Female Pelvic Health

Question 1

Purpose of pelvic floor anatomy

Answer 1

• Spinteric
• supportive
• sexual function

Question 2

Urinary or anal incontinence

• males
• females

Answer 2

• Males: Typically Post-prostate and bladder cancer

- females: Post-childbirth, trauma or surgery

Question 3

Pelvic Floor Dysfunction Categories

- hypertone

Answer 3

• inadequate sphincter closure
• voiding/ defacation
• pelvic pain: dyspareunia
• impaired PFM coordination and ROM

Question 4

Pelvic Floor Dysfunction Categories

- hypotone

Answer 4

• inadequate sphincter closure
• urinary/fecal or flatus incontinence
• pelvic organ prolapse
• poor pelvic floor/core muslce performance- strnegth, endurance and coordination

Question 5

stress urinary incontinence

Answer 5

• leakage upon increased load on the pelvic floor accompanied by lack of adequate urethral closure
• • coughing,sneezing, laughing, jumping . lifting

Question 6

Urge Urinary Incontinence

Answer 6

• overactive detrusor
• behavioral components: bladder irritants, just-in-caase voiding
• behavioral management and PFM coordination training: identify triggers

Question 7

Prolapse problems

Answer 7

• sensation of sitting on a ball/grapefruit
• vaginal or rectal heaviness
• palpable bulge/tissue at vaginal opening

Question 8

Pelvic pain and voiding dysfunctions

Answer 8

• impairment in PFM coordination: difficulty relaxing PFM
• incomplete emptying of bladder/bowels
• Pain with vaginal penetration, ejaculation, impaired sexual function
• down-training of teh PFM

Question 9

vaginoplasty: gender reassignment

Answer 9

• transgender female
• vaginal vault is created between the rectum and the urethra
• Orchiectomy performed, the labia majora are ccreated using scrotal skin,a nd teh clitoris is created from a portion of the glans penis
• vaginal dilation needed to stretch vaginal canal

Question 10

Common error of pelvic floor muslce training

Answer 10

• holding breath
• bearing down (valsalva)
• tightening abs
• tightening buttocks

Question 11

Trimesters

Answer 11

• Full term 40 wks
• 1st tri: 1-12
• 2nd tri: 13-28
• 3rd tri: 29-40
• 4th tri: post-partum care

Question 12

Physiological changes during pregnancy

Answer 12

• Increase in resting HR: incr 10-20 bpm from pre-pregnancy resting HR
• incr stroke volume
• decreased vascular resistance: –BP can decrease in 1st and 2nd trimesters
• 3rd trimesters watch for PRECLAMPSIA

Question 13

Guidelines for safe exercise

Answer 13

• avoid supine position >3 min after 1st trimester: 30 degree angle incline recommended if supine
• L side lying preferred position: offload inferior vena cava
• avoid prone position
• avoid srong abdominal compression/ strain during 2nd and 3rd trimester
• avoid rapid bouncing or swinging
• avoid overheating- stay hydrated

Question 14

exercise during pregnancy cam:

Answer 14

• significantly lower incidence of gestational diabetes during pregnancy
• significantly shorter 1st stage of labor
• influence neonatal outcomes in exercise group showed significant difference in APGAR scores at 1 min mark
• help with faster recovery post-vaginal and cesarean delivery

Question 15

Exercise intensity guidelines

Answer 15

• Borg RPE scale: moderate intense activities, 13-14
• talk test
• 150 min/wk; 30 min, 5 days/week

Question 16

COre local stabilizers

Answer 16

• pelvic floor exercises kegels
• synergy with the repiratory diaphragm
• muscle awareness training: isolation –> strnegthening –> integration

Question 17

stop exercise if patient experiences

Answer 17

• vaginal bleeding
• dizziness or feeling faint
• incr SOB
• chets pain
• HA
• muscle weakness
• calf pain or swelling
• uterine contratcions
• decr fetal movement
• fluid leaking from the vagina

Question 18

Absolute contraindications to exercise

Answer 18

• significant heart disease
• restrictive lung disease
• incompetent cervix or cerclage
• persistent 2nd or 3rd trimester bleeding
• placenta previa after 26 weeks
• premature labor
• ruptured membranes
• preclampsia or pregnancy induced HTN
• severe anemia

Question 19

high risk pregnancy

Answer 19

• membrane ruptures
• placenta previa
• cervical incompetence
• hypertensive disorders
• twins or higher order gestation
• getsational diabetes
• MS
• systemic lupus erythematosus

Question 20

Post-partum tx 4th trimester:

Vaginal delivery

Answer 20

• clearancce from OBGYN post- 3 weeks check-up
• initiate PFM awareness training and local stabilization
• initiate pelvic organ prolapse education and training

Question 21

Post-partum tx 4th trimester:

cesarean delivery

Answer 21

• clearance post- 6 wk check-up
• initiate scar massage/ management fro desensitization of hypersensitive nerves
• initiate local stabilization of TrA and PFM