EXAM 3: pelvic health Flashcards
coordination of bladder/urinary sphincters occurs around _ yrs old
2 years = 24 months
signs of bladder sensation appear around
18 months old
By _ they should be able to fully empty bladder
3 years old
median age of day dryness is _ years
3.5 years
night time dryness should happen _ month after dry days
6 months after dry days (4 yrs ish)
infants initially void every ___. Voiding never happens during quiet sleep, but they urinate as they wake up.
every hour
Potty training readiness signs:
- bowel mvmt same time each day
- no bowel mvmt at night
- dry diaper after nap (tells u point 4)
- dry diaper for at least 2 hours at a time
- they are squatting and climbing
- able to pull pants down
- emotional readiness (for child and parent)
involuntary leaks of urine during day time
Urinary incontinence:
involuntary leaks of stool
Fecal incontinence:
night time urine leaks
Enuresis: only diagnosed after age 7 by pediatricians
infrequent, hard, difficult to pass stool
constipation
stool collects in colon and rectum, stool retention can cause stretching (distention) of bowels and loss of control over bowel mvmts.
Not knowing when to poop or huge bowel mvmts
encopresis
incomplete stool evacuation
functional constipation
strong, suddent, uncontrollable urge to urinate, often accompanied by frequent urination (over 8x/day)
overactive bladder
less than 6x/day
incomplete, infrequent bladder emptying
underactive bladder
strenuous, unusually great effort to initiate, maintain voiding or bowel mvmt
takes longer than 3 min
straining
main cause of bedwetting
constipation
If child has day or night time pee leaks, treat constipation if present first!
If your poop looks like chicken nuggets, it is type
5
If poop looks like corn on cob, type
3
normally want type _ and _ poops
3 and 4
size of fist in total
ROME III Criteria
- straining 25% time
- lumpy or hard stool 25% time
- less than 3x/week
- no loose stools without laxative
- manual facilitation of defecation 25%/time
- sensation of incomplete emptying
*2 or more for over 3 months
clinically, what to look for when you think it is constipation
- loose stools (new poop just leaks out)
- fecal inconstinence
- betwetting/urine leaks
- over 3 bowel mvmts/day OR, less than 3x/week
- withholding (scared)
- child will only go in pull up or in standing
red or yellow flags of incontinence
- withholding
- 1mary incontinence
- 2ndary incontinence (dry at least 6 months then regress)
- frequent UTIs
- nocturnal enuresis: after 5 yrs
- straining w/ bowel mvmt, infrequent bowel mvmts (less than 2x/day)
- infrequent (less than 5x) or too frequent (over 8x) voiding per day
- teens: giggle incontinence or when start playing sports
what Dx will you see straining with bowel mvmts in infants?
torticollis
plagiocephaly
tongue, lip tie, Downs (calms nervous system when tongue is at roof of mouth)
what questions to ask during assessment?
- constipation during infancy? (dairy, allergies, etc)
- changes when adding solid food?
- toddler: pacifier or suck their thumb?
- hx of tongue, lip tie, or torticollis?
- How often does your child pee/poop?
- Is urine constant or stop/start?
- hx of UTIs? constipation or urinary retention
- what does poop look like?
- what position do they poop in? infants, or older
- any sensory challenges?
- what does diet look like?
- Have they been to PT/OT/SLP?
Issues with picky eating, tags, loud noises? Patient with B&B issues may have
sensory issues/sensitivity
If kids drink milk with every meal/before bed, what does this cause?
bladder irritant
also causes constipation
*tx: cut amount with water
strength eval for pelvic health zone in on what mm
- core
- scapula
- hips
Why does development matter for toileting?
- rolling = oblique activity
- crawling = scapular stability for stacking, shapes diaphragm and develops pelvic floor
- standing: stability, balance, coordination
- walking: need mature pattern to contract/relax pelvic floor
- frog squat: need for hip ROM
When heel comes down when walking, pelvic floor does what
relax
toe: contracts
*toe walking implications with pelvic floor tightness
Any asymmetries in development will cause
pelvic floor dysfunction
If pelvis is not symmetrical, then what happens?
anterior pelvic tilt on one side: tightness in mm
any asymmetries = asymmetry in mm
need _ pelvic tilt for __ alignment
anterior pelvic tilt for puborectalis alignment
*tight hamstrings, ppt = hard time with pelvic floor
Activating _ and _ helps activate the
ascending and descending
colon
Activating **Psoas and trunk
rotation **helps activate the
ascending and descending
colon
What is activated in your ankles for pelvic floor contraction?
plantarflexors
(toe walking = dysfunction)
squatty potty helps DF, relaxing
In strenth assessment, what functional play aspects do you examine?
Jumping
Transfers
Sitting
Running
Crawling
Squatting
Stairs
Do they use both legs
symmetrically or favor one side?
