Pelvic Health

Question 1

Functions of Pelvic Floor

Answer 1

Sphincteric
Support
Stability
Sexual
Sump pump

Question 2

Sphincteric

Answer 2

prevents leakage

Question 3

Support

Answer 3

support for pelvic organs, bladder, urethra, uterus, rectum

Question 4

Stability

Answer 4

the floor of the core
attachments to pelvis and hip

Question 5

Sump pump

Answer 5

lymphatic pump of the pelvis

Question 6

Layers of Pelvic Floor

Answer 6

Layer 1: sphincteric and sexual function
Layer 2: compresses and supports
Layer 3: Levator ani, supports, lifts, aids in pressure

Question 7

Perineum

Answer 7

inferior portion of the pelvic outlet
diamond shaped that connects coccyx, pubic bone, ischial tuberosities

Question 8

Puborectalis

Answer 8

Pubic bone and rectum
slings around the rectum, relaxes for defacation

Question 9

Chronic constipation…

Answer 9

tightness of puborectalis

Question 10

Fecal incontinence…

Answer 10

weakness of puborectalis

Question 11

Coccygeus

Answer 11

connects ischial spine to coccyx/sacrum
pulls coccyx anterior after defacation
responsible for tailbone pain

Question 12

Urinary Stress Incontinence

Answer 12

Involuntary loss of urine with physical exertion or effort, pelvic floor muscles aren’t strong enough to keep bladder closed

coughing, sneezing, laughing, exercise
common in pregnancy/postpartum, crossfitters, prostatectomy

Question 13

Urge Incontinence

Answer 13

contracting when not full
involuntary loss of urine with strong urge
associated with overactive bladder, urinary frequency, BPH in men

Question 14

Mixed Incontinence

Answer 14

Combo of stress and urge

Question 15

Bladder Norms

Answer 15

voiding every 2-5 hours
5-8 voids/day
0-1 voids a night
capacity is about 400-600 ml

Question 16

Dysfunctional Voiding/Bad Habits

Answer 16

Going just in case
hovering/semi-squatting
straining
kegels mid stream
reducing fluid intake to reduce frequency

Question 17

Stress Incontinence Treatment

Answer 17

pelvic floor strengthening
pelvic floor coordination retraining and diaphragmatic breathing, pressure management

Question 18

Urge Incontinence Treatment

Answer 18

voiding behavior education
SCRUB technique

Question 19

Behavioral Interventions

Answer 19

Avoid bad habits
limit bladder irritants
voiding schedule

Question 20

SCRUB

Answer 20

helps to control urinary urgency

STOP
CONTRACT
RELAX and breathe
URGE assessment
BATHROOM

Question 21

Age related bladder changes

Answer 21

Bladder capacity decreases
decreased bladder contractility
impaired emptying
increased residual volume
night urine production increases
pelvic organ prolapse

Question 22

Pregnancy issues

Answer 22

pelvic girdle pain
LBP
round ligament pain
pubic symphysis dysfunction
diastasis rectus abdominus

Question 23

Treatment for Pregnancy issues

Answer 23

contract vs relax of pelvic floor muscles
lumbopelvic stabilization
activity modification
belly support, KT tape

Question 24

Treatment considerations for pregnancy

Answer 24

avoid supine after 20 weeks
ligamentous laxity
edema
postural and COG changes

Question 25

Exercise guidelines for Pregnancy

Answer 25

150 mins/week mod intensity minimum 3 days a week do not exercise to point of breathlessness or exhaustion avoid exercises that could contribute to falling, diastasis recti, pelvic obliquity

Question 26

Postpartum

Answer 26

just because its COMMON doesn't mean its NORMAL pelvic girdle pain is the leading cause of disability postpartum

Question 27

Postpartum return to running

Answer 27

screen for stress incontinence and pelvic organ prolapse check for leaking, sensation for bulging, pain w/bathroom or period, can you walk 30 mins w/out pain

Question 28

Constipation

Answer 28

most common GI complaint, has to be at least 3 times a week screen in chronic low back pain Commonly caused by lack of fiber, lack of PA, recent surgery, chronically ignoring urge to go

Question 29

Treatment for Constipation

Answer 29

establish bowel routine defection mechanics-->positional, relaxation of pelvic floor, breathing abdominal wall massage diet

Question 30

Prolapse

Answer 30

descent of one or more of the pelvic organs associated with connective tissue laxity, loss of nerve, muscle, ligament or fascial integrity

Question 31

RF for prolapse

Answer 31

childbirth surgery chronic constipation or straining chronic cough

Question 32

S/S of prolapse

Answer 32

vaginal bulging pelvic pressure pelvic heaviness LBP constipation urinary incontinence

Question 33

Treatment for prolapse

Answer 33

activity modifications IAP management constipation management pelvic floor and abdominal strengthening

Question 34

Indications for internal exam

Answer 34

incontinence voiding dysfunction pelvic pain prolapse sexual dysfunction

Question 35

Contraindications to internal exam

Answer 35

lack of consent <6 weeks postpartum <6 weeks postoperative current infection sexual abuse hx pregnancy pediatric client

Question 36

What occurs during inhale?

Answer 36

diaphragm descends abdominals relax/expand pelvic floor lengthens/relaxes

Question 37

What occurs during exhale?

Answer 37

diaphragm rises abdominals contract/draw in pelvic floor contracts/lifts

Question 38

Cues for females for pelvic floor

Answer 38

Stop the flow of urine squeeze a marble vaginally pull pubic bone and tailbone together and in

Question 39

Cues for males for pelvic floor

Answer 39

stop the flow of urine lift the scrotum and retract the penis "nuts to guts"

Question 40

Tips for pelvic floor activation

Answer 40

ensure gluteals, abdominals, adductors are not gripping no breath holding relax AND contract are important

Question 41

Indications for pelvic floor strengthening

Answer 41

PFM weakness stress incontinence pelvic organ prolapse fecal incontinence PFM overactivity urge incontinence incoordination

Question 42

Contraindications for pelvic floor strengthening

Answer 42

overactive pelvic floor pelvic pain

Question 43

Dosage for pelvic floor strengthening

Answer 43

30-80 reps a day submax contraction, 10 second hold, 8 week training quick flicks and elevators coordination training, fast twitch Lifelong maintenance