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PT in Specific Groups > Continence > Flashcards

Continence Flashcards

1
Q

What is urinary incontinence?

A

Any involuntary leakage of urine

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2
Q

To remain continent, you have to: (5)

A
  1. Know you need to go
  2. Location
  3. Physically get there
  4. Undress
  5. Time
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3
Q

How common in pregnancy?

A

46%

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4
Q

How should PTs get involved?

A

“People with this problem often also have problems with bladder/bowel - have you had any issues with that?”

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5
Q

6 Rs for clinical effectiveness

A

The right:

  • Person (continence/PF PT)
  • Thing (self help not best - avoid brochures by themselves)
  • Way (RTUS is only biofeedback - not diagnostic)
  • Place (privacy)
  • Time
  • Results (75% mild-mod stress incontinence improved/cured with PFMT)
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6
Q

If any pain with hip/buttock…

A

Ask about PF

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7
Q

Levator ani (3)

A

-coccygeus
Pubo
Illio
Ischio

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8
Q

Pubococcygeus is most important, what are the three bands?

A

Pubo-

  • vaginalis
  • rectalis
  • coccygeus proper
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9
Q

Sympathetic vs Parasympathetic

A

Symp STOPS

Para PEES

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10
Q

Ax of Continence

A

Hx - nature, duration, severity
PMHx/PSx

Exacerbating factors - meds, diet, fluids, immobility

Funtional/mental status
Impact on QoL

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11
Q

Stress incontinence Rx

A
  • Strengthen PF (match intra-ab pressure)
  • Use PF functionally
  • – Need pelvic exam
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12
Q

Functional PF exercises (2)

A
  • Teach in lying but not fn-al

- Task orientated/specific to pt problem

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13
Q

Normal bladder habits

A

During day = 4-6
Night = 0-1
Volume = 300-600ml

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14
Q

4 steps to good habits

A
  1. Fluid intake = 6-8 CUPS/day
  2. Bowel habits = don’t strain, avoid constipation, position
  3. PF mm exercises
  4. Toilet = NO just in case; take time to empty fully.
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15
Q

Derement strategy

A
  • contract PF
  • pressure to perineum (cross thighs, towel, corner of chair)
  • distract mind/relax

Defer 5 mins and gradually increase.

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16
Q

PF function (6)

A
  • Pelvic organ support
  • Occlusive force to ext urethral sphincter
  • Anorectal angle
  • Rectal support during defecation
  • Bladder inhibition
  • Sex
17
Q

Factors contributing to PF dysfunction

A
  • Menopause/ageing
  • Meds
  • Lifestyle (obese, chronic cough, heavy lift)
  • Pregnancy (freq)
  • Perineal trauma
  • Postnatal care of perineum
18
Q

What is a prolapse?

A

Descent of pelvic organs towards introitus

assoc with vaginal wall/pelvic lig weakness

19
Q

Can a prolapse still occur if you get a Ceasar?

A

YES

20
Q

Causes of prolapse (4)

A

Stretched pelvic fascia/ligaments (very fast/slow 2nd stage)

Cervix on view at delivery = higher risk

Constipation/chronic cough/heavy lifting

Chronic LBP associated (weak TA)

21
Q

Cystocele

A

Bladder into front of vagina

22
Q

Uterine prolapse

A

Uterus into vagina

23
Q

Prolapse Rx

A
  • Strengthen lower abs/PF if necessary
  • Address lifestyle/other disease
  • Will only prevent further descent (needs Sx)
24
Q

Chronic pelvic pain - define.

A

Apparently of gynaecological origin but no definitive cause found.

25
Q

Aetiology of chronic pelvic pain

A

Unclear causes - maybe overexertion of PFM, hyperalgesia…

Physical/sexual abuse association (only small no.)

26
Q

Ax of chronic pelvic pain (5)

A 
Holistic
Multiple Dx
Comprehensive subjective
Discuss sexual issues
Objective
27
Q

Pain behaviour

A
  • May have mech component
  • Stress aggravates
  • Not necessarily assoc with spinal dysfn.
  • Visceral symptoms may be present (diarrhoea, constipation, period pain)
28
Q

PFM Ax (6)

A 
Observe
Sensation/neural
Palpation (int/ext)
PFM contractile activity
Spasm
Relaxation
29
Q

Chronic pelvic pain Rx

A

Limited evidence

  • lifestyle
  • exercises
  • manual therapy
  • biofeedback
  • dilators
30
Q

Goals for chronic pelvic pain

A
  • Pain-free may not be achieved
  • learning to live with it
  • prevent exacerbation

STILL ACHIEVE

  • preg
  • RTW
  • ‘Normal’ life

PT in Specific Groups (5 decks)

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