massage both by the practitioner and patient - Scar tissue massage both by the practitioner and patient - Intravaginal soft tissue massage (aka Thiele massage) - Intravaginal trigger point release and myofascial release - Intravaginal self-stretching techniques includes the use of a dilator - Prostate massage *These techniques may be used for, but are not limited to patients who have dyspareunia, vulvodynia, prostatitis, interstitial cystitis, urgency, urge incontinence, levator ani syndrome, coccydynia, and perineal pain from pregnancy*