L7 Pelvic Health

Question 1

Remember that the pelvic floor affects

Answer 1

bowel, bladder, sexual function

Question 2

Indications for internal exam

Answer 2

cozean pelvic dysfunction (3+ score) screening protocol
incontinence or voiding dysfunction
pelvic pain
prolapse
sexual dysfunction
baseline strength for PFM

Question 3

Contraindications for internal pelvic floor exam

Answer 3

lack of patient consent
<6 weeks postpartum or post op
severe vaginal atrophy
current infection
severe pelvic pain
children, lack of pelvic exam
sexual abuse
pregnancy in 1st trimester

Question 4

Observation during pelvic exam

Answer 4

seated posture
standing posture
gait assessment
breathing pattern
external perineum
ROM, joint, nerve scan
Squatting
diaphragmatic breathing

Question 5

Breathing assessment

Answer 5

first in sitting
then instruct to take deep breath in through nose, out through mouth

should be looking for front, side, back expansion

Question 6

Factors that decrease diaphragm expansion

Answer 6

flared rib cage
poor core coordination
poor posture

Question 7

Breathing pattern

Answer 7

1. take breathe in
2. diaphragm lowers
3. 360° expansion of abdomen, pelvic floor lengthens
4. diaphragm moves up. belly sides, low back retract and pelvis naturally recoils

Question 8

Cough test

Answer 8

sit up tall and cough

–if lower abdomen inflated/ bulged out, indicates abdominal/pelvic floor weakness or coordination deficit of pelvic floor and intra-abdominal pressure management

Question 9

Stop the flow of urine test

Answer 9

unable to fully stop the flow of urine mid-stream

indicates pelvic floor muscle weakness

Question 10

Cues for no leaks

Answer 10

don’t squeeze the abs
squeeze upwards, to prevent pressure from pressing down on pelvis

Question 11

Rectus abdominius test (DRA)

Answer 11

+ if greater than 2+ finger width
assess width and depth

also note doming, invagination, tension or bogginess

Question 12

ASLR

Answer 12

assessing load transfer when lifting one leg 20cm off ground

rate amount of effort to lift, from 0 to 5

test is positive for any score > 0

repeat with passively applied compression to pelvis

testing to evaluate the load transfer

Question 13

One leg stand test

Answer 13

note balance, postural strategy, significant shift, pain

testing for load transfer and postural strategy

Question 14

Internal palpation

Answer 14

vaginal tone, contractility, muscles symmetry, sensation, pain, strength, coordination, A/P vaginal wall laxity with bear down

Question 15

Pelvic floor lengthening

Answer 15

stretching = happy baby, child’s pose, deep yoga squat

standing kickstand deadlift to lengthen the post glute, deep rotators

Question 16

Breath coordination with movement

Answer 16

indicated for LBP with stabilization deficits, S/S of weak or overactive pelvic floor

squats, deadlifts, bed mobility

Question 17

Squat breathing

Answer 17

inahle and slowly lower, causing eccentric lengthing of pelvic floor

forced exhale and contract PFM as they come upright

Question 18

Levator Ani Anterior

Answer 18

suprapubic region, urethra, bladder, perineum

increased urinary urgency/frequency, painful urination

Question 19

Levator Ani Posterior

Answer 19

deep vaginal, rectal, perineal

pain with defacation, painful urination, thrusting pain

Question 20

Coccygeus

Answer 20

buttock pain
pain with sitting, during defecation, intestinal fullness

Question 21

Obturator internus

Answer 21

anal, coccyx, vulvar, urethral, vaginal, post thigh pain

burning or aching pain

Question 22

Piriformis

Answer 22

ipsilateral hip, post thigh, sacroiliac region, buttock

Question 23

Adductors

Answer 23

can refer to groin, bladder, anteromedial thigh, down to knee

Question 24

Modified oxford scale for internal pelvic floor

Answer 24

0 = no contraction
1 = trace
2 = not symmetrical, no lift
3 = moderate contraction w/lift
4 = good contraction with lift
5 = strong contraction with strong lift

Question 25

PERF rating

Answer 25

Power = grade 0-5
Endurance = 0-10 s
Repetition = # of repetable contractions
Fast contraction = 0-10 reps

documented as P/E/R/F

Question 26

LBP and pelvic floor dysfunction

Answer 26

urinary incontinence, 78% of women with LBP reported incontinence

higher risk with breathing problems, obesity, lack of PA

Question 27

Exercise and incontinence

Answer 27

49% of gym exercising women experienced incontinence

constipation, family hx of UI, associated with incontinence

Question 28

Prolapse

Answer 28

worse as the day goes on, standing, better in the AM, weakness or overactivity

Question 29

SI or coccyx pain

Answer 29

attachements of PFM, deep hip rotators, referred pain from PFM, weakness, overactivity piriformis overactivity