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Medcon Rehab IV > Pelvic Floor (All Lectures) > Flashcards

Pelvic Floor (All Lectures) Flashcards

1
Q

Roles of the Pelvic Floor

4:

A
  1. Support
  2. Sphincteric
  3. Sexual
  4. Stabilization
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2
Q

For Muscle Layers of the Pelvic Floor….

Know the Following!!!!

A
  • Layers 1-3
  • Functions of ea. layer
  • What mm’s are included
  • Diff’s in muscles bw men and women
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3
Q

Muscle Layers of the Pelvic Floor

Vaginal: 3

A
  • Layer 1→ Superficial Perineal
  • Layer 2→ Urogenital Diaphragm
  • Layer 3→ Pelvic Diaphragm
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4
Q

Muscle Layers of the Pelvic Floor

Male Muscle Differences: 3 Layers still

A
  • Layer 1→ Superficial Perineal
  • Layer 2→ Urogenital Triangle (same job, same orientation as Female)
  • Layer 3→ Pelvic Diaphragm
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5
Q

Pelvic Floor Muscles: Name Them!

Layer 1: Superficial Perineal M vs F

A
  1. Ischiocavernosus
  2. Bulbocavernosus (erectile tissue)
  3. Superficial perineal (aka Transverse Perineal mm’s)
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6
Q

Pelvic Floor Muscles: Name Them!

Layer 2: Urogenital Diaphragm/Triangle

A
  1. Deep transverse perineal
  2. Sphincter urethrovaginalis
  3. Compressor urethra
  4. External Urethra
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7
Q

Pelvic Floor Muscles: Name Them!

Layer 3: Pelvic Diaphragm (DEEPEST LAYER)

A
  1. Levator Ani Group
    1. Iliococcygeus
    2. Pubococcygeus
    3. Puborectalis
  2. Coccygeus
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8
Q

Know these Pelvic Floor Muscles M vs F and be able to IDENTIFY THEM!

A

see pics

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9
Q

KNOW THIS CHART

(broken down in further slides)

A

see chart!

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10
Q

Muscles Layers of Pelvic Floor

Superf—–→ Deep

A
  1. Superficial Perineal
  2. Urogenital Diaphragm/Triangle
  3. Pelvic Diaphragm (deepest)
    1. Think Levator Ani group
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11
Q

Muscle Layer: Superficial Perineal

Function & MM’s

A
  • Function:
    • Sexual function, Pelvic Floor support
  • MM’s
    • Ischiocavernosus, Bulbocavernosus, Superficial Perineal
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12
Q

Muscle Layer: Urogenital Diaphragm/Triangle

Function & MM’s

A
  • Function:
    • Closes urethral and vaginal openings
    • Assists in maintaining erections
  • MM’s
    • Deep Transverse Perineal, Sphincter Urethrovaginalis, Compressor Urethra, External Urethra
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13
Q

Muscle Layer: Pelvic Diaphragm (DEEPEST*)

Function & MM’s

A
  • Function:
    • Supports organs, pelvis
    • Stabilizes trunk w/ UE, LE motions
  • MM’s
    • Levator Ani group (iliococcygeus, pubococcygeus, puborectalis) *KNOW THESE!!!
    • Coccygeus
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14
Q

Male Pelvic Floor MM Differences

Layer 2 (Urogenital Diaphragm/Triangle) differs how???

A

Same Job, Same Orientation….BUT!

*Layer 2 differs in anatomical layout, the set-up is different

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15
Q

The DEEPEST pelvic floor layer, ______________, is comprised of 3 muscles within the ______________ group…..what are they and pics??? ?

A
  • Deepest Layer→ Pelvic Diaphragm
  • 3 mm’s within the Levator Ani group
    1. Iliococcygeus
    2. Pubococcygeus
    3. Puborectalis

***REMEMBER→ “Sling that holds UP the anus” Levator (lift) Ani (anus)

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16
Q

Pelvis→ complex structure containing…..

