Using past history, symptoms, and results of the physical examination, my diagnosis for this patient, Eleanor, is pelvic floor dysfunction (PFD). It is a condition in which the pelvic floor, a group of muscles, is unable to be controlled properly because of an injury or weakness (Faubion et al., 2012). It happens most often to women (Wang et al., 2012), and Eleanor is a female. Pregnancy and childbirth may also cause impairment of the pelvic floor and cause PFD (Bartling et al., 2016). Eleanor has given birth twice, which further explains that her condition is most likely PFD. She is also currently 88 years old, an age in which numerous body parts may start to weaken, and this puts her at a higher risk for PFD (Wang et al., 2012). She also …show more content…
These include the bladder, rectum, and vagina and/or uterus (Elneil, 2009). Impairment to the bladder could cause urinary incontinence. This could cause having to urinate frequently, being unable to control urination, and suddenly urinating during coughs and sneezes. Rectum impairment could lead to bowel problems, constipation and fecal incontinence. These are all symptoms Eleanor experiences. Eleanor also feels a sensation of “something coming down” her vagina and this could be caused by pelvic organ prolapse, a problem involving organs “falling down” through the vagina and/or …show more content…
The pelvic floor supports numerous organs including the intestines (Bartling et al., 2016). The intestines are involved in the storage and elimination of packed waste material. Thus, problems with the pelvic floor could also cause problems with the intestines, which could then lead to constipation. PFD also causes problems in the relaxation and control of anal sphincters (Faubion et al., 2012). The anal sphincters are structures that control the release of feces, and there are two of them. The internal anal sphincter is involved in involuntary control, while the external anal sphincter is involved in voluntary control. Impairment in these structures may lead to impairment in bowel emptying (Faubion et al., 2012), which explains why PFD could cause Eleanor’s symptom of
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Women are normally affected during their childbearing years and develop pain in the pelvic region, menstrual cramps (dysmenorrhea), and pain with sexual intercourse (dyspareunia). Other features include infertility and an ovarian mass, which is typically felt on physical examination. Individuals may experiences gastrointestinal or urinary symptoms if ectopic endometrial tissue is next to the bladder or rectum.
During pregnancy, most women may experience overactive bladder or urinary incontinence. This can be mild or infrequent, while for others, it can be severe that can eventually affect their daily routine. This type of incontinence experienced during pregnancy is known as stress incontinence. It is the loss of urine due to increased pressure on the bladder, which makes the bladder sphincter unable to function properly when it comes to holding urine. Pregnancy hormones can also cause the pelvic muscles to relax for the anticipated delivery, which in turn affects the ability to control urine. These hormones also speeds up bloods’ filtration into the kidneys, resulting in accumulation of more fluid in the bladder.
The definition of uterine prolapse is the uterus gradually descends into the vagina and often times takes the upper portions of the vagina with it. Most often a prolapse is caused by weakened pelvic floor muscles and ligaments. It can present at any stage but often comes in three distinct stages. Once it descends into the vagina walls it can continue to descend until it actually protrudes out of the vagina entrance. In the 1st degree the cervix is still inside the vagina. In the 2nd degree the cervix appears outside the vagina opening and the labia can become irritated and ulcerative. In the 3rd degree there is a complete prolapse outside of the body and it can contain the bladder, uterus and rectum. This condition is sometimes called a complete procidentia. It can be caused by a multitude of reasons. Multiple vaginal births, having larger babies, excessive straining from constipation, heavy lifting or being overweight, weak pelvic floor muscles due to lack of use, aging or going through menopause. Although uterine prolapse can happen to anyone at any age, it’s most common in women who have gone through menopause and for many of the reasons stated above.
