Pelvic Floor Rehab Flashcards Preview

Medical Conditions II > Pelvic Floor Rehab > Flashcards

Flashcards in Pelvic Floor Rehab Deck (64):
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)

31

Bladder muscle

-detrusor muscle (smooth muscle)

32

Micturition

-urination

33

When male contracts PFM:

-penis will lift upward

34

causes of incontinence

-weak PFM
-abdominal weakness
-pregnancy
-vaginal delivery
-episiotomy
-estrogen depletion
-meds
-infections
-high impact activity
-diabetes
-stroke
-obesity
-pelvic nerve injury
-prior surgeries
-organ prolapse
-neuro conditions (MS)

35

POP

-Pelvic Organ Prolapse
-tested in supine with bearing down

36

Exam of POP

-2 fingers into vagina and bear down
-observe/feel for displacement of tissue
--anterior: bladder (cystocele)
--apical: uterus (uterine prolapse)
--posterior: rectum (rectocele)

37

Cystocele

-displacement of bladder creating bulge into ant vaginal wall

38

Rectocele

-displacement of rectum creating a bulge into posterior vaginal wall

39

Uterine Prolapse

-displacement of uterus downward into vaginal vault

40

Grades of Organ Prolapse

Grade I: mild bulge (25%)
Grade II: mod bulge (50%)
Grade III: severe bulge, into vaginal opening (introitus)
Grade IV: bulge completely out

PT for grade I and II

41

Precautions/Contraindicatoins for Internal PFM Exam

-pregnancy
-immediate post-partum (6 weeks)
-active infections
-severe pelvic pain
-history of sexual abuse
-inadequate training of PT
-absence of pt agreement
-menses not necessarily a contraindication

42

PFM Contraction

-accessory muscle use
-hold time (endurance)
-repetitions
-Fast contraction (how many fast before fatigue)
-PERFECT Score

43

PERFECT Score

-power
-endurance
-repetitions
-fast

44

Anal Wink Reflex

-stroke side of anal sphincter
-should contract

Rectal branch of pudenal nerve

45

PT for Incontinence

-muscle re-ed (kegel, abdominal)
-biofeedback
-diet (avoid bladder irritants--acidic)
-postural education/ortho
-E-stim
-diaphragmatic breathing

46

Vaginal Weights

-sensory feedback to muscle contraction
-progressive resistive exercise
-5 progressive weights (20-70g)
-progress supine to standing

47

Bladder Irritants

-alcohol
-carbonated
-caffeine
-artificial sweeteners
-dairy
-coffee, tea, (even decaf)
-tomatoes
-tomato based products
-spicy foods
-citrus
-chocolate
-sugar/honey

48

bladder training technique

-scheduled voiding
-pt education for urgency control
-self monitoring with bladder diary
-reinforcement

49

Pelvic floor exercises

-contract: close sphincters, vagina and rectum
-Rela: open sphincters, vagina, rectum
-Bulge/expand/drop: for bowel movements/voiding

50

Kegel Exercises

-ID correct muscle
-do not contract abdominal, gluteal or hip addcutors
-pull up and in with PFM

51

Quick Flicks

-PFM hold 1 sec

52

Slow Holds

-PFM 10 second hold

53

Pelvic Floor Instruction

-life, draw up and in, squeeze and close
-wink the anus, move the penis
-pull underwear/tampon in
-lift your perineum off the chair
-hold back gas

54

Pelvic Floor Educator

-device to improve pt understanding and motivation
-used with HEP
-plastic piece with stick so pt can see it move with contraction

55

When doing Kegels:

-push to limit and a little beyond but never to fatigue

56

to make a change

-do 40-60 PFM contractions per day

57

Average ____ visits over ____

4-8 visits

2-3 month period

58

2nd most common complaint in GYN

-pelvic floor pain

59

Levator Ani Syndrome

-spasming of levator ani Mm

60

PFM Disorders

-levator ani syndrome
-coccyodynia
-connective tissue dysfunction
-vaginismus/vulvodynia
-pelvic floor tension myalgia

61

Vaginismus

-can't open vaginal opening bc muscles too tight

62

Organic Diseases

-interstitial cystitis (painful bladder syndrome)
-endometriosis
-pelvic inflammatory disease

-subsequent pelvic floor pain

63

Typical Complaints

-feels like insides falling out
-pressure in pelvis
-constipation/trouble starting urine
-vagina aches deep inside
-feels like sitting on golf ball

64

Questions to ask?

-prior injuries
-surgeries/childbirth
-pn with or after sexual intercourse
-pain/pressure/aching in suprapubic, vaginal or rectal area
-abuse