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BPT 17 - Geriatric > 9 - WOMEN’S & MEN’S HEALTH - UI > Flashcards

9 - WOMEN’S & MEN’S HEALTH - UI Flashcards

1
Q

Difference btw women’s health PT & pelvic health PT

A

Tableau

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2
Q

Examples of women’s health conditions

A
  • Urinary / bowel incontinence
  • Pregnancy & childbirth
  • Pelvic organ prolapse
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3
Q

Examples of men’s health conditions

A
  • Urinary / bowel incontinence
  • Enlarged prostate
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4
Q

Description of internal urethral sphincter

A
  • Under automatic control
  • Smooth muscle
  • Stronger than external one
  • Works for longer
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5
Q

Description of external sphincter

A
  • Under voluntary control
  • Consists of skeletal muscle fibers
  • Fatigues easily
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6
Q

Facts about women’s & men’s health

A
  • Quite often undiagnosed
  • Common condition among older adults
  • Possible to have more than one type: mixed UI
  • Risk of fractures related to falls at night increases by. 34%, if UUI episode happens least once per week
  • Increased nursing home admissions
    Many people will hide incontinence as they feel embarrassed Contribute to:
  • Depression
  • Social isolation
  • Anxiety
  • Deterioration in sexual life
  • Decrease in physical activity
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7
Q

Micturation cycle: def & description of each

A

Emptying (micturition) & closing mechanism (continence) of bladder)

Continence (bladder filling):
- Detrusor muscle needs to be relaxed
- Sphincters need to be contracted

Emptying/voiding:
- Opposite effect observed
- Detrusor muscle contracts to release urine & elevator ani & urethral sphincter muscle relax

Normal micturition cycle:
- Empty bladder about 6-8 times/day

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8
Q

Women’s health other conditions

A
  • Pelvic floor prolapse: repair surgery, pelvic organ moves downwards in vagina
  • Hysterectomy: uterus removal, major surgery. Recovery times btw 6 to 8 weeks, depending on type
  • Myomectomy: surgical procedure that removes fibroids from wall of uterus
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9
Q

PT management of women’s health

A
  • Advice on bed transfers
  • Pelvic floor exercises
  • Manual handing advice
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10
Q

Women’s health: clinical categories

A
  • Urological
  • Gynecological
  • Ontological
  • Geriatrics
  • Surgical
  • Orthopedics
  • Obstetric
  • Chronic (persistent pelvic pain)
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11
Q

Younger/middle age & older women suffering with:

A
  • Incontinence (urinary or fecael incontinence)
  • Constipation
  • Bladder urgency or bladder hesitance
  • Bladder pain
  • Pelvic organ prolapse
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12
Q

Chronic conditions

A
  • Dysmenorrhoea
  • Polycystic ovary syndrome
  • Endometriosis
  • Coccydynia
  • Persistent pelvic pain
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13
Q

Urinary incontinence: def & main categories + description of each

A

Definition
= complaint of any involuntary loss of urine on effort or physical exertion or on sneezing or coughing

Main categories
Stress Urinary incontinence (SUI)
- Loss of urine on effort or during physical exertion / sneezing / coughing

Urgency urinary incontinence (UUI)
- Associated with urgency
- Person, unexpectedly desires to urinate, which can result in urine leakage

Mixed urinary incontinence (for male)

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14
Q

Urinary incontinence: prevalence & common causes in men & women

A

Prevalence
- Women > men
- 1/4 person affected during life
- High prevalence in athletes like gymnasts

For male
- 11% at 60-64y
- 31% > 85y

Common causes
In men
- Prostate enlargement
- Dysfunction of continence mechanism secondary to prostate Ca
- Combination of bladder dysfunction / sphincter dysfunction

In women
- Dysfunction of bladder / pelvic floor muscle associated with pregnancy, childbirth or menopause
- Nerve damage innervating bladder muscles
- Side effects of medications (high BP, antidepressants)

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15
Q

Urinary incontinence: risk factors

A
  • Age
  • Decreased mobility & manual dexterity making more difficult to be on time in toilet
  • Common conditions as Diabetes, stroke, hypertension, Parkinson, arthritis…
  • Increased BMI & obesity
  • High impact exercise
  • Smoking
  • Childbirth & gynecological surgeries for women
  • Urinary tract infections (UTI)
  • Cognitive impairment
  • Neurological disease
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16
Q

Stress urinary incontinence: def, pressure factors, pressure game in males & females

A

Definition
= involuntary loss of urine on effort or physical exertion, or sneezing or coughing
- Dysfunction of sphincter mechanisms
- Increased intra-abdominal pressure
- More often than UUI
- Bladder fills up —> pressure increases
- Pressure in sphincters increases
- Too much pressure on mechanism —> sphincter could not control amount of generated pressure
- Treatment targets pressure & sphincters

Pressure factors
- COPD patient
- Asthmatic patients
- Running
- Jumping on trampoline activity

Pressure game
Males
- Prostatectomy
- Catheter
- Cystoscopy
- TURP operation

Female
- Pregnancy & childbirth (vaginal delivery)
- Hysterectomy

17
Q

Urgency urinary incontinence: def

A

= loss of urine associated with desire to pass urine or sudden event

  • May or may not be due to detrusor muscle over activity
  • Less common than SUI
  • Urge to go
  • Release of small amounts of urine
  • Detrusor muscle contractions
  • Detrusor triggers could be: alcohol consumption, coffee, bladder infection
18
Q

Pelvic floor muscles: components & function

A

Components
- Levator ani muscles (largest component)
- Coccygeus muscle
- Fascia coverings of muscles

Function
- Support pelvic organs in women (bladder, bowel & uterus)
- Urine & fecal continence mechanism
- During pregnancy, support baby
- Control intra-abdominal pressure increases
- Play important role in sexual sensation & function

19
Q

Physiotherapy management: goals, approach

A

Goals
- Promotes pelvic floor awareness via biofeedback, exercise..
- Prevent reoccurrence of impairments
- Restore bowel/bladder/sexual & muscle functioning
- Reduce frequency of episodes

Approach
- Take holistic approach (physical aspect, psychological aspect)
- Use evidence based practice
- Patient centered care
- Educate patients
- MDT approach

20
Q

Subjective assessment of UI

A
  • HOPC (onset, triggers, numb op pads per day)
  • What type is it? (Urgency, stress, mixed)
  • Storage symptoms vs voiding symptoms
  • Severity (little amount, moderate amount, large amount of leakage) of symptoms
  • Duration / frequency of symptoms
  • Bowel / prolapse
  • Effect of symptoms on sexual function
  • Social history: environment & lifestyle
  • PMH: past medical history
  • Medical & surgical treatments affecting genitourinary tract & lower bowel. Effectiveness & side effects of treatments
  • Meds
  • Coexisting diseases
  • Obstetric & menstrual history
  • Assess for physical impairment
21
Q

Outcome measures UI

A
  • ICIQ: International consultation on incontinence questionnaire
  • BFLUTS (Bristol female lower urinary tract symptoms questionnaire
  • I-QOL (incontinence quality of life questionnaire)
  • SUIQQ (stress & urge incontinence & QoL questionnaire)
  • UISS (urinary incontinence severity score)
  • SEAPI-QMM
  • ISI (incontinence severity index)
  • KHQ (king’s health questionnaire)
22
Q

Additional tools

A

Patients with SUI
- Usually normal voiding frequency with small amounts of urine leaking
Patients with UUI
- Higher voiding frequency with larger amounts of leaking
Bladder diary: self reported for 3 days When, what & how much patient drinks

23
Q

Objective assessment: General status, pelvic examination & abdominal examination

A

General status
- Mental status
- Obesity
- Physical dexterity & mobility

Pelvic examination (digital examination)
- Examination of perineum & external genitalia including tissue quality & sensation
- Examination for vaginal pelvic organ prolapse
- Pelvic floor muscle / contractions

Abdominal examination
- Distended bladder, surgical scar
- During examination, maintain dignity & comfort of patient at all times
- Keep eye contact whenever possible, watch for nonverbal communication cues, guarding, signs of pain or breath holding

24
Q

Pelvic floor muscle training: def, strengthening exo

A

Definition
= alone or combined with bladder control strategies & self-monitoring, should be recommended for older women with urinary incontinence

+ schema

Strengthening exercises / Kegel exercises
Slow twitch contractions
- Instruct patients to tighten muscles around back passage & draw them up & forwards. At same time, instruct them to tighten muscles around front passage
- Aiming to hold 10 sec

Fast twitch contractions
- Instruct patient to tighten & lift pelvic floor muscles as quickly & as strongly as they can, then relax
- Aiming to hold for 10 sec

25
Q

PFMT: management for women & men & bladder training

A

Adult women
- Supervised PFM training for at least 3 months, 8 contractions /3 times per day
- Offer pelvic floor muscle training to women in first pregnancy as preventive strategy for UI
- Use validated outcome measures for evaluation of therapy
- Bladder diary use
- Introduce PFM strengthening ideally by 10th week in pregnancy
- Exercise program include
* TrA training in different positions
* Train co-activation TrA & PFM

Men
- Pelvic floor exercises
- Penile clamps
- Sling surgery
- Artificial urinary sphincter - Psychological approach
- Education
- Pharmacological options

Bladder training
Aims to:
- Reduce number of times going to toilet
- Hold on for longer or put off emptying of bladder
- Increase amount of urine patient passes each time

26
Q

PT education

A
  • Avoid caffeinated, fizzy drinks, hot chocolate, alcohol, green tea
  • Drink that doesn’t irritate bladder: water, milk, fruit teas

BPT 17 - Geriatric (11 decks)

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