pelvic health

Question 1

components of pelvic floor, describe (4) what is it marked by (2)

Answer 1

2 innominate (ischium, ilium, pubis), coccyx, sacrum
pelvic inlet (entrance), outlet (exit)
inlet cranial to outlet

Question 2

differentiate false and true pelves (area, organs it holds)

Answer 2

false pelves - iliac crest to pelvic inlet; liver, intestine, uterus, when urinary bladder is full
true pelves - inlet to outlet; sex organs, rectum, urinary bladder

Question 3

main ms of pelvic diaphragm and innervation

Answer 3

levator ani (puborectalis, pubococcygeus, iliococcygeus); innervated by S2-S4, pudendal nerve
also coccygeus (not part of levator ani but ms of pelvic floor)

Question 4

ms of levator ani and their attachments

Answer 4

pubococcygeus - pubic bone, coccyx
puborectus - pubic bone, rectal opening; tightens rectal sphincter
iliococcygeus - coccygeus and obturator internus (not ilium)

Question 5

function of compressor urethrae, urethrovaginal sphincter, external anal sphincter

Answer 5

compressor urethra - compresses urethra and ventral wall of vagina
urethrovaginal sphincter - supports perineal body and introitus ( external opening of vagina)
external anal sphincter - closes anus

Question 6

what ms of perineal pouch can be found in both sexes, and what are found in only females?

Answer 6

both: external urethral sphincter, deep transverse perineal membrane
females: urethrovaginal sphincter, compressor urethra

Question 7

functions of pelvic floor ms (5)

Answer 7

support pelvic floor organs
withstand intra-abdominal pressure
stabilize spine and pelvis
continence thru control of sphincters
reproductive function

Question 8

define incontinence, list types (4) differentiate

Answer 8

incontinence - involuntary loss of urine

1. stress - bladder cant hold pressure
2. urge - heightened sense of urgency; hypersensitive bladder
3. overflow - bladder too full; or hyposensitive reflex
4. mixed - both hypersensitive and unable to withstand much pressure (stress + urge)

Question 9

anatomical changes in pregnancy

Answer 9

1. weight gain
2. postural changes - inc COG
3. balance changes - weight gain, inc abdominal size

Question 10

systemic changes in pregnancy (5)

Answer 10

CV, pulmo, posture & balance, genitourinary, MSK

Question 11

genitourinary changes (3)

Answer 11

• inc uterus size 25-36cm
• inc kidney size by 1cm
• ureter goes into bladder perpendicularly (increased risk for UTI)

Question 12

pulmo changes (2)

Answer 12

• breathes deeper later on becomes tachypneic; inc oxygen demand
• rib cage goes up & pulmonary secretions; diaphragmatic pressure as baby grows

Question 13

CV changes

Answer 13

• inc blood volume 35-50%
• inc cardiac output - 30-60%
• dec BP d/t vein distensibility

Question 14

MSK changes (3)

Answer 14

• ms elasticity, jt laxity -> to help in delivery (separation of pubic bone etc)
• abdominal wall gets stretched, weakness (possible: diastasis recti)
• pelvic floor drops d/t inc weight (1in)

Question 15

posture and balance (6)

Answer 15

• inc COG
• inc BOS when walking
• cervical and lumbar lordosis
• genum recurvatum (knee hyperextension)
• changes can’t automatically be corrected after childbirth
• rounded shoulders and upper back

Question 16

pregnancy induced pathology (7)

Answer 16

1. pelvic floor muscle injury during childbirth
2. diastasis recti
3. posture related back pain
4. sacroiliac/pelvic pain
5. varicose veins
6. joint laxity
7. nerve compression

Question 17

effect of childbirth to pelvic floor ms

Answer 17

1. overstretching of pelvic floor ms
2. tearing/incision of pelvic floor ms
3. vaginal prolapse (bladder, uterus, rectum)

Question 18

degree of lacerations

Answer 18

1st deg - skin
2nd deg - superficial ms layer
3rd - reaches sphincter
4th- sphincter to rectum

Question 19

classification of pelvic floor dysfunction (3)

Answer 19

incontinence, prolapse, pain/hypertonicity

Question 20

roles of PT in caring for pregnant women (6)