A

Pelvic viscera, Urinary/GI tract, Support and Suspensory ligs, Fascial connections, Skeletal and striated mm’s

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17
Q

Structures of Bony Pelvis

4 specific articulations

A
  • R &L SI joints
  • Sacrococcygeal symphysis
  • Pubic symphysis
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18
Q

Greater & Lesser Pelvis

A
  • Greater pelvis
    • Support portion
    • Supports lower abdom viscera
  • Lesser pelvis
    • Inferior portion
    • Contains pelvic cavity and pelvic viscera
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19
Q

Pelvic INlet

Describe + Pics

A
  • Boundary bw greater & lesser pelvis
  • Pelvic brim is most superior border
  • Determines size and shape of birth canal
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20
Q

Pelvic OUTlet

Function + Pics

A
  • End of lesser pelvis
  • Inferior portion
  • Coccyx, sacrum move during childbirth to widen pelvic OUTlet
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21
Q

Male Perineum

Urogenital, Anal Triangles

A

see pics

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22
Q

Female Perineum is a passage to _______, ________, ________ systems

A

Reproductive tract; Urinary; GI Systems

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23
Q

A healthy bladder should…..

A

STRETCH!!!

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24
Q

What is Continence and What does it Require?

A

Voluntary control of bladder and bowel

  • Requires:
    • intact NS, adequate PFM contraction strength, quality, timing
    • bladder must expand to contract→ should stretch!**
    • full sensory awareness of bladder filling
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25
Q

Know these anatomical structures for Bladder Anatomy

A
  • Vesical
  • Detrusor
  • Trigone
  • 2 Ureters
  • Urethra
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26
Q

Bladder Anatomy:

Vesical

A

Actual bladder

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27
Q

Bladder Anatomy:

Detrusor

A

Bladder muscle

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28
Q

Bladder Anatomy:

Trigone + functions

A

Posterior to bladder wall

  • Sensitive to stretch
  • Can create urgency
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29
Q

Bladder Anatomy:

2 Ureters and what do they do?

A

Deposit into superior bladder wall

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30
Q

Bladder Anatomy:

Urethra is where?

A

@ the distal bladder

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31
Q

Urethral Sphincters

(2):

A
  1. Internal urethral sphincter
  2. External urethral sphincter
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32
Q

Internal Urethral Sphincter

A
  • Base of bladder neck
  • Autonomic, smooth (internal) muscle → INvoluntary
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33
Q

External Urethral Sphincter

A
  • Inferior to bladder neck and internal urethral sphincter
  • Somatic, skeletal (EXternal) muscle→ VOLUNTARY
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34
Q

INTERNAL urethral sphincter muscle

A

Smooth muscle→ INvoluntary

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35
Q

EXTERNAL urethral sphincter muscle

A

Skeletal mm→ VOLUNTARY

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36
Q

Pelvic floor muscle role in continence→ IMPORTANT!!!

In general, PF ________ w/ _______ of urine

A

PF contracts w/ storage of urine

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37
Q

Pelvic floor muscle role in continence→ IMPORTANT!!!

In general, PF _________ when _______ urine

A

PF relaxes when empties urine

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38
Q

PF contracts w/ storage of urine

This is during what stage of breathing?

A

INHALE → elevates

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39
Q

PF relaxes when empties urine

During what stage of breathing?

A

During EXHALE → descends

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40
Q

What happens when PF contracts w/ storage of urine?

A

Bladder gets heavier and PF holds it up!!!

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41
Q

If PFM is weak….

what happens as a result?

A

Pee more/clench

Bc PFM’s are weak and cannot hold up the bladder!!!

*as a result of this, pts may reduce fluid intake==> BAD!!!

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42
Q

Good intervention for weak PFM’s

A

Incremental lowering and lifting of PFMs

*Ecc. control

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43
Q

PFM Dysfunction picture

A

see pics

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44
Q

NS Role in PF

Parasympathetic is what plexus?

