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Pelvic Health > H&W Pelvic Function Level 1 > Flashcards

H&W Pelvic Function Level 1 Flashcards

1
Q

Layer 1: Superficial PFM

A
  1. superficial transverse perineal
  2. ischiocavernosus
  3. bulbocavernosus/bulbospongiosus
  4. external anal sphincter
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2
Q

where is the superficial transverse perineal muscle located

A

from ischial tuberosities to perineal body

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3
Q

what layer 1 muscle is the main difference between males and females

A

bulbocavernosus/bulbospongiosus

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4
Q

Layer 2: Intermediate PFM

A
  1. deep transverse perineal
  2. perineal membrane
  3. external urethral sphincter
  4. compressor urethra
  5. sphincter urethrovaginalis
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5
Q

what layer 2 muscles are different in males vs females

A

females have:
1. sphincter urethrovaginalis
2. compressor urethra

males do not

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6
Q

what is embedded in layer 2 PFM

A

perineal membrane - thick fibrous sheet of dense fascia
- external genitalia and structures attach to this

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7
Q

Layer 3: Deep PFM

A
  1. Levator Ani:
    * pubococcygeus
    * iliococcygeus
  2. (ischio)coccygeus
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8
Q

what muscles are associated with the pelvic floor hammock

A

levator ani
- pubococcygeus
- iliococcygeus

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9
Q

why is the coccygeus not considered part of the levator ani group

A

doesn’t elevate the anus

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10
Q

what layer is at the level of the pelvic diaphragm

A

layer 3 (deep PFM)

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11
Q

what are the borders of layer 3

A

Anterior
- pubic bone

Lateral
- ischiopubic ramus
- ilium
- arcus tendineus levator ani (ATLA)

Posterior
- sacrum
- coccyx
- piriformis

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12
Q

what muscles make up the pelvic wall

A
  1. piriformis
  2. obturator internus
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13
Q

perineal pain can be referred from

A

bulbocavernosus
ischiocavernosus

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14
Q

posterior pelvic floor pain can be referred from

A

sphincter ani

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15
Q

anococcygeal pain can be referred from

A

obturator internus

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16
Q

sacrococcygeal pain can be referred from

A

levator ani
coccygeus

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17
Q

anterior thigh pain can be referred from

A

iliopsoas

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18
Q

posterior thigh pain can be referred from

A

obturator internus
piriformis

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19
Q

vaginal pain can be referred from

A

levator ani
obturator internus
ischiocavernosus
bulbocavernosus

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20
Q

penile pain can be referred from

A

bulbocavernosus
ischiocavernosus

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21
Q

scrotal pain can be referred from

A

iliopsoas

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22
Q

pelvic clock: what is 12 o’clock?

A

pubic symphysis inferior angle

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23
Q

pelvic clock: what is 1 o’clock?

A

bulbocavernosus

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24
Q

pelvic clock: what is 2 o’clock?

A

ischiocavernosus

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25
Q

pelvic clock: what is 3 o’clock?

A

superficial transverse perineal

26
Q

pelvic clock: what is 4 o’clock?

A

levator ani: pubococcygeus

27
Q

pelvic clock: what is 5 o’clock?

A

levator ani: iliococcygeus

28
Q

pelvic clock: what is 6 o’clock?

29
Q

pelvic clock: what is 7 o’clock?

A

levator ani: iliococcygeus

30
Q

pelvic clock: what is 8 o’clock?

A

levator ani: pubococcygeus

31
Q

pelvic clock: what is 9 o’clock?

A

superficial transverse perineal

32
Q

pelvic clock: what is 10 o’clock?

A

ischiocavernosus

33
Q

pelvic clock: what is 11 o’clock?

A

bulbocavernosus

34
Q

stages of POP: what is a stage 0 and what intervention(s) is indicated

A

absent, none

no intervention

35
Q

stages of POP: what is a stage 1 and what intervention(s) is indicated

A

> 1 cm above hymen

pelvic PT

36
Q

stages of POP: what is a stage 2 and what intervention(s) is indicated

A

1 cm above or beyond the hymen

pelvic PT
pessary

37
Q

stages of POP: what is a stage 3 and what intervention(s) is indicated

A

> 1 cm beyond hymen

pessary
external support
surgical consult

38
Q

stages of POP: what is a stage 4 and what intervention(s) is indicated

A

complete eversion

surgical consult
external support

39
Q

how is the stage of a POP measured

A

with pt doing maximum strain effort

40
Q

perineal lacerations: 1st degree

A

vaginal mucosa
skin

41
Q

perineal lacerations: 2nd degree

A

mucosa
skin
perineal muscles (layers 1&2)

42
Q

perineal lacerations: 3rd degree

A

mucosa
skin
perineal muscles (layers 1&2)
perineal body
external anal sphincter (EAS)

43
Q

perineal lacerations: 4th degree

A

mucosa
skin
perineal muscles (layers 1&2)
EAS + anterior rectal wall
internal anal sphincter
rectal mucosa

44
Q

type of prolapse: cystocele

A

bladder (anterior wall)

45
Q

type of prolapse: urethrocele

A

urethra (anterior wall)

46
Q

type of prolapse: urethrocystocele

A

urethra + bladder (anterior wall)

47
Q

type of prolapse: rectocele

A

rectum (posterior wall)

48
Q

type of prolapse: enterocele

A

small intestine (posterior wall)

49
Q

type of prolapse: vaginal vault prolapse

A

apical vagina after hysterectomy (vagina)

50
Q

type of prolapse: rectal prolapse

51
Q

type of prolapse: uterine prolapse

52
Q

what are the 3 most common POP types

A

cystocele
rectocele
uterine prolapse

53
Q

s/sx of cystocele, urethrocele, or urethrocystocele

A
  • poor/prolonged urinary stream
  • feeling incomplete emptying
  • positioning changes to start/complete emptying
  • SUI
  • urinary retention w bladder outlet obstruction
  • post-void dribble
54
Q

what is a clinical pearl of pt education in cystocele, urethrocele, or urethrocystocele

A

double void: after 1st void, do some PFM/squats/hip circles, then void again to fully empty bladder/urethra

55
Q

s/sx of rectocele

A
  • vaginal pressure/discomfort
  • protrusion from post vaginal wall
  • need to reposition during BM, incomplete emptying
  • difficulty evacuating rectum w splinting
56
Q

what is a clinical pearl of pt education in rectocele

A

splinting: apply pressure to perineum manually OR insert finger in vaginal canal to push on back wall to better empty rectum during BM

57
Q

s/sx of enterocele

A
  • pelvic/vaginal pressure
  • difficulty evacuating rectum/bladder
  • low back discomfort worsening as day progresses
  • inc discomfort w prolonged standing, relieved by lying down
58
Q

what is a clinical pearl in enterocele

A

consider further medical referral for additional dx testing for sx that persist or not improving in therapy

59
Q

s/sx of uterine prolapse

A
  • blood stained purulent dc
  • difficulty w bowel/bladder emptying
  • LBP or discomfort worsening as day progresses
  • inc discomfort w prolonged standing better in supine
60
Q

what is a clinical pearl of pt education in uterine prolapse

A

optimal bowel strategies
pressure management
decreasing gravity/pessary

61
Q

s/sx of vaginal vault prolapse

A
  • pelvic/vaginal pressure
  • difficulty evacuating rectum/bladder
  • low back discomfort worsening as day progresses
  • inc discomfort w prolonged standing, relieved by lying down

Pelvic Health (1 decks)

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