Neuro Peds - 02 - Women's Health Flashcards
What constitutes women’s health?
Breast & Ovarian Cancer Osteoporosis Pregnancy Post-Partum Female Athlete Triad Pelvic pain Lymphedema Incontinence Aging Domestic Violence & Abuse Arthritis Menopause Eating Disorders Autoimmune Disorders
‘A woman’s health encompasses all functions related to her mental and physical wellness from ____
___ puberty through old age’
what are Considerations Across the Lifespan?
Teenager - Female-athlete triad 20’s and 30’s - Pregnancy & Post-Partum 40’s & 50’s - Menopause 60’s & Beyond - Osteoporosis Across the lifespan - Depression, Arthritis, Breast Cancer, etc
why is Women’s Health important to PTA?
- Time spent with patients = insight
- Knowledge of important screening questions
- Necessity of recognizing when a referral is appropriate
- Prevalence3
- > NAFC estimates 25 million Americans are incontinent
- > 50% of nursing home residents are incontinent
- > 1 in 5 adults over 40 yoa experience OAB
there are differences between male and female pelvis
yep. go look them up.
name the three ligaments in the pelvic area
pubovesical
round
uterosacral
how many layers of the pelvic floor?
three layers
three functions
what are the voiding phases of micturition?
Filling – transition – voiding
what is the neurologic control of the bladder?
- via Bradley’s Loops I-IV
Brain = Loop I, II, IV; Spinal Cord = Loop III
what is there to know about the Storage of Urine?
- Initial urge at 150-200 mL
- 400-600 mL normal capacity
- Detrusor relaxes & internal urethral sphincter contracts via sympathetics
- External urethral sphincter & PFMs contract via somatic motor control
how does the Emptying of Urine happen?
- Sensory receptors cause micturition reflex (involuntary)
- Detrusor contracts & internal urethral sphincter relaxes via parasympathetics
- External urethral sphincter & PFMs relax via somatic motor control
- Normal 20 seconds
- Normal post-void residual (PVR) 5-50 mL
- 2-3 hour intervals, 5-8x/day
what is the Storage Dysfunction?
Damage to Bradley’s Loop IV = involuntary control of external sphincter during filling
what are the Emptying Dysfunctions?
- Damage to Bradley’s Loop I = no awareness of voiding
- Damage to Bradley’s Loop II = increased PVR
- Damage to Bradley’s Loop III = involuntary relaxation of external sphincter, dyssynergia with detrusor
what are subjective considerations for the pelvic floor evaluation?
- Medications: side effects!
- Obesity
- Childbirth: vaginal deliveries
- Chronic increased intra abdominal pressure
- Lifecycle: hormonal contributions
- Trauma: surgeries
- Frequency of Voiding/Incontinence
what is included in the pelvic floor evaluation?
Postural Evaluation Manual Muscle Testing - Hips & Abdominals - Intravaginal and/or Intrarectal Musculoskeletal Considerations - Thoracic & Lumbar Spine - Sacroiliac Joint - Hips
what is Stress Urinary Incontinence?
SUI
- Involuntary loss of urine due to an increase in intra-abdominal pressure6
- Associated with physical exertion
- Caused by:
- -Intravesical pressure > maximum urethral pressure
- –Decreased extrinsic urethral support
- –Insufficiency of intrinsic urethra
what is the treatment of the SUI?
Pelvic Floor Exercise Strengthening - Pelvic floor contractions: kegels - Biofeedback: pelvic floor uptraining - Vaginal weights: 20 to 70 grams - Electrical stimulation: 35-50 Hz to facilitate muscle awareness, strength Synergist Strengthening Functional Application - Avoiding valsalva & straining - PFM strengthening with functional activities
What is Urge Urinary Incontinence?
UUI Involuntary loss of urine accompanied by an intense sense of urgency6 Bladder is overactive, irritable Caused by: - Detrusor instability - Faulty behavioral habits
what is Overactive Bladder?
OAB
Symptoms of frequency, urgency without loss of urine6
60% of population with urgency frequency (vs. 40% UUI)
Caused by:
- Incomplete emptying of the bladder
- Detrusor instability
- Faulty behavioral habits
what are treatments of UUI and OAB?
Behavioral Modification
- Dietary
- Voiding schedules: bladder diary, timed voiding
- Urge suppression techniques
- Poor bladder habits: JIC, hovering
Neuromuscular Approach
- Electrical Stimulation: 12.5 Hz, detrusor inhibition reflex7
- Re-education: biofeedback for PFM down training
- Physiologic quieting: diaphragmatic breathing
name 4 additional types of incontinence
- Mixed Urinary Incontinence-Combination of stress and urge urinary incontinence
- Overflow Incontinence-Loss of urine due to over distension of the bladder, failure to empty
- Functional Incontinence-Loss of urine due to impaired mobility
- Fecal Incontinence-Involuntary loss of feces
what is Pelvic Organ Prolapse?
POP
Descent of anterior, posterior vaginal wall, apex of the vagina
name 4 POPs
Cystocele: bladder
Rectocele: rectum
Uterine: uterus
Enterocele: peritoneum or small bowel
what are the symptoms of Prolapse?
