CUA: Interstitial Cystitis (2016): Difference between revisions
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===== Physical Exam ===== | ===== Physical Exam ===== | ||
* '''Abdominal and pelvic exam''', with particular focus on looking for masses, bladder distension, hernias, and tenderness. | * '''<span style="color:#ff0000">Abdominal and pelvic exam</span>''', with particular focus on looking for masses, bladder distension, hernias, and tenderness. | ||
** '''The female pelvic exam should screen for vulvodynia, vaginitis, atrophic changes, prolapse, cervical pathology, and adnexal masses or tenderness'''. | ** '''The female pelvic exam should screen for vulvodynia, vaginitis, atrophic changes, prolapse, cervical pathology, and adnexal masses or tenderness'''. | ||
*** Point tenderness, a mass, and expression of pus on palpation of the urethra are classic signs of a urethral diverticulum. | *** Point tenderness, a mass, and expression of pus on palpation of the urethra are classic signs of a urethral diverticulum. | ||
* '''Digital rectal examination in males is essential''' | * '''<span style="color:#ff0000">Digital rectal examination in males is essential</span>''' | ||
* '''A musculoskeletal and focused neurological exam may also be contributory'''. | * '''<span style="color:#ff0000">A musculoskeletal and focused neurological exam may also be contributory</span>'''. | ||
** Although there is no physical finding specific to patients with IC/BPS, suprapubic tenderness and bladder neck point tenderness, in both males and females, is very often noted. | ** Although there is no physical finding specific to patients with IC/BPS, suprapubic tenderness and bladder neck point tenderness, in both males and females, is very often noted. | ||
** In males, tenderness may be elicited by palpating the perineal area between the scrotum and anus | ** In males, tenderness may be elicited by palpating the perineal area between the scrotum and anus | ||
** In females, palpating the anterior vaginal wall along the course of the urethra up to the bladder neck may elicit pain. | ** In females, palpating the anterior vaginal wall along the course of the urethra up to the bladder neck may elicit pain. | ||
* '''Palpation of the levator muscles''' in both sexes, looking for tenderness, spasm/tight bands, and/or trigger points, is important for both diagnosis and treatment recommendations | * '''<span style="color:#ff0000">Palpation of the levator muscles</span>''' in both sexes, looking for tenderness, spasm/tight bands, and/or trigger points, is important for both diagnosis and treatment recommendations | ||
** '''Pelvic floor or rectal spasms may respond well to pelvic floor physiotherapy'''. | ** '''Pelvic floor or rectal spasms may respond well to pelvic floor physiotherapy'''. | ||
** Hypo or hypersensitivity of the perineum, in combination with a weak or absent anal reflex, may suggest pudendal nerve entrapment. | ** Hypo or hypersensitivity of the perineum, in combination with a weak or absent anal reflex, may suggest pudendal nerve entrapment. | ||