Physiotherapy: Management of O&G Disorders Flashcards
(17 cards)
Presentation of pelvic floor dysfunction?
Urinary symptoms: • Incontinence • Inability to pass urine • Hesitancy • Poor flow • Incomplete emptying
Pelvic organ prolapse
Vulvodynia
Faecal symptoms
Defaecatory dysfunction
Assessment of a patient?
History: • PMH - lung disease (chronic cough), surgery, DM (risk factor for urinary incontinence), neurological (e.g: MS) • O&G history • DH • SH - smoking (chronic cough), weight
Bladder diary
QoL measures; the goals are set by the patient
Method of allowing a patient to identify the characteristics of their stool?
Bristol stool form scale
Type 1 - separate hard lumps, like nuts (difficult to pass)
Type 2 - sausage-shaped but lumpy
Type 3 - like a sausage but with cracks on its surface
Type 4 - like a sausage or snake, smooth and soft
Type 5 - soft blobs with clear-cut edges (passed easily)
Type 6 - fluffy pieces with ragged edges, a mushy stool
Type 7 - watery with no solid pieces, entirely liquid
Details in a bladder diary?
Time of bathroom visit and volume passed (patient must measure their urine output); also includes the time to bed and time to rise
Any pads used
Total intake
ADD IMAGE
Ix for a patient presenting with urinary incontinence?
Urinalysis
Post-void residual - even a fully emptied bladder has ~50ml leftover
Visual assessment of the perineum, e.g: dryness, lichen sclerosis, skin infection
Vaginal +/- rectal examination (pelvic floor assessment)
Real time ultrasound biofeedback - abdominal or translabial methods
Pelvic organ prolapse
Method of grading pelvic floor muscle function and dysfunction?
Modified Oxford Scale and ICS:
• Grade 0 - no discernible contraction (ICS = absent)
• Grade 1 - flicker (ICS = weak)
• Grade 2 - weak contraction (ICS = weak)
• Grade 3 - moderate contraction (ICS = normal)
• Grade 4 - good contraction (ICS = normal)
• Grade 5 - strong contraction against maximal resistance (ICS = strong)
Effect of urinary incontinence on QoL?
Significant -ve effects on QoL
Detrimental effect on wider aspects of health, e.g: depression, fall, etc
For this reason, goals are patient-set
Lifestyle measures used to improve urinary symptoms?
Encourage healthy BMI
Avoid constipation - usually achieved with diet
Smoking cessation
Avoid heavy lifting
CAFFEINE REDUCTION
NOTE - lifestyle measures are 1st line
Further options to control bladder symptoms?
Bladder training
Voiding / double voiding techniques - double voiding is very useful for patients with prolapse, where they sit down and P from the prolapse prevents them from completely voiding
Pelvic floor exercises
Mx of bowel symptoms?
Regulate stool to type 4
If patient finds it difficult to wipe clean, lepicol or similar
Pelvic floor exercises
Holding on programme for urge
Holding on programme and caffeine reduction for frequency
Performing pelvic floor exercises?
Structured pelvic floor exercise programme, ensuring correct technique
Should be performed until muscle fatigue, several times per day for 15-20 weeks; a ‘knack’ should be achieved (contraction of the pelvic floor muscles before and during events that increase P on the pelvic floor, e.g: cough and sneeze)
Maintenance programme with, at least, daily exercises
What is biofeedback training?
Uses info about something happening in the body and presents it in a way that can be seen/heard
Can be used to help with learning to control/strengthen the pelvic floor muscles, using computer graphs; there are 2 techniques:
• Transabdominal ultrasound biofeedback
• Translabial ultrasound biofeedback
Management of incomplete bowel emptying?
Consider defaecation dynamics
Biofeedback training
Ferrneze - presses on the back of the vagina, pushing the prolapse away
Irrigation - water into the colon
Options for OTC biofeedback?
Pelvic educator
Vaginal cones
Kegel exerciser
Pelvic floor trainers
Muscle stimulators - inconclusive evidence; recommended for use in patients with muscle strength of grade 2 or less on the Modified Oxford Scale, for daily home use
Core-stability exercises?
Lumbo-pelvic cylinder: • Pelvic floor • Transversus abdominus • Diaphragm • Lumbar multifidus
Pilates
Gym ball
Use of pelvic floor exercises during pregnancy?
+ve effects of strengthening the pelvic floor in pregnancy
Women are encouraged to do pelvic floor exercises throughout pregnancy and after giving birth
Management of women who had a forceps delivery OR 3rd/4th degree tear inv. the anal sphincter complex?
Have 1-to-1 contact where exercise technique is discussed
For 3rd/4th degree tears, there is a follow-up appointment 10-12 weeks post-natally:
• Complete assessment
• More tailored programme of exercises
• Further treatment, if indicated
