Pelvic Health

Question 1

Functions of Pelvic Floor

Answer 1

Urination, sex and reproduction, evacuation of stool and gas

Question 2

“S” Functions of Pelvic Floor

Answer 2

Supportive, Sphincteric, Sexual, Stabilization

Question 3

Anterior Anatomy

Answer 3

Symphysis Pubis

Question 4

Posterior Anatomy

Answer 4

Coccyx

Question 5

Lateral Anatomy

Answer 5

Ischial Rami and Tuberosities

Question 6

Anterolateral Anatomy

Answer 6

Inferior Pubic Rami

Question 7

Posterolateral Anatomy

Answer 7

Sacrotuberous Ligament

Question 8

Urogenital Triangle

Answer 8

Anterior, superficial muscle, first layer

Question 9

Anal Triangle

Answer 9

Posterior, second and third layers of muscle, external anal sphincter

Question 10

Levator Ani and Coccygeus

Answer 10

Largest muscle in group in PF
Responsible for most function/dysfunction
Innervated by S3-S5
Contract as a unit to support viscera and compress urethra, vagina, rectum

Question 11

Third Muscle Layer

Answer 11

Includes 2 PF muscles and 2 LE muscles
Impairments in piriformis or OI muscles contribute to PFM issues and vice versa
PC fibers interdigitate with the OI, therefore hip problems may be related to bladder/bowel issues

Question 12

Piriformis Problems

Answer 12

Muscle pads are posterior wall of pelvis, so they form a bed for the sacral plexus–sacral nerve roots can become affected

Question 13

PF Muscle Fiber Types

Answer 13

Tonic- Type 1 (support, 70%-Levator Ani)

Physic- Type 2 (act intensely, fatigue quickly, 30%, decrease with aging)

Question 14

Hip Adductors

Answer 14

Fibers interdigitate with Levator muscle

Can facilitate action of Levator muscles

Question 15

Gluteals

Answer 15

Frequently tightened with Levator muscles

Question 16

Abdominals

Answer 16

Play a role in IAP (pressure changes what is happening in the pelvic floor!)

Question 17

Connection between PF and Breathing

Answer 17

As you exhale, PF rises

As you inhale, PF comes down

Question 18

PF and Abdominal Connection

Answer 18

Transversus Abdominis is recruited to perform full PF contraction

Contraction of TA assists the pelvic floor to pull the bladder and urethra up and in

Question 19

PFM Function

Answer 19

Support pelvic organs using ligaments above and PFM function below
Increase IAP and force of gravity encourage protrusion of pelvic organs –> PFM activity should increase with increased IAP

Question 20

PFM Voluntary Contraction

Answer 20

PFM shortens moving cranial lay (upward)

Question 21

Voluntary Relaxation

Answer 21

PFM lengthens moving caudally (downward)

Question 22

Involuntary Contraction of PFM

Answer 22

PFM shortens before increase in IAP during cough, laugh, “knack”

Question 23

Involuntary Relaxation of PFM

Answer 23

Automatic PFM lengthening before defecation

Question 24

Risk Factors for PFM Dysfunction

Answer 24

Pregnancy and vaginal childbirth (also C-section)
Obesity
Chronic or repetitive coughing, vomiting, straining
Pelvic Surgery
Pain
History of sexual abuse
Muscle imbalance- trunk ad pelvis

Question 25

Childbirth

Answer 25

Vaginal- nerve compression and traction | Cesarean- record high, causes implications for PT

Question 26

Low Tone PFM Dysfunction

Answer 26

``` Under-active Pelvic Floor Laxity, loss of support- weakness Urinary Incontinence Fecal incontinence Pelvic organ prolapse ```

Question 27

High Tone PFM Dysfunction

Answer 27

``` Overactive PF Shortened muscle-weakness Trigger points- connective tissue restrictions Muscle guarding- poor relaxation Constipation Urinary urgency and frequency Incomplete Emptying Pain ```

Question 28

Sensitive Issues with PFM Dysfunction

Answer 28

``` Cultural, religious Possibility of past sexual abuse Ability to interpret nonverbal info Terms for genitalia Forms of sexual expression/identity ```

Question 29

Urinary Tract -Lower

Answer 29

Bladder, urethra, internal and external sphincters

Question 30

Urinary Tract- Upper

Answer 30

Kidneys and Ureters

Question 31

Continence Principle

Answer 31

Urethral Resistance pressure must be greater than bladder pressure

Question 32

Storage Phase- Adult Voiding

Answer 32

Bladder is relaxed, bladder files 15 drops/min, PFM are contracted

Question 33

Emptying Phase- Adult Voiding

Answer 33

At critical level of filling, strong sensation of dissension, PFM relax, bladder contracts

Question 34

Micturition Facts

Answer 34

Bathroom "just in case" is a bad habit Squatting over toilet may result in incomplete emptying Each urination street should last about 10 seconds

Question 35

Micturition Facts- Fluids

Answer 35

Decreasing fluids does not decrease incontinence and may increase urgency Some fluid can irritate the bladder--causes urgency!

Question 36

Urinary Incontinence Treatment Categories

Answer 36

Behavioral, Pharm, surgical Recommend the conservative option first!

Question 37

Prevalence of Incontinence

Answer 37

More than 15 million women in U.S. have SUI and 16 million have overactive bladder 1/10 women suffer from anal incontinence 11% of women likely to have pelvic surgery for UI and/or prolapse 29% will have multiple surgeries for PF dysfunction

Question 38

Urinary Incontinent Prevalence

Answer 38

25% of young women 57% of middle-aged women 75% of older women

Question 39

Urinary Incontinence in Athletes?

Answer 39

Athletes report significantly greater frequency of UI; must consider physical activity frequency and intensity related to UI

Question 40

Psycho-social Impact of Incontinence

Answer 40

QOL issues- avoidance, fear, limitations Self-esteem, emotional, relationships, activity, safety, cost

Question 41

Urinary Incontinence Types

Answer 41

``` Stress- outlet problem Urge- bladder problem Mixed- combo Overflow- over-distension of bladder Functional- inability to get to bathroom ```

Question 42

Stress Incontinence

Answer 42

Occurs with increase in IAP Loss of small amount of urine associated with physical exertion Cough, sneeze, lift, exercise, sex, position change

Question 43

Urge Incontinence

Answer 43

``` Associated with abrupt sense of urgency "Key in the Door" May be triggers Worsened by bladder irritants Leads to frequency ```

Question 44

Overflow Incontinence

Answer 44

Destructor muscle is under active (low SCI, DM, Meds) Urethral Obstruction (tumor, prolapse)

Question 45

Functional Incontinence

Answer 45

Inability to get to bathroom or remove clothing in time Result of gross or fine motor impairment

Question 46

Male Urinary Incontinence

Answer 46

Radical Prostatectomy, damage to internal untether all sphinchter during surgery, stress UI, dependent on pads