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 know?
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
What physiotherapy techniques are used to prevent bladder symptoms?
Bladder training
Voiding/ double voiding techniques
Pelvic floor exercises
Education on constipation (bulking agents)
What physiotherapy techniques are used to prevent bowel symptoms?
- Pelvic floor exercises
- Education on anorectal angle (use of footstool)
- Urge : holding on programme (especially in mothers who have experienced perineal tears
What methods of OTC biofeedback are recommended?
Pelvic muscle stimulators can be lent out to women
but OTC products often dont work
HOw do core stability exercises help women with incontinence, and what can be used?
- deep abdominal muscles sometimes thought to help with pelvic floor
- easier to explain how to correctly tense muscle this way
- Lumbo-pelvic
- Pilates
- Gym ball
How are women who have had a forceps delivery or have sustained a 3rd or 4th degree tear during childbirth normally followed up?
- one-to-one contact
- exercise technique is discussed
- especially if anal sphincter is involved in care
Women are encouraged to do Pelvic Floor excersises throughout pregnancy and after giving birth. TRUE/FALSE?
TRUE
How are women with 1st/2nd degree tears managed after childbirth?
- spinal anaesthetic given to relax sphincter
- sutured back together
- given laxatives and antibiotics for healing process to occur
- usually do not require much follow up after this
