2230 part 2

Question 1

Risk factors for pelvic floor injuries? x 5

Answer 1

1. Parity
2. Childbirth (vaginal)
3. Birth weight above 4kg
4. Active pushing > 90 mins
5. Forceps or ventouse
   = indications for WHP for PFM assessment via VE

Question 2

Management of perineal injury (episiotomy or tear) (acute x 5 and bowel x 4)

Answer 2

1. Ice 20 mins every 2 hours + firm underwear
2. Minimise sitting up (oedema)
3. Support perineum with cough
4. Good hygiene
5. PFM exercises for swelling

Bowel:
1. Toilet positioning
2. minimising straining
3. Hydration + diet
4. Perineal splinting

Question 3

Management of PN LSCS (acute) x 4 (BWAA)

Answer 3

1. Bed mobility (transfers STS)
2. Wound support for cough
3. Abdominal compression
4. A + E :
   Fluid intake (2L)
   Bowel management (pain relief causing constipation?)
   Bladder function: Trial of avoid (TOV)

Question 4

DRAM assessment x 5?

Answer 4

1. Assessment of LA distance at widest point using fingers width (measure 4cm above, at and below umbilicus)
2. Assess tension of LA
3. Assess doming (height, integrity, changing with functional tasks)
4. Functional assessment with TrAb and see what happens to depth width e.g. in standing, carry toddler etc
5. Check intengrity of LA (how soft?)

Question 5

DRAM management x 6?

Answer 5

1. Postural education to minimise rib trusting to stop the reuduction in stretching the abdominal wall
2. Breath work to reduce IAP
3. Cue TA + RA to tension & reduce doming and IAP
4. Compressive garments for abdominal support and decrease IAP
5. Education around the appearance and how it can be management going forward. There is always a plan B for surgery if other options fail
6. Log roll in bed if pain present

Question 6

Breastfeeding advice x 2?

Answer 6

1. Feet resting flat
2. Elbows supported

Question 7

Exercise 0-6 weeks PN x 5

Answer 7

1. PFM strengthening
2. Gentle walking
3. Low impact cardio e.g. stationary bike
4. Functional bodyweight exercises (squats, lunges, modified pushups
5. Abdominal exercises based off DRAM assessment

Question 8

Exercises 6-12 weeks x 3

Answer 8

Progress
1. low impact cardio
2. PFM/Ta strengthening
3. General strength

Question 9

Exercise beyond 12 weeks x 2

Answer 9

1. PF assessment (WHP) to check POP and assess LAA risk for running
2. Adequate limb strength to clear functional test e.g. squats, hopping, jog for 1 min.

Question 10

Psychometric screening x 1

Answer 10

3PSQ

Question 11

0-6 weeks LSCS & VD x 1 each

Answer 11

LSCS:
1. Diaphragmatic breathing for scar pain

VD:
1. monitor vaginal heaviness / bulging

Question 12

6-12 weeks LSCS x 3 and VD x 2

Answer 12

LSCS:
1. Diaphragmatic breathing
2. Scar massage
3. Ab exercises

VD
Monitor POP symptoms
Do not run

Question 13

Red flags x 5 and how to rule out?

Answer 13

1. Urinary retenton - bladder scan or PVR
2. Bladder obstruction from clot from PPH
3. UTI - Bladder scan or referral to GP
4. PFM spasm from trauma or episiotomy
   referral WHP
5. Placenta previa (temperature, abdominal cramping)

Question 14

What type of referral each of GP, Psych, WPH, Gyni and Urologist? for Persistent pelvic pain

Answer 14

Gp - Mental health
Psych - mental health
WP - PFM exam
Gyni - Red flags
Urologist - bladder pain

Question 15

Genito-pelvic pain penetration disorder (GPPPD) explain x 4

Answer 15

> 6 months & causes distress

1. Pain with vaginal penetration
2. Vulvovaginal or pelvic pain during intercourse or attempted intercourse
3. Fear or anxiety of penetration
4. Tension PFM during or attempted penetration

ALSO KNOWN AS (dyspareunia or vaginismus)

Question 16

Vulvodynia x 2

Answer 16

1. Sharp pain or burning
2. Present with or without sexual penetration

Question 17

Extended management for sexual pain?

Answer 17

Dilators for graded exposure

Question 18

Menopause symptoms x 4?

Answer 18

1. Vaginal dryness
2. Hot flushes
3. Sleep disturbances
4. Mood changes

Question 19

Menopause treatment x 2 medical and 2 non-medical

Answer 19

1. Medical- HRT or low dose topical oestrogen
2. Medical: Non hormonal e.g. osteo management
3. vitamin D
4. Diet

Question 20

PFMT for GSM

Answer 20

12 weeks of strength, endurance and coordination = 15-20 mins daily + 1 hour supervised weekly.

Question 21

Prolapse management 1st line x 3

Answer 21

1. A + E constipation, bladder and bowel management (EXPAND ON EACH)
2. Prolapse relief positions (Anti gravity positions shoulders below pelvis)
3. PFMT - strength (helps with UI)

Question 22

Prolapse management 2nd line x 3

Answer 22

1. Vaginal pessary
2. NMES
3. Topical oestrogen