LECTURE 4: PELVIC FLOOR

Question 1

pudendal nerve innervates external genitalia. What nerve roots?

Answer 1

S2-4
dermatomes: S2-5
anal wink: S4-5

Question 2

sympathetic does___
parasympathetic controls____

Answer 2

SNS: storage (pelvic floor contract)
PNS: peeing (PF, relax)

Question 3

5 pelvic floor functions

Answer 3

1. sphincteric (continence)
2. sexual
3. stability
4. sump pump (veins, lymphs)
5. support

Question 4

abdominal cavity changes ____, thoracic cavity changes____ in breathing

Answer 4

abdominal: shape (water balloon)
thoracic: volume (accordion)

Question 5

What is form closure?

Answer 5

ligaments, joints

Question 6

What is force closure

Answer 6

muscular support

Question 7

healthy amount to pee per day

Answer 7

4-7 times a day
every 2-5 hours
0-1x/night

Question 8

What is normal bowel movement frequency?

Answer 8

3x/day
3x/week

Question 9

what bladder irritants should you avoid?

Answer 9

carbonation
caffeine
alcohol
sugar!

Question 10

Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

Answer 10

stress incontinence (PRESSURE)

Question 11

sudden, intense urge to urinate followed by an involuntary loss of urine.
You may need to urinate often, including throughout the night.

Answer 11

Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.

Question 12

You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

Answer 12

Overflow incontinence

Question 13

A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

Answer 13

functional incontinence

Question 14

Experiencing more than one type of urinary incontinence.

Answer 14

mixed incontinence

Question 15

Feces or gas leaks unexpectedly from rectum.

Answer 15

fecal/anal incontinence

Question 16

If pelvic floor mm are really weak, what position can you start in?

Answer 16

gravity reduced!
supine
prone
quadriped

Question 17

recommended weight gain in pregnancy

Answer 17

15-35 lbs, 11-20 if obese

Question 18

exercise precautions for pregnancy

Answer 18

1. avoid heat
2. prologned supine (less than 5 min)
3. contact sports, scuba diving, risk for falling
   *consider pelvic floor stretching in 3rd trimester
   *maintaining PLOF/intensity is good!

Question 19

When should you stop exercise in pregnancy?

Answer 19

1. vaginal bleeding
2. dizzy
3. SOB
4. chest pain
5. headache
6. mm gets weak, calf pain/swelling
7. contractons of uterus!
8. fluid from vagina

Question 20

relative contras for pregnancy exercise

Answer 20

Severe anemia
▪ Unevaluated maternal cardiac arrhythmia
▪ Chronic bronchitis
▪ Poorly controlled hypertension, pre-eclampsia, seizure, DM1, thyroid disease ▪ Extreme morbid obesity or BMI less than 12
▪ Current IUGR (intrauterine growth restriction)
▪ Heavy smoker
▪ History of extreme sedentary lifestyle

Question 21

▪ Hemodynamically significant heart disease
▪ Restrictive lung disease
▪ Incompetent cervix/cerclage
▪ Multiple gestation at risk for premature labor
▪ Persistent 2nd or 3rd trimester bleeding
▪ Placenta previa after 26w
▪ Premature labor during current pregnancy
▪ Rupture of membranes
▪ Pregnancy induced hypertension

Answer 21

absolute contras for pregnancy exercise

Question 22

If someone has persistent back pain post partum, not getting better… what could it be?

Answer 22

pelvic floor! prolapse

Question 23

considerations before progressing exercise in pregnancy

Answer 23

*Should not have coning/doming
*Should not have heaviness in pelvis or vagina
* Should not have leaking

Question 24

PF strength requirements to run post natal

Answer 24

▪ 10x fast reps
▪ 8-12 reps of 6-8 s max voluntary contraction ▪ 60s submaximal 30-50% contraction