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Pelvic Health/PT Flashcards

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1
Q

Who are pelvic health specialists?

A

PTs interested in treating pelvic health after graduating begin to continue this area of education while treating pts

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2
Q

Two pelvic health specialist certification

A
  1. Pelvic rehabilitation practitioner certification (PRPC)

2. Certificate of achievement in pelvic physical therapy (CAPP)

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3
Q

What can PT and OT both do?

A

Treat pelvic health problems and take continuing education

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4
Q

What can PT do that OT cannot

A

Treat the spine

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5
Q

Ability to treat the spine (PTs) is important for pt. who have pelvic pain involving…

A

The SI joints, coccyx, or pubic symphysis

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6
Q

Function of pelvic floor muscles

A
  • Support of pelvic organs
  • Coordination for bowel & bladder control
  • Trunk & pelvic mobility and stability
  • Sexual function
  • Lymphatic fcn
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7
Q

Three layers of pelvic anatomy

A
  1. Pelvic organs - bladder, bowels (rectum), prostate, uterus
  2. Supportive tissue - fascia, ligaments, connective tissue
  3. Pelvic floor muscles (3 layers)
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8
Q

Pelvic muscle layer one

A

Superficial perineal layer

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9
Q

Innervation of muscle layer one

A

Pudendal n.

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10
Q

What muscles are in layer one?

A
  • Bulbospongiosus
  • Ischiocavernosus
  • Superficial transverse perineal
  • External anal sphincter
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11
Q

Pelvic muscle layer two

A

Deep urogenital diaphragm layer

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12
Q

Innervation of muscle layer two

A

Pudendal n. and deep branch of the perineal n.

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13
Q

What muscles are in layer two?

A
  • Compressor urethra
  • Uretrovaginal sphincter
  • Deep transverse perineal
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14
Q

Pelvic muscle layer three

A

Pelvic diaphragm

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15
Q

Innervation of muscle layer three

A

Sacral n. roots S3-S5, levator ani n., pudendal n.

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16
Q

What muscles are in layer three?

A
  • Levator ani (iliococcygeus, pubococcygeus, puborectalis)

- Coccygeus

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17
Q

Other important pelvic floor muscles

A
  • Obturator internus

- Piriformis

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18
Q

Type 1 pelvic floor muscles are ____ twitch

A

Slow

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19
Q

Type 2 pelvic floor muscles are ____ twitch

A

Fast

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20
Q

Type 1 pelvic floor muscles account for ___% of the pelvic floor muscles, type 2 ___%

A

Type 1 - 70%

Type 2 - 30%

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21
Q

T/F: only type 1 muscles need to be trained

A

FALSE - both need to be trained

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22
Q

How do we train the pelvic floor muscles?

A

Kegel’s

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23
Q

Endurance kegels are useful for

A

Resisting urination

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24
Q

Quick kegel’s are useful for

A

Resisting a high degree of force/pelvic pressures (e.g. laughing, coughing, jump)