Do they have habitual postures? toe walking (sign they need to pee), sitting with heel in anus (sign of holding in poop)
Are transitions controlled?
How do they get off the floor?
Can they hold static positions– tall kneel, 1⁄2 kneel?
What do you look for in global coordination assessment
Does child cross midline?
Is jumping take off and landing
symmetric?
Can they isolate movements? Do you see Mirroring?
Jumping jacks? Or snow angels
*ATNR, Moro integration, stairs step over step
*grapevine? dual tasking?
What is the best potty posture?
- feet on stable surface and flat
- knees above hips
- elbows on knees (lean forward 35 degrees)
- sit tall, breathe
kids will lean back on toilet or hands on the toilet to brace, but NEED slight anterior pelvic tilt, isolated mvmt with static posture.
Why is straining bad?
pushing poop out of a closed anus, causing dysfunction and pain
T or F: LLD, Posterior pelvic tilt, using hands to sit, or straining will have negative impact on pelvic floor function
True
How does torticollis affect toileting challenges?
more than tight SCM
tight back, lats, etc.
leads to asymmetries
OR if severe and not treated, facial/palate assymmetries, leaning trunk, affects obliques and whole body
Why do we have neurological considerations with pelvic floor dysfunction regarding voiding?
For voiding, need intact neuro system for involuntary detrusor contraction, relaxing sphincter coordination
*rest and digest PNS activation
*calm coloring, yoga can help
What about neurological considerations regarding defecation?
RAIR reflex/automatic reflex: tells body if gas or stool
*mechanoreceptors tell body with stretch of rectum that its time to defecate (chronic constipation ingnores urge when rectum is full, so this is suppressed)
need intact internal and external sphincters (SB, CP)
abdominal activation and PFM relaxation to defecate
What is a good potty routine for bowel?
- sit on potty after meal DAILY for reflex loops
- sit and blow bubbles/destress activity
- sit on toilet for 1-2 min
stress-free, no pressure to go
good routine for potty training voiding
- pair with time of day
- schedule voids every 2-3 hours
- you can use a potty watch if you want (set 1.5 hours or longer time)
What are possible root causes of constipation that you may see as a PT?
- diastasis?
- poor core or hip strength?
- overactive pelvic floor?
- poor posture?
What are possible root causes of bedwetting?
- constipation?
- overactive bladder?
What are possible root causes of day time urinary incontinence?
Overactive or Underactive bladder? Poor
hydration? Poor posture? Not fully emptying?
Lack sensation? Constipation?
What is the ILU massage?
used to improve colonic activity
What are strategies to increase colonic motility?
- ILU massage
- potty posture
- diaphragm scooping
- sensory E-stim 20 min/day 4x/week
- stretch pelvic floor after these for 5-10 minutes
For healthy bowel and bladder health, pelvic floor needs to be able to do 3 things
Contract and shorten.
Relax at rest for slight mobility with breathing - specifically
inhalation
Lengthen and open
If pelvic floor is short, tense and immobile, what tx can you do?
toe walking, holding in poop, etc.
1. stretching (child pose, frog squat, duck walks
2. deep breathing practice
3. calm activity before bathroom
pelvic floor is weak, lengthened. What tx?
full bladder accidents
Tx:
long sit on wedge,
adductor activation–> overflows to PFM
balance training
diastasis recti: why does it happen?
It stays open with __ _ or _
born with it or develops over time
opens with chronic constipation, bloating, or poor posture
diastasis recti should close between age
1-3 years
If patient has a rib flair or wide rib angle (100-120), doming, then they might have
diastasis recti
*affects posture, coordination, etc.
Tx for diastasis recti:
- chin tucks
- upper abs
- lower abs
- obliques
*ensure TrA activation throughout
goal for pelvic floor coordination
pelvic floor relax with inhale, contract with exhale
pelvic floor relax with voiding and defecation
tall kneeling up and down
squats
breath work with bubbles, party horns, etc. if through ribcage and diaphragm
these work on….
pelvic floor coordination
anterior pelvic tilt: what is a reason it can cause urinary incontinence?
all organs and colon are pushing on bladder, which can create leaks throughout the day
What are bladder irritants?
Milk/Dairy, Tomatoes, Chocolate, Caffeine, Citrus, carbonation
top constipating foods
bananas
applesauce
cheese
milk
tapioca
_ children in US suffer from enuresis
5-7 million
What do you need to rule out if your kid is bedwetting?
- consipation
- sleep anpea
- diabetes
- genetic causes
- chronic kidney disease
full bladder is __ seconds of voiding, and going _ to _ hours between voids
full bladder is over 8 seconds of peeing
2-3 hours between pees
What diagnoses have increased risk for bowel and bladder challenges
- autism (core weakness)
- ADHD/ADD
- neurologic deficits
- sensory processing disorder
- low tone (Down)
- high tone
- obesity