A

Pelvic plexus

  • S2-S4
  • M & S innervation to bladder
  • Detrusor contraction + bladder emptying
  • Cholinergic receptors in bladder

NOTE: these are medication targets!!!

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45
Q

NS Role in PF

Sympathetic

What plexus?

A

Hypogastric Plexus

  • T10-L2
  • Detrusor relaxation for filling and storage
  • Beta adrenergic receptors in bladder

NOTE: these are targets for medications!

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46
Q

Normal Urinary Tract Function

Pushing/Straining is….

A

UNNECESSARY!!!

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47
Q

Normal Urinary Tract Function

Post Residual Void (PRV) ==>

A

50ml OR LESS

*what’s left after pee

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48
Q

Normal Urinary Tract Function

When you void, it can be ____ or _____ than total bladder volume (???)

A

Half OR Greater than total bladder volume

~300ml

Bladder can hold more than 2 cups of liquid***

49
Q

Proper Voiding Habits

A
  • Leaking is NOT a sign of aging or having kids
  • 5-8 voids per 24 hr→ even if drinking proper amt H2O*
  • Every 2-4hr intervals
  • 0-1 voids after bedtiem
  • Should be able to hold 2hrs
50
Q

Dysfunctional Voiding

BAD HABITS

A
  • “Just in case” pee
  • Semi squat/hovering over toilet
  • Dehydration/too many viscous drinks
  • Straining to empty
  • Fear of using public toilets
  • Post-partum habits of freq voiding
51
Q

Types of Urinary Incontinence

3:

A
  1. Urge
  2. Stress (most common)***
  3. Mixed
52
Q

Types of Urinary Incontinence: Urge

Definition, Causes, Interventions

A

Strong desire to void (“urge”) w/ INvoluntary loss of urine BEFORE or AFTER the urge

  • Cause:
    • Detrusor instability
  • Interventions
    • Diaphragmatic breathing, PFMC exercises
    • Distraction, meditation
53
Q

Types of Urinary Incontinence: Stress (MOST COMMON*)

Definition, Causes, Interventions

*Think “stresses” PF

A

INvoluntary loss of urine during physical exertion (cough, lifting, jumping, valsalve)

  • Causes:
    • Sphincter deficiency, weak or overactive PF
  • Interventions:
    • PFMC exercises to relax/contract properly
    • Diaphragmatic breathing
54
Q

Types of UI: Mixed

Definition, Causes, Interventions

A

Combo of urge and stress sx’s

  • Interventions:
    • Treat Urge first!!!….then SUI
55
Q

Urge incontinence

Triggers/Key Question

A
  • Triggers:
    • Cold, running water, key in door/waking up in AM
  • Question: Do you leak urine on the way to the toilet or with a strong urge to go?

NOTE: May or may NOT be pelvic floor problem

56
Q

Stress Incontinence

Key Questions

A
  • Key Questions: Do you lose urine when you laugh/cough/sneeze/exercise?
57
Q

Mixed Incontinence

Rule of Thumb

A
  • Treat Urge and Frequency FIRST!!!
  • THEN treat stress incont. sx’s
58
Q

Incontinence in Males

Urinary freq or retention

Characteristics?

A
  • Linked to prostate issues
  • HIGH PFM tone
  • Prior sx
  • Coord. issues of PFM

Bottom Line: Make sure prostate has been checked or if pt has been eval’d by urologist

59
Q

Pharma in Incontinence— ON BOARDS!!! IMPORTANT!!!

Types:

A
  1. Anticholinergics ***
  2. Mirabegron
  3. Imipramine
  4. Duloxetine
  5. Estrogen (NOT best case scenario)
  6. OnabotulinumtoxinA (Botox)
60
Q

Pharma in Incontinence

Anticholinergics

KNOW THIS!!!

