9a Ax Pelvic Floor

Question 1

So, what do physiotherapists assess when performing a VE?

Answer 1

1. Structural changes that could be contributing to symptoms
2. Pelvic Floor contraction technique
3. Pelvic Floor Strength / Co-ordination Assessment

Question 2

VE Step One - Observation

Answer 2

Initial anatomy at REST

Ability to perform a PELVIC FLOOR CONTRACTION

3: Ability to maintain a PFC DURING INCREASES IN IAP

4: Anatomy during a COUGH
5: Anatomy during VALSALVA

Question 3

PF strength grade 0

Answer 3

nil

Question 4

PF strength grade 1

Answer 4

flicker

Question 5

PF strength grade 2

Answer 5

weak, non fluttering pressure

Question 6

PF strength grade 3

Answer 6

moderate - small degree of lift

Question 7

PF strength grade 4

Answer 7

good examiners fingers firmly gripped. Lift against some resistance

Question 8

PF strength grade 5

Answer 8

very strong grip of fingers. lift afainst strong resistance

Question 9

PERFECT =

Answer 9

Power
Endurance
Reps
Fast ( nymber of fast, max contracts pt can perform before they can no longer acheive max)
ECT = every contraction timed

Question 10

Manometry

Answer 10

eg peritron

Question 11

Methods to quantify PF strength

Answer 11

EMG
Manometry
Vaginal cones

Question 12

Disadvanmtages vaginal cones

Answer 12

– Disadvantages
• Varying Vaginal Diameters
• Influenced by vaginal mucous amount

Question 13

Advantages Translabial / Transperineal(RTUS)

Answer 13

• Can visualise lifting action of pelvic floor
• Can visualise bladder, Uterus & Rectum
– Can assess Prolapse
– Can assess bladder neck mobility

Question 14

DisadvantagesTranslabial / Transperineal(RTUS)

Answer 14

• Few people well trained

* Infection control issues

Question 15

Advantages Transabdominal / Suprapubic

Answer 15

• Can visualise lifting action of pelvic floor
• Avoids contact with genital area
• Non-confronting for patient

Question 16

Disadvantages Transabdominal / Suprapubic

Answer 16

• Unable to visualise other organs (uterus,

rectum)

Question 17

Paper Towel Test Method

Answer 17

– Patient dries the perineum to eliminate any vaginal
discharge/prior leakage
– Pt hold folded tri-fold paper towel tightly against the
perineum
• 1. Patient is asked to cough hard 3 times
• 2. Dimensions of resultant wetted area is measured
• 3. Patient performs a further 3 coughs
• 4. Dimensions again recorded

\Attempt to Standardise bladder volume
• 2hours before patient should void and then drink 250mls
• 1hour before patient should drink another 250mls
• patient should then not empty bladder until after test

Question 18

Pad Tests

Answer 18

1. 24 hour pad test (patient given multiple pads that are pre-weighed)
2. 1hour pad test (patient wears one pad for 1hour)

Question 19

1 hour Pad Test

Answer 19

• Patient drinks 500mls of sodium free liquid within 15minutes
• Patient rests for 30min, then performs……
– Sit-stand x 10
– Cough vigorously x 10
– Run on the spot for 1min
– Bend to pick object up off floor x 5
– Hand wash for 1minute

Question 20

Normal Nocturnal Urine Production

Young Adults 20- 50

Answer 20

<20% 24hr urine volume

Question 21

Normal Nocturnal Urine Production

Middle Adults 50-65

Answer 21

< 25% 24 hr urine volume

Question 22

Normal Nocturnal Urine Production

– Older Adults > 65yrs

Answer 22

< 33% 24hr urine volume

Question 23

Deferring urge: 1

Answer 23

Could Delay 1hr

Question 24

Deferring urge 2

Answer 24

Could Delay 30min

Question 25

Deferring urge 3

Answer 25

Could Delay 15min

Question 26

Deferring urge 4

Answer 26

Couldn’t Delay 5min

Question 27

Urge 0 bladder volume

Answer 27

0-150

Question 28

The Pitfall of Bladder Diaries

Answer 28

Bladder diaries don’t definitely tell you what was in the bladder at
the time of voiding!!!!!!!!!! What if there is a high post void residual????