Answer 20

• preparing for childbirth
• improving fxal ROM
• improving posture and trunk stabilization
• prevent LBP/pelvic pain
• improve pelvic floor awareness, strenght and training
• improve overall health, quality of life, overall well-being

Question 21

general interventions (2) and details of each (2-3)

Answer 21

pt. educ - pelvic floor anatomy, exercise instruction
neuromuscular facilitation - facilitate pelvic floor activation, isolate pelvic floor contraction, integrate pelvic floor contraction into ADLs, fxal activity

Question 22

AVOID (pt. educ) [6]

Answer 22

• avoid valsalva
• do not lie in supine for more than 5 mins; if supine, look to left at an angle
• avoid prolonged motionless standing
• avoid single leg exercises
• stop exercises if there is pain
• dont exercise in high temperature/humidity

Question 23

ENCOURAGE (pt. educ) (3)

Answer 23

• adequate caloric intake (eat enough)
• movement is important; position changes
• complete bladder emptying -> avoid downward pressure on pelvic floor
• do warm-up and cool-down activities

Question 24

diastasis recti (ax and tx)

Answer 24

ax: hook lying, towel or brace abdominals, partial curl-up
- place fingers over umbilicus (3 parts- above, around, below) , see if there’s separation of rectus abdominis/tearing of linea alba
- (+) 2in width
tx: partial curl-ups with bracing

Question 25

precautions for exercise in pregnant women (8)

Answer 25

gestational diabetes, severe anemia, systemic infection, obesity/underweight, diastasis recti, MSK issues (e.g., jt laxity), overheating, extreme fatigue

Question 26

absolute CIs for pregnant women (10)

Answer 26

premature birth, other factors implying premature birth (multiple gestation, incompetent cervix/early dilation), placenta comes first before baby, vaginal bleeding 2nd or 3rd term, water break, preeclampsia (pregnancy HTN), maternal thyroid/heart/resp disease, maternal T1 diabetes, intrauterine growth retardation

Question 27

signs of overexertion/complication (11)

Answer 27

vaginal bleeding, leakage of amniotic fluid (water leak), dizziness, pain, SOB, tachycardia, dec fetal mvmt, irregular heartbeat, swelling/pain in calf, persistent pain in pelvic girdle/chest/low back, hard to walk

Question 28

guidelines for exercise: stretching (3) fitness exercises (3)

Answer 28

stretching: dont go past normal range, go for single ms groups instead of compound, avoid overstretching hip and pelvic muscles fitness: RPE=12-14; dont use HR, go for low reps low intensity, NEVER exercise to exhaustion, avoid sports/exercises with high risk of abdominal trauma/falling

Question 29

critical exercises for pregnant women (6)

Answer 29

- postural exercises - diastasis recti activities (head lift - w pelvic tilt) - stabilization exercises (supine-cervical; quadruped-thoracolumbar) - dynamic trunk exercises (pelvic tilt, pelvic clock, trunk curls) - modified strengthening exercises (push-ups, squats, bridging, leg raises, scaps retract) - perineum adductor flexibility

Question 30

pelvic floor awareness training (4) and volume, rationale

Answer 30

1. contract-relax (hold for 3-5s, 10reps) - tighten pelvic floor 2. quick contractions (15-20 reps) - develop T2 ms fibers, withstanding pressure 3. elevator (start with a few floors then increase; practice control) - strengthen levator ani 4. pelvic floor relaxation - start at 1st floor of elevator

Question 31

unsafe exercises/postures (7)

Answer 31

1. (B) SLR -> uni is fine 2. fire hydrant pose 3. hip extension in quadruped -> knee flexed is fine 4. lying in supine for longer than 5 mins 5. quick posture changes -> OH 6. unilateral WB exercises 7. prolonged static standing

Question 32

exercises for postpartum (3)

Answer 32

- strengthening and aerobic exercises - diastasis recti correction - pelvic floor awareness, strengthening

Question 33

oliviera 2007

Answer 33

Causes increase in PFM pressure and strength during pregnancy (olive pressure)

Question 34

price 2010

Answer 34

preventing leakage postpartum, managing urinary incontinence (stress, mixed) (price leakage)