A
  • BLOCK parasympathetic system and hence, acetylcholine
    • ACH sends signals that trigger detrusor contractions (you know this!!!)
61
Q

Pharma in Incontinence

Anticholinergics Mechanism of Action:

3:

A
  1. Inhibition of bladder spasms
  2. Increase bladder capacity
  3. Delay initial urge to void

Types: Oxybutynin (Ditropan XL), Tolterodine (Detrol), etc..

62
Q

Anticholinergics SE’s

A

Dry mouth, blurred vision, diarrhea, Constipation, drowsy, tachycardia

63
Q

Anticholinergics are the MOST COMMON

A

MOST COMMON FRONTLINE!!!!!

64
Q

Pharma in Incont.

Mirabegron (Myrbetriq)

A

Relaxes detrusor to inc amt of urine in bladder*

INC amt you are able to urinate @ one time to empty bladder

65
Q

Pharma in Incont.

Imipramine

A

Tricyclic antidepressant

Detrusor relaxation, cause smooth mm @ bladder neck to contract

Treats mixed incont.

66
Q

Pharma in Incont.

Duloxetine

A

Serotonin and NE reuptake inhibitor

Urethral sphincter relax

Helpful for urinary incont. and depression

67
Q

Pharma in Incont.

Estrogen

*NOTE: NOT best case scenario

A

LOW dose topical estrogen (cream), rejuvenate deteriorating support tissues in vagina and urinary tract???

DEC sx’s thru estrogen receptors in the urethra and PFM

68
Q

Pharma in Incont.

OnabotulinumtoxinA (Botox)

A

BLOCKS actions of ACh and paralyzes detrusor

Lasts several months (peaks 2wks)

69
Q

Prostate Patho’s to know:

3:

A
  1. Prostatitis
  2. Benign Prostatic Hyperplasia (BPH)- enlarged prostate
  3. Prostate Cx
70
Q

Prostate gland function

A

Produce elements to keep sperm healthy and alive

71
Q

What is the most common cause of Prostatitis?

A

BACTERIA

1.Acute 2. Chronic

72
Q

ACUTE bacterial prostatitis

A
  • Bacteria finds its way into the prostate from kidneys, bladder, etc.
73
Q

CHRONIC bacterial prostatitis

A
  • Mild bacteria infx lingers several mos
  • **Post UTI OR acute bacterial prostatitis
74
Q

Out of all the Prostate pathologies……

When you see PAIN….. think what???

IMPORTANT!!!!!!!!

A

PROSTATITIS!!!!!!

NOTE: Specific in MEN related to Pelvic Floor*****

75
Q

Sx’s of Prostatitis

A
  • PAIN anywhere in area*
  • WEAK stream of urine
  • Diff RELEASING a stream of urine
  • PAIN w/ urination*
  • “Heavy” scrotum feeling
  • PAIN post-ejaculation
76
Q

BPH aka

A

Enlarged prostate

77
Q

Benign Prostatic Hyperplasia

Broken down…

A
  • Benign→ NOT cancerous
  • Hyperplasia→ OVERgrowth of cells
78
Q

What can cause BPH??

A
  • Hormones
    • AGE causes Dec in testosterone, Inc in estrogen
  • Aging
    • Growth spurt of prostate again in middle age
  • Other
    • Diet, exercise, lvl of sexual act., race, exposure to toxins, gen health
79
Q

BPH is NOT

80
Q

Sx’s of BPH

What is NOT on list?

A

PAIN!!!

So.. if you see pain, you know its NOT BPH !!

81
Q

Sx’s of BPH

A
  • Enlarged prostate restricts normal urine flow
    • Frequency
    • Diff releasing a stream of urine
    • DEC in stream
    • WEAK flow
    • Urinary retention
82
Q

Sx’s of BPH

Things you need to know!

A
  • PAIN is NOT on list****
  • **Cx vs. BPH
    • Biopsy will show Cx, therefore we know its NOT BPH
    • