9 - WOMEN’S & MEN’S HEALTH - UI Flashcards
Difference btw women’s health PT & pelvic health PT
Tableau
Examples of women’s health conditions
- Urinary / bowel incontinence
- Pregnancy & childbirth
- Pelvic organ prolapse
Examples of men’s health conditions
- Urinary / bowel incontinence
- Enlarged prostate
Description of internal urethral sphincter
- Under automatic control
- Smooth muscle
- Stronger than external one
- Works for longer
Description of external sphincter
- Under voluntary control
- Consists of skeletal muscle fibers
- Fatigues easily
Facts about women’s & men’s health
- 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
Micturation cycle: def & description of each
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
Women’s health other conditions
- 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
PT management of women’s health
- Advice on bed transfers
- Pelvic floor exercises
- Manual handing advice
Women’s health: clinical categories
- Urological
- Gynecological
- Ontological
- Geriatrics
- Surgical
- Orthopedics
- Obstetric
- Chronic (persistent pelvic pain)
Younger/middle age & older women suffering with:
- Incontinence (urinary or fecael incontinence)
- Constipation
- Bladder urgency or bladder hesitance
- Bladder pain
- Pelvic organ prolapse
Chronic conditions
- Dysmenorrhoea
- Polycystic ovary syndrome
- Endometriosis
- Coccydynia
- Persistent pelvic pain
Urinary incontinence: def & main categories + description of each
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)
Urinary incontinence: prevalence & common causes in men & women
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)
Urinary incontinence: risk factors
- 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
Stress urinary incontinence: def, pressure factors, pressure game in males & females
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
Urgency urinary incontinence: def
= 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
Pelvic floor muscles: components & function
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
Physiotherapy management: goals, approach
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
Subjective assessment of UI
- 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
Outcome measures UI
- 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)
Additional tools
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
Objective assessment: General status, pelvic examination & abdominal examination
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
Pelvic floor muscle training: def, strengthening exo
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
