Pelvic Floor Lecture Flashcards by Maria Benjamin

History

● Chief Complaint
● PMH
● Obstetric History
● Urinary symptoms
● Bowel symptoms
● Pain (Vulvovaginal, penile, rectal)complaints
● Sexual dysfunction complaints
● Fluid Intake and diet
● Employment/Social (what are the patient’s
functional requirements)

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MSK Exam

● Functional screening (gait, balance)
● Movement and posture analysis
● Breathing assessment
● Range of motion
● Flexibility testing
● Muscle testing
● Joint mobility
● Soft tissue assessment

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goal examples for PF

○ Patient is able to run 3 miles without leakage
○ Patient is able to increase time between voids to 2 hours in order to reduce
interruptions at work

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what % of PFM are fast twitch? slow twitch?

fast: 30%
slow: 70%

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“wall” of the pelvic floor

obturator internus
piriformis

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functions of PF

Support
Sphincter
Sexual
Stabilize
Sump Pump (blood/lymph)

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normal input from kidney and which mm activates / relaxes

1 mL/min input from kidney
pelvic floor relax
bladder contracts and empty all the way
bladder relax and pelvic floor / sphincter return to normal tone

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normal voiding

4-8 voids / day
or
interval of every 3-4 hrs

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night time voids

NONE

1x normal for over 65

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poor bladder habits

“just in case” peeing
semi squat
straining
drive by peeing (pushing to pee)
pelvic floor exercise on the toilet
post partum nocturnal habit

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○ Leakage of urine with increased intra-abdominal
pressure
○ Cough, sneeze laugh, exercise, change in position

stress incontinence

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○ Leakage associated with a strong urge, often on the
way to the bathroom

urge incontinence

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over active bladder

is urgency and frequency without leakage

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Leakage from a full bladder, urge to void missed or
blockage to urethra

overflow

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Patient with mobility issues preventing getting to the
bathroom in time

functional incontinence

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what are bladder irritants?

● Caffeine
● Alcohol
● Carbonation
● Artificial sweeteners
● Citrus juices/foods
● Tomatoes
● Spicy foods
● Chocolate

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“just do kegals”

● 40% women are unable to perform a pelvic floor muscle contraction with
verbal instructions alone
● Squeeze of posterior muscles, anterior muscles and cranial lift present for
correct contraction
● Full relaxation is important
● Where things go wrong
○ Preconceived ideas
○ Stop Test as practice

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T/F strength train an overactive pelvic floor is recommended

FALSE

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pt complains of:
Feeling of heaviness in pelvis, feeling of
something in the vagina (ball or stuck tampon)
● Tissue laxity assessed anterior, apical and posterior
● Associated Levator avulsion - 13% of births

prolapse

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ways to treat prolapse

Study These Flashcards

● PT trials 12-16 week: PFMT, behavioral modifications resulted in improved
symptoms and staging of prolapse
● PT + pessary (device to help with POP)

Pelvic floor mm training

Study These Flashcards

○ Coordination
○ Strength and endurance
○ Address breathing

behavior modifs

Study These Flashcards

○ Address poor voiding and defecation mechanics
○ Fluid Management and reduce bladder irritants
○ Bladder Diary
○ Timed Voiding
○ Weight Loss
○ Urge Distraction Techniques
○ Address constipation if present

cueing for correct contraction

Study These Flashcards

● General
○ Stop the flow of urine
○ Picture urethra as turtle head drawing back into shell
○ Try to stop from passing gas
○ Close the front passage / close the back passage
○ Tighten around the anus
● Female specific
○ Pick up marble/blueberry/raisin with your vagina
○ Try to close the labia as if they were saloon doors
● Male Specific
○ Shorten the penis
○ Contract the muscle like when you sit on a cold toilet seat
○ Lift the scrotum
○ Elevate the bladder

urge mgmt techniques

Study These Flashcards

○ Breathing
○ Quick Flicks
○ Distraction
■ Counting backwards by 7 from 100
■ Thinking of shopping list

as a PT choosing appropriate interval (if patient going to bathroom every 15 min then 2 hours
is not an appropriate interval, importance of building confidence in
themselves)

normal bowel movement

3x/day to 3x/week

favorable consistency of stool

Type 3,4,5 easiest to pass

T/F stool form is a better indicator of transit time than defacation frequency

fecal incontinence Tx

pelvic floor training especially EAS normalizing bowel consistency treat dyssnergia (coordination of the mm) rectal pain coccyx pain

Unsatisfactory defecation due to infrequent stools, difficult stool passage or both

constipation (considered part of aging but not caused by aging)

constipation prevalence ● 1⁄5 of population ● 2-3 times more common in ____ and in____ ● More common in non-caucasians and lower SES ● Common in ____ 0.7%-29.6%

women and elderly peds

contributing factors to constipation

● Metabolic Problems ● Fiber Deficiency ● Anorectal problems ● Medications

dysnergia / outlet constipation

puborectalis unable to relax or is contracting when attempting to defecate work on coordination

