Lecture 4 - Pelvic floor health Flashcards
What is pelvic floor dysfunction (PFD) and what are the different symptoms?
When pelvic floor muscles (PFM) are weak or tight
- Bladder/bowel incontinence
- Incomplete emptying
- Pelvic organ prolapse
- Pelvic pain
- Dyspareunia = intercourse pain
Describe the features and prevalence of bladder/bowel incontinence
- Any age, both genders, embarrassing = hidden, 1 in 3 with bladder = bowel
- Greatly affects quality of life
What are the 6 types of incontinence?
- Stress = PFM not strong enough to support downward pressure
- Urgency = PFM not strong enough
- Overflow = holding too much no proper emptying
- Leaking with coughing, sneezing etc
- Gotta go might not make it = bladder muscles can’t stay calm filling
- Leaking constantly unaware
What is the process of physio for reducing incontinence?
- Eliminate red flags and triggers, find cause
- Pelvic floor exercies
- The Knack
- Bladder calming
- Fluid and fibre intake
- Voiding dynamics = posture
- Defaecation dynamics
- General exercise and health
Describe the location of the pelvic floor muscles and why they control the bowel and bladder
- Coccyx -> anal sphincter -> around and thru vagina (or not) -> urethra -> pubic bone
- Anal sphincter and urethra = control
Describe how a physio explains how to do pelvic floor exercises
- Sit up and forward on perineum and pretend to hold back urine, squeezing and releasing slowly
- Don’t push and don’t start/stop quickly
- Start small up to 8-12reps 3x day
What is the Knack, when is it used and how is it explained by physios including how the PFM work
- Ability to isolate and turn on muscle when you need it by grouping muscles correctly
- PFM + transverse corset stomach muscles = pelvis + spine
- Breathing + wearing tight jeans, feet hip width and butt tucked, squeeze up like holding urine
- Use before coughing or sneezing
What are the signs and triggers of an overactive bladder (OAB)?
- Signs = urgency, frequent, nocturia, urge, bedwetting
- Triggers = latch-key, water, going to toilet, standing after sitting, getting out of bed, anxiety, cold
Describe how bladder training is used to reduce an overactive bladder
- No fizzy, caffeinated, irritating drinks
- 1.5-2L max fluid intake incl food
- Calming tactics = crossing legs, clenching toes (posterior tibial nerve = inhibitory bladder), tongue behind teeth (same spot in brain as urge)
What are normal bladder habits?
- 4-6x day, optional 1x night
- 250-550mL each = 1500mL total
- 2L max intake, no irritants
- No straining, no just in case
What is voiding and what is the correct voiding posture?
- Ability to empty bladder easily and completely at a socially appropriate time
- Full squat hands on knees lines up brain, SC, detrusor bladder muscle, urethra and PFM
What are normal bowel habits?
- 3x day->3x week
- Type 3-4 = smooth-bumpy sausage
- Correct position, no strain, no pain, no bleeding, completion, normal desire to go
What are the stats on bladder and bowel incontinence?
Bladder
- 38% women 10% men
- 70% don’t seek help
- 75-81% nursing home
- 1 in 5 children bedwet (boys>girls)
Bowel
- 12.9% women 6% men
- One of 3 causes of aged care admittance
