Women's Health

Question 1

What is stress urinary incontinence? (SUI)

Answer 1

Involuntary leakage of urine on effort or exertion, or on sneezing or coughing.

Question 2

What is urge urinary incontinence?

Answer 2

Involuntary leakage accompanied by or immediately preceded by urgency.

Question 3

What is overactive bladder?

Answer 3

Urinary urgency, with or without urinary incontinence, usually accompanied by frequency and nocturne.

Question 4

What is post-prostatectomy incontinence?

Answer 4

Incontinence occurring after prostate surgery, likely caused by bladder dysfunction or urethral sphincter dysfunction due to muscle or nerve injury.

Question 5

What is pelvic organ prolapse?

Answer 5

Abnormal descent of pelvic organs (uterine prolapse, cystocele, rectocele).

Question 6

What is peripartum low back, and pelvic girdle pain?

Answer 6

Pain in the low back or pelvic girdle occurring during or after pregnancy.

Question 7

What is a diastasis recti?

Answer 7

Separation of the two sides of the rectus abdominus at the linea alba with a widening of the linea alba greater than 2 cm.

Question 8

What is pelvic pain syndrome?

Answer 8

Pain in the pelvic floor musculature or surrounding structures; may be associated with a variety of diagnoses. .

Question 9

What is the “pelvic floor?”

Answer 9

Clinically, it is the muscles of the pelvic diaphragm and the perineum. It is split into 3 layers: superficial, middle, and deep.

Question 10

Which muscles are in the superficial layer of the pelvic floor? (3)

Answer 10

1. Superficial transverse perineal muscle
2. Bulbospongiosus muscle
3. Ischiocavernosus muscle
4. External anal sphincter

Question 11

Which muscles are in the middle layer of the pelvic floor? (3)

Answer 11

1. Compressor urethrae
2. Urethrovaginalis sphincter
3. Deep transverse perineal

Question 12

Which muscles are in the deep layer of the pelvic floor? (4)

Answer 12

Levator ani group:

  1. Puborectalis muscle
  2. Pubococcygeus muscle
  3. Iliococcygeus muscle 4. Coccygeus muscle

Question 13

Which nerve levels innervate the muscles of the pelvic floor?

Answer 13

S2-24 for all except coccygeus, which is S5.

Question 14

What are some causes of stress urinary incontinence? (8)

Answer 14

1. Urethrohypermobility
2. Disuse
3. Childbirth
4. Chronic straining from constipation
5. Chronic coughing
6. Decreased estrogen
7. Bearing multiple children (parity)
8. Being overweight

Question 15

What is the PERFECT scheme for SUI?

Answer 15

P = power (MMT)
E = endurance in seconds
R = repetitions of endurance hold
F = fast contractions

Question 16

What is the rational behind the PERFECT scheme for SUI?

Answer 16

• Levator ani are 70% type I and 30% type II.
• The E (endurance) and R (repetition) components of PERFECT address type I.
• The F (fast contractions) component addresses type II.

Question 17

What is the Kari Bo approach for SUI?

Answer 17

8-12 reps of 6-8 sec holds, multiple positions, followed by 3-4 maximum quick contractions, 3x/week.

Question 18

What is the rational behind the Kari Bo approach?

Answer 18

It is based off of the current recommendations/principles of strength and conditioning.

Question 19

What are some pros and cons of the PERFECT approach?

Answer 19

Pro: Individualized
Con: Does not follow standardized principles of strengthening programs

Question 20

What are some pros and cons of the Kari Bo approach?

Answer 20

Pro: follows established strengthening principles
Con: not as individualized

Question 21

True or False: PFM contractions and TrA contractions normally occur together.

Answer 21

True.

Question 22

True or False: Overactive Bladder (OAB) always means the patient will have urinary incontinence.

Answer 22

False. OAB means the patient has urinary urgency with or without UI, usually with a frequency (> 8/day) and nocturia.

Question 23

True or False: Urge Urinary Incontinence (UUI) can be caused by bad diet, bad bladder habits, and genetics.

Answer 23

True.

Question 24

What are normal voiding habits?

Answer 24

Every 2-4 hours during the day; 0-1x/night

Question 25

Which is voluntary, the external or internal anal sphincter?

Answer 25

External anal sphincter.

Question 26

Which nerve(s) innervates the external and internal anal sphincters?

Answer 26

Inferior anal nerve (S2-S4) = External anal sphincter | Pelvic splanchnic nerves (S2-S4) = Internal anal sphincter

Question 27

Cystocele and urethrocele are:

Answer 27

These are anterior defects. Bladder or urethra bulges into vagina (anterior vaginal defect). This is visible during a vaginal exam.

Question 28

Rectocele is:

Answer 28

This is a posterior defect. Rectum bulges into vagina.

Question 29

Uterine prolapse is:

Answer 29

When the uterus drops down into vagina. Common in women w/ altered normal uterine position.

Question 30

Are vaginal weights placed above or below the legator ani muscle group?

Answer 30

Above.

Question 31

What types of patients with POP are vaginal weights best for?

Answer 31

Patients who are not particularly weak in the PFM.

Question 32

What types of patients with POP is electrical stimulation best for?

Answer 32

Patients with little to no PFM contraction ability.

Question 33

True or False: If a woman was a consistent vigorous exerciser before she became pregnant, she can continue to perform vigorous exercise throughout her pregnancy.

Answer 33

True. However, she should stop/reduce exercise intensity if she develops UI or postural pain.