**Chronic pelvic pain** defined as pain in abdomen and /or pelvis that has lasted longer than ____, and is not caused by diseases or conditions such as dyspareunia, dysmenorrhea or endometriosis ● 90% pain with intercourse ● 50% depressed ● 1 in 7 American women ● 61% no diagnosis ● Vulvodynia 3-15% of women

3 months

vulvovaginal pain

● Post-delivery scar pain (sulcus, periurethral, perineal tears) ● Overactivity ● Vaginismus ● Shortened pelvic floor muscles due to pathology ○ Lichen Sclerosis, Planus, Simplex ○ Radiation ○ Surgery

● Pain in vulva not related to a specific, identifiable disorder ● Pt c/o discomfort with sensations of burning, irritation or rawness, knife-like pain ● Many contributing factors ○ Hormonal (including OCP use) ○ Neuroproliferative factors ○ Abnormalities of embryonic development ○ genetic/immune factors ○ infection

vulvodynia and vestibulodynia

pain treatment

● Pain Neurophysiology Education ● Downtraining of pelvic floor ○ Biofeedback ○ Breathing instruction ○ Physiological quieting/ progressive relaxation ● Graded exposure ○ Manual treatment ○ Speculum training ○ Sensate focus ● Dilator program ● Stretching ● Manual therapy ○ Joint mobilizations/manipulations ○ Soft tissue (muscle or connective tissue) mobilization

T/F you can do manips and mobs during first trimester

FALSE (b/c that's when most miscarriges happen)

patient c/o pain with transition from STS and feels a stretching sensation that causes the pain

round ligament pain

normal BP for pregnant women

140/90

PT tx during pregnancy

● Body Mechanics training ● Specific exercise ● Cardiovascular Exercise ● Manual Therapy ● Pain Science Education ● Sacroiliac belts, support bands, kinesiotaping

What is Diastasis Recti? ● How much separation is normal? ● DRA or hernia? ● How do I know if I have one?

● Abdominal wall separation between rectus muscle bellies at the linea alba - 1-2 finger separation normal. 2 1/2 indicates consult w/ MD - DRA is a separation of the abdominal muscles with no organ protrusion, while a hernia involves an actual protrusion of abdominal contents through a weakness in the wall. - perform a DR check test

DRA associated with

LBP Incontinence prolapse constipation

DRA risk factors

Female ○ Age > 33 ○ Multiparity or multiple gestation ○ Large baby ○ Greater weight gain ○ C-section birth ● Male ○ Obesity ○ Abdominal straining ○ Post abdominal aortic aneurysm surgery

Orthopedics ● Back and Hip pain Differential DX - - - - ● LBP with UI ● Orthopedic considerations for Intercourse ● Exercise Prescription

- proalpse - diastasis - incontinence - labral and pelvic floor issue

PEDIATRICS ● ____ is the primary cause of urinary accidents and bedwetting ● May have neurological conditions such as spina bifida or tethered cord that contribute to bowel or bladder dysfunction ● Questions to ask: ○ Do they have a history of reflux, abdominal pain, pain with bowel movements, bloating, poor appetite or fear of the toilet? ○ Do they ever have any leakage of any kind during the day or at night (including a smear or poop in their underwear?) ○ Are they wearing pull ups past the age of ____? ○ Do they wet the bed or notice peeing while laughing or playing? ○ "I don't ever want you to touch the poop, but if you were to pretend to smoosh it into a ball, would that ball of poop be bigger than your child's fist?"

constipation 4

GERIATRICS ● ____ is the 2nd reason for nursing home admissions ● Many older people have accepted their ____ because they have not been presented with treatment options ● Many may have already had a failed surgery ● ____ is embarrassing and many people are not forthcoming with information ● Screen for fecal ____

incontinence

Low back and hip pain

always ask urinary, constipation, pain with sexual activity, abdominal pain

Specific Screening questions

● Older adults - Are you having any loss of urine or stool beyond your control? ● Patients on pain medications - How often are you having a bowel movement? Are you straining or do you have pain with a bowel movement? ● Patients with Diabetes with peripheral neuropathy: Erectile dysfunction, increased urgency, frequency, nocturia, weak stream, incomplete emptying

primary care screening ROS

● Do you ever have any urinary leakage (even a small amount)? ● Do you feel a strong urge to urinate or have to rush to the bathroom? ● How frequently do you urinate? / Do you urinate more than 10 times/day? ● Are you able to have a bowel movement at least 3 times / week without pain or excessive straining or pushing? ● Do you have pelvic, vulvar or vaginal pain, or penile pain? ● Do you have any pain in the pelvis or pain with sexual activity ● If you are sexually active, are you able to be intimate the way you want to be without pain?

Pelvic Floor Lecture Flashcards

(49 cards)