Mens health Flashcards
What are pelvic floor Dysfunctions? (5)
Erectile dysfunction
Urinary incontinence
Feacal incontinence
Pelvic Pain disorders
Obstructive Disorders
What are the actions of PF muscles?
Pelvic organ support
Urethral anal/rectal pressure
Intra-abdominal pressure generation – walking, coughing, sneezing
Sacroiliac forces
Sexual function
How do you evaluate PF muscles? What do they assess
- Anal EMG - assesses the activation of urethral muscles
- Transperineal US - assesses the activation of individual pelvic floor muscles. Measures tone and stiffness of muscles
Assessment:
Anatomy
Voluntary contraction
Repeated rapid contractions x10
Cough
Preactivation + cough
Sustained hold 30s - Digital rectal examination - Evaluation of contraction of external anal sphincter and puborectalis, muscle tone, areas of tenderness. Can look at strength, endurance and coordination
- Subjective assessment:
- Can you stop peeing? - Assess the ability to contract
- Self palpation to test tightness
- Observation - assess Scrotal elevation, Penis retraction, Penis elevation. Can be used at home to monitor contraction strength
What are the types of Incontinence in Men?
o Post-prostatectomy incontinence
o Stress urinary incontinence
o Urge incontinence
o Mixed incontinence
o Detrusor/bladder overactivity
o Increased frequency
o Nocturia
o Hesitancy
o Incomplete emptying
o Detrusor-Sphincter dyssynergia
Post-prostatectomy incontinence
- When prostate cancer is treated with Radical Prostatectomy. Many side effects including incontinence
Side effects of radical prostatectomy
Impotence – 7-8/10 affected
Urinary incontinence 1-2/3 affected
Urinary obstruction - rare
Pelvic pain
Impact of Radical prostatectomy
Removal of prostatic urethra including smooth muscle
Interference with bladder neck
+/- striated urethral sphincter injury
Exposure/irritation of bladder
Lower bladder position
Incontinence
*Sphincter incompetence= compromised function
*Detrusor overactivity of bladder contraction, reduced storage
Rehabilitation of Radical prostatectomy
Penile rehabilitation
Maintain positive attitude
Management of persistent pelvic pain
Weight control
Physical activity
Focus on muscle complexes that control urethral pressure + trans perineal ultrasound imaging assessment & feedback
Training using principles of motor skill training
What are the instructions for Voluntary activation?
*Retract/shorten the penis – greatest dorsal displacement of the mid-urethra and SUS muscle activity
*Elevate the bladder – greatest increase in abdominal EMG and IAP
*Tighten around the anus – greatest anal sphincter muscle activity
Management of post-prostatectomy incontinence
Preoperative – assessment and commencement of training
Target findings of assessment
Restore optimal function of muscles that increase urethra pressure
Minimal/no anal assessment training focused on anus
Assessment and feedback using transperinal US imaging
Functional re-education
* Individualization to patient urethral striated muscle activation
* Skill learning
* Tonic
* Pre-activate
* Relaxation when required
* Strength and co-ordination for high demand and unexpected
Optimal program for post-prostatectomy incontinence
- Optimise pattern of pelvic floor muscle control for urethral pressure control
- Activation of PF, retract penis, contract as if you are trying to stop the flow of urine
- reduce the overactivity of abdominal muscles - Integrate PF control into funcitonal
- Golf, sit to stand, cough and sneeze - Bladder training to improve volume and time between emptying
What is the role of PF in sexual function?
o Contribution to:
Ejaculation
Penile rigidity and hardness
Orgasm – contraction of PFM
What are the Pelvic Pain disorders?
o Prostatitis
o Chronic pelvic pain syndrome
o Painful bladder syndrome/interstitial cystitis
Role of physio in sexual function:
o PFM training
o General exercise health
o Counseling/education
o Part of multifaceted intervention