Incomplete emptying of bowel and bladder
Pressure
what causes Prolapse?
Decreased support of vaginal wall tissues
what treats Prolapse?
- Strengthening of pelvic floor muscles comparable to program for SUI - Focus on gravity assisted positions
- Splinting with voiding
- Pessary (MD prescription, fitting)
name Organ Based Pelvic Pain (4)
- Irritable Bowel Syndrome-Increased sensitivity of the intestines contributing to abdominal pain, changes in BMs
- Interstitial Cystitis or Painful Bladder Syndrome-Chronic inflammation of the bladder contributing to frequent and urgent urination, pelvic pain
- Endometriosis-Endometrial cell growth outside of uterus contributing to painful menstruation, abdominal and pelvic pain
- Dysmenorrhea-Painful menstruation
name Musculoskeletal Pelvic Pain (5)
- Chronic Pelvic Pain10
- Pelvic Floor Tension Myalgia-PFM spasm and pain
- Coccygodynia-Coccygeal pain
- Levator Ani Syndrome-Chronic pain and aching in the perivaginal and/or perirectal muscles
- Vaginismus-Vaginal muscle spasm preventing penetration
name Pelvic Pain with unknown cause or multi-system etiology (4)
- Vulvodynia-Burning, stinging of the vulvar tissues
- Prostatodynia (Male)-Chronic nonbacterial prostatitis contributing to pain and urinary symptoms
- Proctalgia Fugax-Sharp, fleeting rectal pains
- Pudendal Neuralgia-Inflammation of the pudendal nerve contributing to pelvic pain, sexual dysfunction, and urinary/defecatory symptoms
how is Pelvic Pain treated?
- Therapeutic Exercise-Stretching and/or strengthening of the pelvic floor and pelvic girdle muscles
- Neuromuscular Approach-Biofeedback: relaxation, down training of pelvic floor; Diaphragmatic breathing
- Postural education-Corrected alignment with activities of daily living
- Modalities- Electrical Stimulation: TENS, IFC, Heat, ice, Ultrasound
- Manual Therapy - Joint mobilization, Scar massage, Trigger point release, muscle energy techniques, Myofascial release
postural changes associated with pregnancy:
Uterus becomes abdominal organ from pelvic organ14
COG moves forward
Base of support shifts
Increased lumbar lordosis
Abdominal muscles lengthen and can separate (diastasis recti)
Excessive work on gastrocnemius and soleus causes cramping
Weight bearing on metatarsals instead of heel
pregnancy effect on joints
Pelvic girdle instability14 SI joint malalignment Symphysis pubis – separates up to 12mm Trochanteric bursitis and radicular pain Lumbo-sacral pain Peripheral joints less stable
pregnancy effect on muscles and nerves
Diastasis recti14 PFM traumatized causing incontinence, prolapse and post-partum pelvic pain Nerve compression and stretching
treatments for pregnancy effects on joints, muscles, nerves
Positioning and use of pillows14 Postural education PFM strengthening sEMG to coordinate and re-train PFMs (peri-anal) Manual therapy techniques Support belts Stretching and stabilization exercise Ice or heat to sore muscles and joints
contraindications for treatments for pregnancy effects
Multiple gestation14 Preterm labor Pre eclampsia DM with vascular disease Pulmonary hypertension Renal disease with HTN Vaginal bleeding Incompetent cervix Chronic hypertension Sick cell anemia Heart disease
guidelines for exercise during pregnancy
Maternal HR < 140 BPM14
< 15 minutes of strenuous exercise at a time
Proper clothing for heat dissipation important after first trimester
Positioning: supine after 4th month
Adequate calorie intake
Proper fluid intake
3x/week exercise
name surgical intervention for breast cancer
Lumpectomy15 Mastectomy - Quadrantectomy - Modified Radical - Radical Sentinel Node Biopsy Axillary Lymph Node Dissection Reconstruction
name adjuvant therapies to surgical interventions for breast cancer
Chemotherapy15 Radiation Therapy Hormone Therapy - Tamoxifen - Aromatase Inhibitors
associated diagnoses and impairments to breast cancer
Shoulder Pain & ROM Limitations Axillary Web Syndrome Myofascial Pain Syndrome Cervical Pain Lymphedema Fatigue Osteoporosis
treatments of associated diagnoses and impairments to breast cancer
Manual Therapy
- Myofascial release
- Scar & Joint mobilization
Therapeutic Exercise & Neuromuscular Re-Education
- Normalization of scapulo humeral mechanics
- Restoration of flexibility & strength
- Postural education
- Endurance training
- Weight-bearing exercise
- Balance training
considerations and contraindications to treatments for associated impairments to breast cancer
ROM & Lifting Restrictions
- Post-operatively
- JP drains
- Reconstruction
Decreased Tissue Integrity
- Radiation induced
Risk of Infection
- Incision healing
Lymphedema
- Lymph node removal +/- radiation
Fall Risk & Neuropathy
- Chemotherapy induced
Fracture Risk
- Adjuvant therapy induced osteoporosis
Fatigue & Blood Counts
- Chemotherapy induced