Gastroparesis is defined as a chronic symptomatic syndrome of delayed gastric emptying without any indications of mechanical obstruction.1 The etiologies for gastroparesis are diverse, but a majority of cases are from idiopathic causes or secondary to diabetes mellitus.2 In a study done of 146 patients with gastroparesis, 36% were suffering from idiopathic gastroparesis, 29% from diabetic gastroparesis and the remaining 35% had a variety of etiologies which included: postgastric surgery, Parkinson’s disease, collagen vascular disorders, intestinal pseudoobstruction and miscellaneous causes.3
Sphincter control is the human capacity to relax or contract sphincter muscles at will, although as we will see later, there are some sphincters we do not voluntarily control. Anal and bladder sphincter control is perceived as particularly important by people, considering they prevent us from the unexpected urine and fecal matter excretions. As such, much emphasis is placed on control of the sphincter during early childhood, when it is necessary kids to develop a control over their bowels. Generally, children begin to develop this capacity between 18 and 24 months. On other hand,
In the beginning I inferred that Eleanor may be overweight due to her hypertension medications. It’s important to change her lifestyle by losing weight, because obesity is one of the causes of pelvic floor dysfunction. When the muscles in the pelvic region does not contract properly, it is known as Pelvic floor dysfunction. Pelvic floor exercises will help increase contractions and improve coordination (Jundth, 2015). This treatment will also help improve urinary incontinence or stress incontinence. Surgery should be the last resort if the pelvic floor exercise treatment fails. The reason for so is because of the multiple side effects such as bladder perforation, persistent bladder emptying dysfunction, and internal bleeding (Jundth,
Arnold Kegel, a gynecologist from the University of Southern California, was the first one who highlighted the importance of pelvic floor muscles. The aim of Pelvic floor muscle Exercises (PFMEs) is to condition and strengthen the striated pelvic floor muscles through regular exercise in order to improve the urethral sphincter closure. Celiker Tosun O et al had done randomized controlled clinical trial on 130 women with stress and mixed urinary incontinence after random allocation of participants for pelvic floor muscle training (PFMT). The symptoms of urinary incontinence were significantly reduced in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training.49 García-Sánchez E et al presented a 10 years of data on effectiveness of pelvic floor muscle exercises and found that pelvic floor muscle training programmes are very effective even in preventing UI especially
Chronic constipation is more likely to cause rectal prolapse than infrequent, episodic constipation. Spinal cord injury or surgery might precipitate rectal prolapse as can a long-lasting habit of straining to have a bowel movement. Determination of treatment depends in part on the reason of the prolapse. Pelvic muscle workouts would not be useful in prolapse occasioning from perpetual neurological impairment to the involved muscles. Reddish-colored tissue might protrude from the anus, particularly after a bowel movement. Trivial amounts of rectal bleeding might be noted intermittently. Contingent on the severity of the prolapse, fecal incontinence might occur.
• A referral to a specialist (such as a urologist or surgeon) to check for any loss of function in the affected body part.
Elimination disorders are responsible for the inappropriate elimination of urine or feces and are commonly first diagnosed in childhood or adolescence. This group of disorders includes enuresis, the repeated voiding of urine into inappropriate places, and encopresis, the repeated passage of feces into inappropriate places. In Enuresis, we can find the presence or absence of constipation and overflow incontinence for encopresis. However, there are minimum age requirements for diagnosis of Enuresis and Encopresis. These requirements are based on developmental age and not especially on chronological period of time. Enuresis and Encopresis disorders can be volimtary or involuntary because both disorders happen discretely, although coincidences may also be observed in many cases.
Endometriosis is when the endometrial lining of the uterus bleeds and attaches to other organs and healthy tissues in the body. There is no one organ endometriosis favors it had been known to attach to the bladder, bowel, intestines and fallopian tubes. All though it has been found in the lungs and heart.
Proctosigmoiditis involves the rectum and the lower end of the colon (the sigmoid colon). Common symptoms of this form of UC are bloody diarrhea, an inability to make bowel movements known as tenesmus, and abdominal pain.
Inflammatory bowel disease is a life long disease, and it particularly targets the gastrointestinal tract (GI tract), which consists of the mouth, esophagus, stomach small intestine, large intestine (appendix, cecum, colon (ascending, transverse, descending, and sigmoid), and rectum), and anus. The gastrointestinal tract is very important to the human body; some of its functions include mechanical and chemical digestion of food, the movement of food and waste from mouth to anus, secretion of enzymes and mucus, and the absorption of nutrients. These are some reason why it’s so destructive when this part of the body becomes impaired or even damaged.
Acupressure sessions to reduce her back pain & excessive urination. It is done by applying pressure to certain points on the bladder meridian.