Pelvic and Obstetric Physiotherapy Flashcards
What MSK problems in pregnancy are addressed by physiotherapists?
- back pain
- pelvic girdle pain (SI joint pain and pubic symphysis)
HOw long does it take for most females to present with incontinence problems to the GP?
- average = 7 years
Why do prolapse patients normally present quicker?
- present quicker as they assume that the lump = “cancer”
During what screening test can prolapse be picked up?
smear test
How long do new referral appointments for incontinence or prolapse last?
1 hour
What must you remember to ask about in a new referral presentation?
- “near misses” (almost incontinent before reaching toilet)
- constipation (prevent straining)
- What bothers patient most and what do they want to achieve
What conditions are considered pelvic floor dysfunction?
- Incontinence of bladder/bowel
- Difficulty with bowel emptying
- Pelvic organ prolapse
- Vulvodynia or other male/female pelvic pain
Why may patients suffer from faecal incontinence with a Bristol Stool rating of 7?
- if faecal matter is liquid, this cannot be held in by anal sphincter
- stool modification can be used to fix this
What is meant by stool modification?
- Bulking agents (Fybogel) - attracts water to stool and makes them easier to pass?
- Loperamide if high Bristol Stool chart rating
Why do many women with stress incontinence often being to tolerate less fluid in their bladder?
- women begin to go to the bathroom “just in case”
=> have less in their bladder when they feel need to go
HOw many episodes of nocturia are normal if a patient is over the age of 60 versus over the age of 80?
> 60 y - 1 episode nocturia
>80 y - 2 episodes nocturia
What components are measured in a bladder diary?
- frequency
- volume
- episodes of nocturia
- total fluid intake
- number of pads used
What other investigations should be carried out in relation to incontinence?
- Urinalysis (for haematuria)
- Post void residual (may be due to kink in urethra)
- Perineal skin examination (may be irritated by incontinence)
- Assess for evidence of prolapse whilst patient is standing (aided by gravity)
Why is nocturia a risk in the elderly?
- getting up during the night to go to the loo causes many elderly patients to fall
What lifestyle measures can physiotherapists advise to help with pelvic floor dysfunction?
- BMI
- Avoid constipation
- Smoking cessation
- Avoid heavy lifting
- Caffeine reduction
