Medical brain notes 42

  PELVIC SUPPORT DEFECTS   Pelvic support defects  comprise a variety of conditionsrelated to loss of connective tissue support surrounding the reproductive tract organs, including loss of uterine support, paravaginal tissue support, bladder wall and urethrovesical angle support, and support overlying the distal rectum.  Pelvic organ prolapse  is a disorder in which organshave lost their support and descend through the urogen-ital hiatus.  Patients with pelvic support disorders present inmany different and often subtle ways.  To identify patientswho would benefit from therapy, the physician should be familiar with the types of pelvic support defects and the approach to the patient with symptoms suggestive of these problems.   Although not exclusively a condition of advancing age, pelvic support defects are more common among women of this group, as tissues become less resilient and accumulated stresses have an additive effect.  Possible risk f...

  URINARY INCONTINENCE   The prevalence of urinary incontinence appears to increase gradually during young adult life, has a broad peak around middle age, and then steadily increases in the elderly. Urinary incontinence has been shown to affect women’s social, clinical, and psychologic well-being. It is esti-mated that less than one half of all incontinent women seek medical care, even though the condition can often be treated.   Types   Several types of urinary incontinence have been identified, and a patient may have more than one type (Table 28.1).   DETRUSOR OVERACTIVITY (URGE INCONTINENCE)   The normal voiding “reflex” is initiated when stretch receptors within the  detrusor muscle,  the layer of mus-cle that lines the interior bladder wall, send a signal to the brain. The brain then decides if it is socially acceptable to void. The detrusor muscle contracts, elevating the blad-der pressure to exceed the urethral pressure. The external urethr...

  URINARY TRACT INFECTIONS   An estimated 11% of U.S. women report at least one physician-diagnosed  urinary tract infection (UTI)  per year, and the lifetime probability that a woman will have a UTI is 60%.  Most UTIs in women ascend from bacterial contamination of the urethra. Except in patients with tuberculosis or in immunosuppressed patients, infections are rarely acquired by hematogenous or lymphatic spread. The relatively short female urethra, exposure of the meatus to vestibular and rec-tal pathogens, and sexual activity that may induce trauma or introduce other organisms, all increase the potential for infection (Box 28.1).  Estrogen deficiency also causes a decreasein urethral resistance to infection, which contributes to ascending contamination.  This increased susceptibility may explain the20% prevalence of asymptomatic bacteriuria in women over the age of 65. Of first infections, 90% are caused by Escherichia coli .The remaining 10% to 20%...