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Flashcards in Pelvic Floor Rehab Deck (64)
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1

Pelvic Floor Overview

-3 layers of muscles
-layers of fascia surrounding

2

The pelvic floor is suspended

-from the pubis to the coccyx

3

Superficial (1st) Layer

-pudenal nerve
-sexual function
--contract to enlarge clitoris and penile erection
--vaginal sphincter assists in clitoral erection
--external anal sphincter

4

Middle (2nd) Layer

-Pudenal nerve
-sphincteric
--urethral sphincter
-slow twitch
-compress urethra and 1/3 of resting urethral closure pressure

5

Deep (3rd) Layer

-nerve to levator ani
-supportive (pelvic diaphragm)
-constricts lower end of rectum, vagina
-supports viscera (hammock)

6

6 Functions of Pelvic Floor

-supportive
-sexual
-sphincteric
-stabilizing
-withstands intra-abdominal preSSure
-Allows baby's head to Slide out

7

Muscle fibers in pelvic floor

-70% slow twitch
-30% fast twitch

8

Bony boundries

-Ant: symphusis pubis
-Anterolat: inferior pubic rami
-Lateral: ischial rami
-Lateral: ischial tuberosities
-Posterolat: sacrotuberous ligament
-post: coccyx

9

S2, S3, S4

Pudenal nerve

"S2, 3, 4 keeps the baldder off the floor"

10

3 First Layer Muscles

-superficial transverse perineal
-bulbocarvernosis
-Ischiocavernosis

11

Muscles of the 3rd Layer

-pubococcygeus
-iliococcygeus
-puborectalis

(levator ani muscles/pelvic diaphragm)

12

Muscles of 2nd Layer

sphincter urethrae

13

Other muscles of pelvic region

-coccygeus
-piriformis
-obturatur internus

14

Coccygeus

-flexes coccyx
-supports viscera
-stabilizes SI joint

15

Piriformis

-lateral hip rotator
-assist abduction with hip in flexion

16

Obturator Internus

-lateral hip rotator
-assist abd with hip in flexion

17

MMT of Pelvic Floor Muscles

-levator ani
--index finger along vaginal wall, on thickest part of levator ani
-ask pt to contract

18

Grading of MMT of PFM

-0=none, absent
-1=flicker, trace
-2=weak squeeze, no lift, weak
-3=fair squeeze, definite lift, moderate
-4=lift with squeeze, good
-5=strong squeeze with resistance, strong

19

Dynamic MRI

in upright position to understand PFM function

20

contraction of PFM is _____

-concentric

--moving coccyx in ventral, cranial direction

21

Coccyx pressed ___during straining

-dorsally

22

Real-Tie US to visualize PFM

-trans abdominal US to assess PFM function
-assess PFM activity when invasive procedure not appropriate or possible

23

normal # times to go to urinate per day

4-7 times

24

Negative Effects of Incontinence

-embarrassing (stop socializing due to fear of accidents)
-depression
-nursing home admits
-cost ($11.2 bill spent on pads/diapers)

25

Why they don't come in earlier

-belief it's expected part of aging
-rely on incontinence products
-embarrassed
-healthcare provider never ask them
-lack of awareness for treatment

26

Normal Voiding

-every 2-4 hours
-4-7x/day
-0-1x/night
-no just in case voiding
-urine stream steady for 8 seconds
-no straining
-no leaking (even after pregnancy)

27

Types of Incontinence

-urinary stress incontinence (USI)
-Urinary Urge Incontinence (OAB-overactive bladder)
-Mixed Urinary Incontinence
-Fecal Incontinence

28

Urinary Stress Incontinence

-involuntary loss of urine with activities: laugh, cough, sneeze, run, jump, lift

-incr IAB + weak PFL = leakage

29

Urinary Urge Incontinence

-invol loss of urine associate with strong urge to urinate

-running water, can't get pants down in time, key in door

-bladder instability causes contraction of bladder + weak pelvic floor = leakage

30

Male Incontinence

-most common after prostate surgery
-prostate adds support to bladder
-male pelvis narrow
-internal pelvic floor muscle exam (rectally)