Case Study Pelvic Floor Dysfunction

Incontinence is one of the major problems faced by the elderly. Nurses can play a significant role in discovering continence problems (Lea R.et.al.2007). Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect more than 50 million people in the developed world.(NHS.UK). To identify the problem and provide necessary treatment at the early stage, a thorough physical assessment is necessary.

HISOTRY OF PRESENT ILLNESS: This 40-year-old Latin female presents with complaints of low back and right leg pain she said that she hurt her back in a motor vehicle accident three years ago and she has had a history of intermittent low back pain since that time. Last December she started a job where she had to lift boxes that weighed approximately 40 pounds. Around the first of January this year she began to complain of back pain that

with diagnosis, treatment, and follow-up of IC patients. With this in mind, I feel my research can help in getting the word out there about IC/PBS, and Chronic Pelvic Pain (CPP).

“Oh, this is awful,” Jenny muttered to herself. She was sitting on the toilet with a pair of very wet panties and slacks around her ankles. Jenny never knew when it would hit―this need to urinate quickly. She would find herself running to the bathroom like a woman possessed and then usually not making it in time. “It also seems like I’m peeing all the time,” she said. “This is getting old really fast,” she thought, as she continued trying to squeeze the urine out of her panties using quantities of toilet paper.

For the purpose of this assignment the chosen title is ‘structured skin care regimes based on cleanse, moisture and protect must be seen as an essential components in the prevention of incontinence associated dermatitis’ (Holroyd, 2015). Incontinence associated dermatitis (IAD) (see Appendix 1) results due to damage to the skin. The areas of skin usually affected include the perineum, perianal area, buttocks, inner thighs, sacrum, and coccyx. The damage occurs due to prolonged exposure to any form of moisture. This moisture exposure can occur from a variety of sources or causes –which includes faecal or urinary incontinence, highly exuding wounds, excessive perspiration and peri-stomal skin. The skin becomes erythematous, macerated, denuded, and inflamed following exposure moisture (Beeckman et al. 2011).

constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination.

Asymptomatic patients would have functional impairment such as, dementia, urinary, and bowel incontinence. According to Urinary Tract Infections in the Elderly: Symptomology and Prevention, classic signs and symptoms of a urinary tract infection includes; dysuria, urgency, frequent urination, flank pain, suprapubic pain, fever, cloudy urine, urine with foul odor, recent onset of urinary incontinence. In elderly patients with a urinary tract infection may exhibit signs of altered mental

Latest investigations propose a higher prevalence of SUI in postmenopausal women who have a collagen type I α1Sp1polymorphism (Sioutis, 2011). In other studies, connected risk factors included lower urinary tract symptoms (LUTS), impaired mobility, and urethral surgery or irradiation is connected with UI in both men and women. Urinary incontinence is common after a cerebrovascular accident (CVA). (Divani, 2011). Also, condition such as arthritis or parkinson’s disease may slow the ambulation of elders in addition to their ability to manipulate clothing (Miller, 2012, & Offermans, Du Moulin, Hamers, et al, 2009). similarly, dementia, depression, and delirium can get in the way with the ability to know toileting needs and perform the necessary psychomotor activities involving in the toileting (Good, Burgio KL, Richter,et al, 2010). As elderly people with dementia may have problem with holding on, finding the toilet, knowing or remembering how to take his or her clothes off and pull their pants down, knowing when their bladder is empty, or being unconscious of the need to go to the toilet (DoHA, 2010). As well, UI may be the primary signs of urinary tract infections (UTIs). A study done in Pakistan (2010) found that, UTIs are common reason of UI, with a yearly

She has refused to have a shower and do her routine ROM exercises due to the pain in her knee. She requires assistance to perform ADLs at this stage and expresses feelings of embarrassment and frustration. Mrs. Green has also reported that she has not opened her bowels since the operation.

In women, pelvic organs (bladder, uterus, vagina, small bowel, and rectum) are well supported by the cardinal ligaments, levator ani skeletal muscles and the endopelvic fascia that comprise the Pelvic Floor (DeLancey, 1992). Pelvic Organ Prolapse (POP) is a very common condition affecting millions of women worldwide. It is the downward descent of the pelvic organs and/or vault into the vagina due to the weakened or damaged pelvic floor support structures (Figure 3) (Jelovsek et al., 2007). There are different types of POP depending upon the organs that herniate through the vagina. Cystocele occurs when the bladder herniates through the weakened anterior vaginal wall. Enterocele is the descent of small bowel into vagina and rectocele occurs

The pelvic floor, also called pelvic floor, consists of a thin layer of muscle fibers and connective tissue enclosing the pelvic cavity at its lower portion and the sacrum. The pelvic floor muscles are made up of the urethra, vagina and anus.

The current medical literature shows that imaging such as MRI is essential in the diagnostic criteria for transverse myelitis (Frohman, 2010), (Goh, 2011), (Beh, 2013). The patient complainted of urinary incontinence could be due to a number of medical conditions not related to transverse myelitis. The differential diagnosis for urinary incontinence in a female patient include child birth history, aging, urinary tract infection,

I will still continue the same process in manging this case with adding several more components during the screening process. Since the trunk instability could affect the lower limb, I woulde investigate about the lumbo-pelvic stability to see if thre is any instablity or weaknes in those area. Additionally, I would add in this process a screnning for the central sensitisation. Sence the injury hapend long time ago, the soft tissu that injuried should be healed. However the brain may still think the injury still there, thus produce pain bilaterally. I would screen for the stress when the injury occured and if there are any stress in the family as well as if there are any history of other injury, which indicat central sensitisation. Moreover,

Pelvic floor muscle denervation has been implicated in the pathophysiology of urodynamic stress incontinence (USI).(66) The EMG techniques have been used to identify sphincter injury after childbirth and to evaluate women with USI. Stress incontinence and genitourinary prolapse were associated with partial denervation of the pelvic floor.(122) The changes were most marked in women who were incontinent after delivery, who had a prolonged second stage of labor, and had given birth to heavier babies. In some studies, nearly all EMG parameters showed significant differences between continent and SUI women consistent with better motor unit recruitment in continent women. Continent women had larger amplitude, longer-duration MUPs with increased turns

The bladder and urinary tract depict the epitome of various old age associated conditions. Urinary incontinence otherwise known as loss of bladder control is a common problem associated with aging. Besides old age, diabetes and other conditions also contribute to incontinence. Other common conditions include menopause for women and enlarged prostate for men.