Pelvic Floor Flashcards
What are the primary functions of the Pelvic Floor?
supports bladder, bowel, and reproductive organs.
aids in holding and evacuation of waste.
What are the structures of the Anal Triangle?
- (Anterior)
Ischial tuberosities and superficial transverse ligament - (Posterior)
Sacrotuberous ligament, gluteus maximus and coccyx - (Lateral)
ischium and inferior part of obturator internus muscles
What are the superficial muscles of the Urogenital Triangle
- Ischiocavernosus
- bulbocavernosus
- superficial transverse perineal
What are the functions and innervation of the Urogenital Triangle?
- Aid in sexual responsiveness
- Supports pelvic organs/fixes the perineal body
- innervated by the pudendal nerve
What muscle works in the closure of the anus?
External Anal Sphincter
What are the insertion/origins of the Deep Transverse Perineal for men/women?
Originates from the pubic ramus
Males: wraps around the urethra and attaches on the same muscle of the opposite side; may be joined with the deep transverse perineal
Females: inserts into the vagina
What muscles support the Pelvic Diaphragm?
Levator
Coccygeus
What are the functions of the Pelvic Floor/Pelvic Diaphragm?
- Supports the pelvic organs/viscera
- Resists increases in intra-abdominal pressure
- Pulls the rectum toward the pubic bone
- Maintain continence at the urethral and anal sphincter
- Stabilizes SI joint
What are the 3 fibers that make up the Levator Ani?
What innervates these fibers?
Pubococcygeus
Puborectalis
Iliococcygeus
S3 to S4
What muscle serves as a base of support for the bladder, supports the walls of vagina and provides tone during sexual activity?
Levator Ani
Originates on the ischial spine
Inserts on the sacrum and coccyx
Innervated by the spinal nerves S3-4
Flexes the coccyx
Coccygeus
Has a tendinous attachment to the levator ani
Refers pain to the sacral-coccyx area, posterior thigh and vagina
Tightness and trigger points can cause a feeling of fullness in the rectum.
Muscle tightness can cause pudendal and obturator nerve entrapment
Obturator Internus
An involuntary loss of urine that is sufficient to be a
problem and occurs most often when bladder pressure
exceeds sphincter resistance. More common in women and increases with age.
Urinary Incontinence
What are the different types of Incontinence?
- Stress Incontinence
- Urge Incontinence
- Overflow Incontinence
- Functional Incontinence
What are the causes of Stress Incontinence?
- Weakness of pelvic floor or sphincter weakness
- May be a result of childbirth
- Trauma to internal sphincter mechanism
(from prostate surgery in men)
A strong, unexpected urge to urinate followed by uncontrolled
loss of urine.
Urge Incontinence
What are the causes of Urge Incontinence?
- Decreased bladder capacity
- Detrusor muscle instability
- Neurologic disease affecting the bladder
- Prolonged bladder outlet obstruction
Urine leaks and dribbles from a bladder that is not full caused by pelvic relaxation, constipation, prostrate obstruction, DM and or SCI.
Overflow Incontinence
Urinary loss when there is difficulty with mobility, dexterity, and impaired cognition.
Functional Incontinence
Causes of Incontinence
- Disuse atrophy
- Childbirth trauma: loss of pelvic floor support
- Hormonal changes
- Repetitive Valsalva
- Post surgical
- Bacterial infection
- Cystocele, Urethrocele, Rectocele, Enterocele - (Prolapse)
- Neurogenic
What data should you collect as a PTA regarding Incontinence?
- PFM strength, coordination, and resting tone
- Accessory muscle group strength/recruitment
- Abdominal strength/muscles recruited
- Diastasis recti
- Bladder diary
What are the treatment options for Incontinence?
- E-stim
- Biofeedback
- Vaginal weights
- Home exercise program
- Diet/prevention education
- Medication review
- Bladder retraining
Treatment Objectives/Interventions for Stress Incontinence.
improve pelvic floor muscle strength/endurance
improve support of abdominal viscera
Treatment Objectives/Interventions for Overflow Incontinence.
- Eliminate outflow obstruction or improve detrusor contractility
- May require surgery
- Pelvic floor relaxation exercises
- Biofeedback
Treatment Objectives/Interventions for Urge Incontinence.
- Inhibit bladder contractions
- Increase bladder capacity
- Pelvic floor and abdominal exercises
What are some examples of Bladder irritants?
• Carbonated drinks • Caffeine (coffee, tea) • NutraSweet • Alcoholic beverages • Spicy foods • Vinegar • Strawberries • Sugar, honey, chocolate, corn syrup • Vit. B complex • Tomato based products • Milk/milk products • Citrus juice and fruits • Cranberry juice
Physical Therapy Interventions for Pelvic Health and Rehab.
- Kegel exercises
- General strengthening exercises
- Modalities to facilitate contraction of Pelvic Floor
- Soft Tissue Massage
Supine Kegel Exercise instruction and parameters.
- Men: The penis moves upward and inward
- Women: The vagina contracts and tightens as it moves upward
- Isometric Hold
- 10 seconds
- Reps. 10x
- Repeat 3x
How are Kegel Exercises progressed?
Perform Kegel Exercises in conjunction with following: • Resisted TheraBand hip abduction and external rotation • Resisted adduction with a squeeze ball • Bridging • Standing • Squatting • Lunges • Sit to Stand
What are the contraindications for E-stim for Incontinence?
• Infection - bladder or vaginal • Pregnancy or attempting pregnancy • Urogential or colorectal cancer • Anti-coagulation therapy, pacemaker, arrythmia • History of urinary retention • Cognitive impairment
Parameters for Electrotherapy with Stress and Urge Incontinence.
15 min sessions
2x daily - 12 weeks
50Hz for Stress
10Hz for Urge
Examples of strength exercises for Pelvic Health and Rehab.
Pelvic Tilt Bridging Quadruped SL Leg lift Drawing-in Wall Squat Birddogs
