Cystocele-faalen bladder

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Cystocele-faalen bladder

  1. 1. CYSTOCELE Presented by : Rahila Najihah Ali DPH/0102/11
  2. 2. Anatomy of Pelvic
  3. 3. Definition • Also known as prolapsed bladder • Occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina • May associated with problems emptying the bladder, urinary tract infections or incontinence
  4. 4. Causes • Stress on the supportive "hammock" during childbirth • Frequent heavy lifting • Chronic coughing (or other lung problems) • Constipation (frequently straining to pass stool) • Obesity, • menopause (estrogen levels start to drop) • previous pelvic surgery.
  5. 5. Symptoms • • • • • Frequent urination or urge to urinate Stress incontinence Not feeling bladder relief immediately after urinating; Frequent UTI Discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back • Heaviness or pressure in the vaginal area; • Painful intercourse • Tissue protruding from the vagina that may be tender and/or bleeding.
  6. 6. Grade of cystocele • Divided into 4 grade
  7. 7. Investigation • • • • • Pelvic examination Voiding cystourethrogram Urodynamics Cystoscopy Fluoroscopy.
  8. 8. Treatment • • • • Kegel exercises Estrogen replacement therapy Pessary (vaginal support device) Surgery
  9. 9. Complication • If case is left untreated, over time the condition may get worse. • Can cause to urinary retention (inability to urinate) which may lead to kidney damage or infection
  10. 10. Subjective Assessment Name : Age : Sex : D.O.Ax : Dr. dx: Dr. mx : Madam B 57 y/o Female 3rd October 2013 Mild cystocele with grade I uv prolapse conservative mx and refer to physio
  11. 11. C/c : Pt. c/o having incomplete urine and feel there’s mass protrusion at vaginal opening when BO. Problem occur many times in a week but no pain Current Hx : Pt. start having this problem since many years ago (not remember since when) but just recently came to see doctor at Klinik Kesihatan batu 14 and referred to physiotherapy General Health : Good PMHx : Pt. has DM and under medication ( since 5 years ago)
  12. 12. Medication / Steroid : • Pt. cannot remember the name Obstetric Hx : • Gravida 3 • 1st child, do abortion in 1975. 8/52 . D&c done
  13. 13. Gynecological Hx : Pt have 2 children - 2nd female child, born in 1976 wt. 3.9kg through svd. Episiotomy done. - 3rd female child, born in 1979 wt. 4.2 kg through SVD. Episiotomy done. Menopausal Status : already menopause since 5 years ago
  14. 14. Bowel fx : Normal Stress Incontinence : Present during coughing wt. minimal leakage Incontinence frequency : Everyday wt. moderate severity. Micturation Frequency : Day : 9 times Night : 1 time
  15. 15. No. of drinks : 1 Type of drink : Warm water (6 cups/day) Urgency : No Social Hx : Every evening, pt. go to jogging nearly 2 hrs.
  16. 16. Objective Assessment Observation : • Pt. is moderate size of Chinese lady. She presented with mild flabbiness of abdominal muscle. Palpation : • Unable to palpate d/t patient resist Special test : • Provocation test (-ve)
  17. 17. Analysis • Incontinence and bladder prolapse d/t pelvic floor muscle weakness • Pelvic floor muscle d/t weakness of slow twitch fiber (STF) and fast twitch fiber (FTF)
  18. 18. Goals Short term Goal : • To strengthen the pelvic floor muscle • To minimal the amount of protrusion Long term goal : To regain pelvic floor muscle control during stress activity
  19. 19. Plan of Treatment • Do kegel’s exercise • Biofeedback’s training • Kegel’s exercise on the gym ball • HEP
  20. 20. Intervention Kegel’s exercise Position : Supine lying wt both knees flex Instruction : Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Repetition : Do for 10 times
  21. 21. Biofeedback’s training Position : Supine lying with both knees flex Instruction : Put Ten’s pad to the pt. 2 at between ASIS. 2 at the pt.s’ gluteal fold. Cross the tens’ wire. Do the kegel’s ex. along with ten’s contraction. Duration : 15 minutes Precaution : Keep breathing and do not use help from abdominal muscle
  22. 22. Kegel’s exercise on the gym ball Position : Pt. sit on the gym ball with the leg slightly apart Instruction : During sitting, bring the gym ball to forward, backward and side. While bring the ball, do the kegel’s exercise. Duration : do for 10 minutes
  23. 23. Home exercise programme Ask pt. to do the kegel’s exercise at home for 80 times per day. Kegel’s can do in every static position like sitting and standing. Do kegel’s every times pt. fell like to do stress activity to pelvic floor muscles.
  24. 24. Evaluation • Pt able to do the kegel’s exercise correctly • KIV biofeedback training
  25. 25. Review • Reassess the grade of the pelvic floor muscle • Continue with biofeedback training and kegel’s ex. On the gym ball on next visit
  26. 26. Reference Book • Mantle J , Haslam J , Barton S ; Physiotherapy in Obstretrics and Gynaecology . 2nd edition . ELSEVIER ( 2005) • Madhuri G.B (2007) Textbook of Physiotherapy for Obstretrics and Gynaecological conditions , Jaypee Publishers.

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