Pelvic and Obstetric Physiotherapy

Question 1

categories of pelvic floor dysfunction?

Answer 1

bladder and bowel dysfunction
prolapse
vulvodynia
chronic pelvic pain

Question 2

assessment in pelvic floor dysfunction?

Answer 2

PMH
lifestyle
drug history
Obs and gynae history
socia history
bladder and bowel symptoms
QoL measures
patient set goals

Question 3

how can stool be assessed?

Answer 3

bristol stool form scale

- ranges from type 1 (seperate hard lumps) to type 7 (entirely liquid)

Question 4

how can bladder function be assessed?

Answer 4

Bladder diary
- records frequency and volume of urination
- also records urination during the night 
urinalysis
post void residual volume
perineal, vaginal/rectal examination
abdo/translabial US
pelvic floor assessment

Question 5

what is the oxford scale and ICS

Answer 5

scale of measuring strength of muscle contraction

• grade 0 = no contraction
• grade 1 = flicker
• grade 2 = weak contraction
• grade 3 = mod contraction
• grade 4 = good contraction
• grade 5 = strong contraction against maximal resistance

associated with ICS which goes from absent > weak > normal > strong with increasing grade

Question 6

what lifestyle changes can help incontinence?

Answer 6

healthy BMI
avoid constipation
smoking cessation
avoid heavy lifting 
caffeine reduction

Question 7

what non-medial measures can help incontinence?

Answer 7

bladder training
voiding/double voiding techniques
pelvic floor exercises

Question 8

how can bowel symptoms be improved?

Answer 8

pelvic floor exercises
lepicol or other probiotics (good if difficulty wiping clean)
holding on programme (good for urge incontinence)
holding on programme and caffeine reduction (good for frequency)

Question 9

what is pelvic floor training?

Answer 9

structured pelvic floor exercise programme ensuring correct technique
“knack” prior to any rises in intra-abdominal pressure
performed until muscle fatigue several times per day for 15-20 weeks
individualised - fast and slow twitch fibres

Question 10

what is biofeedback training and when might it be used?

Answer 10

EMG/US based bladder training programme

used when pelvic floor is working too hard at the wrong time

Question 11

what can be used for over the counter biofeedback training?

Answer 11

pelvic educator
vaginal cones
kegel exereciser
pelvic floor trainers
muscle stimulators

Question 12

how effective is electrical stimulation as a treatment for incontinence and when might it be used?

Answer 12

inconclusive evidence in regards to effectiveness
recommended use in patients with muscle strength grade 2 or less on oxford scale
active assisted

Question 13

core stability exercises?

Answer 13

pilates
gym ball
target lumbo-pelvic cylinder

Question 14

components of lumbo-pelvic cylinder?

Answer 14

pelvic floor
transversus abdominus
diaphragm
lumbar multifidus

Question 15

effect of pregnancy on pelvic floor?

Answer 15

positive effect of strengthening pelvic floor in pregnancy
women encouraged to do pelvic floor exercises throughout and after giving birth
forceps delivery or 3rd/4th degree tear increases risk of pelvic floor weakness