Continence Flashcards
What is urinary incontinence?
Any involuntary leakage of urine
To remain continent, you have to: (5)
- Know you need to go
- Location
- Physically get there
- Undress
- Time
How common in pregnancy?
46%
How should PTs get involved?
“People with this problem often also have problems with bladder/bowel - have you had any issues with that?”
6 Rs for clinical effectiveness
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)
If any pain with hip/buttock…
Ask about PF
Levator ani (3)
-coccygeus
Pubo
Illio
Ischio
Pubococcygeus is most important, what are the three bands?
Pubo-
- vaginalis
- rectalis
- coccygeus proper
Sympathetic vs Parasympathetic
Symp STOPS
Para PEES
Ax of Continence
Hx - nature, duration, severity
PMHx/PSx
Exacerbating factors - meds, diet, fluids, immobility
Funtional/mental status
Impact on QoL
Stress incontinence Rx
- Strengthen PF (match intra-ab pressure)
- Use PF functionally
- – Need pelvic exam
Functional PF exercises (2)
- Teach in lying but not fn-al
- Task orientated/specific to pt problem
Normal bladder habits
During day = 4-6
Night = 0-1
Volume = 300-600ml
4 steps to good habits
- Fluid intake = 6-8 CUPS/day
- Bowel habits = don’t strain, avoid constipation, position
- PF mm exercises
- Toilet = NO just in case; take time to empty fully.
Derement strategy
- contract PF
- pressure to perineum (cross thighs, towel, corner of chair)
- distract mind/relax
Defer 5 mins and gradually increase.
PF function (6)
- Pelvic organ support
- Occlusive force to ext urethral sphincter
- Anorectal angle
- Rectal support during defecation
- Bladder inhibition
- Sex
Factors contributing to PF dysfunction
- Menopause/ageing
- Meds
- Lifestyle (obese, chronic cough, heavy lift)
- Pregnancy (freq)
- Perineal trauma
- Postnatal care of perineum
What is a prolapse?
Descent of pelvic organs towards introitus
assoc with vaginal wall/pelvic lig weakness
Can a prolapse still occur if you get a Ceasar?
YES
Causes of prolapse (4)
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)
Cystocele
Bladder into front of vagina
Uterine prolapse
Uterus into vagina
Prolapse Rx
- Strengthen lower abs/PF if necessary
- Address lifestyle/other disease
- Will only prevent further descent (needs Sx)
Chronic pelvic pain - define.
Apparently of gynaecological origin but no definitive cause found.
Aetiology of chronic pelvic pain
Unclear causes - maybe overexertion of PFM, hyperalgesia…
Physical/sexual abuse association (only small no.)
Ax of chronic pelvic pain (5)
Holistic Multiple Dx Comprehensive subjective Discuss sexual issues Objective
Pain behaviour
- May have mech component
- Stress aggravates
- Not necessarily assoc with spinal dysfn.
- Visceral symptoms may be present (diarrhoea, constipation, period pain)
PFM Ax (6)
Observe Sensation/neural Palpation (int/ext) PFM contractile activity Spasm Relaxation
Chronic pelvic pain Rx
Limited evidence
- lifestyle
- exercises
- manual therapy
- biofeedback
- dilators
Goals for chronic pelvic pain
- Pain-free may not be achieved
- learning to live with it
- prevent exacerbation
STILL ACHIEVE
- preg
- RTW
- ‘Normal’ life
