M7: 2 Flashcards
Stress incontinence is directly related to
Underactive PFMs
Urge incontinence is related to
Visceral dysfunction
Overflow incontinence is related to
Failure to empty urine
These types of incontinence are generally not related to underactive PFMs
- overflow
- functional
Symptoms: stress incontinence
Small leak with
- cough
- sneeze
- exercise
Symptoms: urge
Mod-large leak with strong urge
Symptoms: mixed incontinence
Mix of stress and urge
Dx classifications: stress incontinence
- underactive PFM
- PFM weakness
Dx classifications: urge incontinence
- visceral dysfunction
- may have PFM weakness
Dx classifications: mixed incontinence
- underactive PFM
- PFM weakness
- visceral dysfunction
Questions to include in a brief pelvic floor screen
- Do you ever leak urine or feces?
- Do you ever wear a pad because of leaking urine?
- Do you have pain during intercourse?
Levator ani syndrome
- constant/freq spasm of PFMs
- spasm and TrPs in pelvic diaphragm
Coccygodynia
- pain in coccyx
- related to TrPs of PFMs, obturatur, g max, piriformis
Vulvodynia
- pain of external genitalia, perineum
- often idiopathic
- provoked or unprovoked
- “stabbing” pain in vagina, less commonly in rectum
Vaginisimus
Spasm of muscle around the vagina (superficial mm or pelvic diaphragm)
Anisimus
Failure of PFMs to relax during defecation
Dyspareunia
- painful intercourse
- common sx of vaginisimus
2 categories of dyspareunia
- pain at initial penetration
- pain at deep penetration
Dyspareunia: pain at initial penetration
- superficial mm spasm
- skin irritation or adherence, painful episiotomy
Dyspareunia: pain with deep penetration
- spasm of PFM
- organ prolapse with visceral adhesion
Stress incontinence questions
- Do you leak urine when you cough, laugh, or sneeze
- Do you lose urine when you lift heavy things?
- Do you lose urine when you run, jump, or exercise?
Urge incontinence questions
- Do you ever have such an uncomfortable strong need to urinate that you leak if you don’t reach the toilet?
- Do you develop an urgent need to urinate when you hear running water?
- Do you develop an urgent need to urinate when you are nervous, under stress, or in a hurry?
Questions for organ prolapse
- Do you ever feel as though you are sitting on a ball or that there is something in the way when you are sitting?
- Do you ever feel as though something is falling out of your perineal area?
Questions for obstruction
- Do you find it hard to begin urination?
- Do you have a slow stream?
- Do you strain to pass urine?
What are 2 typical pt responses to UI that may actually worsen the problem?
- stop exercising entirely
- limit ADLs to reduce risk of leaking
- not drinking as much water » shrinks bladder