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25
How to check if a pt. is doing kegel's correctly
- Have pt lay in hooklying - Palpate the ischial tuberosity (w/ consent) - Bring fingers medial (approx 1/2 inch into levator ani) - Have pt. perform a kegel - You should feel a lift upward away from your finger - Have them hold for a count of 5, then relax fully - Then, have them perform quick squeezes with 1 count hold, then relax - Watch for compensations
26
Common compensations pt. do while attempting to perform kegel's
- Holding breath - Squeeze gluts - Squeeze hip adductors - Contract abd muscles (transverse abdominus)
27
What can retraining the pelvic floor muscles help do?
- Pelvic pain - Incontinence - Constipation - Pelvic organ prolapse
28
What else in important in addition to contracting pelvic muscles?
Fully relaxing them
29
What can you tell a pt. to do in regards to kegel's?
- Perform in many positions (e.g. lying down, sitting, standing) - Contract prior to activities that increase intraabd pressure (prevents urge or stress incontinenece)
30
Common locations for pelvic pain
- Low back, pelvis, hips - Abdominal - Pain w/ urination, bowel mvmts, sexual activity - Vaginal or labial pain
31
How many women worldwide have pelvic pain?
1/4
32
Causes of pelvic pain
- Bony changes - Muscle changes - Scars - Bowel & bladder dysfunction - Surgeries - Childbirth - Radiation, chemo
33
Common evaluation findings with pelvic pain
- Weakness or incoordination of core and pelvic floor muscles - Muscle tightness - Decreased muscle flexibility - Postural dysfunction - Poor body mechanics for mvmts - Poor positioning for sitting/standing/sleeping - Poor breathing patterns
34
What can disturb/disrupt pelvic nerves?
- Pregnancy - Childbirth - Surgeries - Muscle tightness
35
Damage to pudendal nerve is assoc. w/ what type of pain?
Perineal and pelvic pain
36
Damage to obturator nerve is assoc. w/ what type of pain?
Pelvic pain
37
Damage to sciatic nerve is assoc. w/ what type of pain?
Back, gluteal, hip, leg pain
38
Pelvic nerve pain can be treated w/
Manual therapy & exercise
39
What can cause scars in the perineal/vaginal/anal region?
- Episiotomy - Tearing during vaginal birth - Surgical procedures
40
What can cause scars in the abd region?
- C section | - Other surgeries
41
Sx r/t scars
- Decreased sensation @ scar site - Local pain, tenderness - Referred pain
42
Tx of scar tissue
- Manual therapy helps remodel tissue - Desensitization technique decreases pain, sensitivity of scars - Visceral mobilization (organs, ligaments)
43
Scar tissue is best treated
Immediately - resolves faster
44
What is pelvic organ prolapse?
When a pelvic organ drops from its normal position and pushes against the walls of the vagina
45
What causes pelvic organ prolapse?
Muscles that pelvic organs in place get weak or stretched (esp. after surgery)
46
Signs of pelvic organ prolapse
- Pressure, fullness or heaviness - Pain - Painful intercourse - Feeling of something falling out - Leaking of urine or constant feeling of need to urinate
47
Why does constipation increase with age?
- Scar tissue or immobility or organs - Slowing of metabolism - Decreased movement in general - Dietary changes - Decreased water intake - Comorbidities - Medications
48
Treatment of constipation
- High fiber diet (fruit, veggies, whole grains) - Increase fluid intake - Exercise - Defecate at the same time everyday - Do not strain; use stool or squatty potty - Abd massage - Kegels provide relaxation of pelvic floor
49
Types of incontinence
- Stress - Urge - Mixed
50
Is incontinence normal?
NO
51
What is stress incontinence?
Involuntary loss of urine with physical exertion
52
What is urge incontinence?
Urine loss that occurs with a strong desire to urinate | - Can have triggers such as running water, key in the door
53
What is mixed incontinence?
Stress + urge
54
What is required for normal urination?
Bladder contraction + pelvic floor muscle relaxation
55
Normal # of daytime urination
4-6x
56
Normal # of nighttime urination
0-1x (<65) | 1-2x (>65)
57
How long is normal urination?
8-10 sec
58
Normal fluid intake should be ___oz and not exceed ___oz
64; 96
59
Limit bladder irritants to ____ per day
0-1
60
What increases risk of incontinence?
- Venous insufficiency - Heart meds - Lung dz, chronic cough - DM - GI dysfcn - Surgeries (e.g. hysterectomy, C section) - Dementia - Obesity - Competitive athletes, aged 18-25 - Aging - Childbirth (increase w/ # of vaginal births)
61
Bladder tips
- Stay hydrated - Avoid irritants (e.g. coffee, tea, caffeine, sparkling water) - Sit when you void to allow muscles to relax - No "just in case" voiding - Don't rush to void
62
Why does nighttime voiding increase with aging?
- Produce less of a hormone that allows us to retain fluid | - Bladder loses its holding capacity
63
What is it called when there is a separation between the two sides of the rectus abdominis
Diastasis recti abdominis
64
Diastasis recti abdominis commonly occurs
After pregnancy d/t weakness of transverse abdominis
65
Diastasis recti abdominis increases risk of what
Back pain d/t incomplete ability to brace w/ lifting, carrying, prolonged positions, housework, and exercise
66
How to contract the transverse abdominis
Draw belly button toward spine while keeping neutral spine | - Coughing while palpating above and inside the ASIS to feel muscles engage
67
Pelvic health specialist can be used...
- Prior to testing to help with diagnosis - After testing to help with symptoms - Instead of medications to control sx, use muscles and habits - Pre-surgery - Post-surgery - After oncology tx -> decrease sx - Identify pt who does or doesn't need more testing or surgery
68
Examples of pelvic pain syndromes that are appropriate for referral
- Pelvic floor dysfcn - Vulvodynia/provoked vestibulodynia - Vaginismus - Painful scars - Endometriosis - Dyspareunia - Pudendal neuralgia - Levator ani syndrome - Coccydynia - Dysmenorrhea - Male pelvic pain
69
Examples of pelvic organ prolapse that are appropriate for referral
- Pre & post surgical
70
Examples of colorectal syndromes that are appropriate for referral
- Constipation - Fecal incontinence - IBS
71
Examples of bladder dysfcns that are appropriate for referral
- Urinary incontinence - Urgency/frequency - Interstitial cystitis - Dysuria/painful urination - Incomplete emptying - Chronic abacterial prostatitis - Post prostatectomy rehabilitation
72
Examples of pregnancy & post-partum mgmt that are appropriate for referral
- MSK pain - Diastasis recti - Painful episiotomy, C section scars - Carpal tunnel - Thoracic outlet
73
Other conditions that are appropriate for referral
- SI dysfcn - Post hysterectomy rehabilitation - Hip joint/thigh/groin pain

Geriatrics 2 (4 decks)

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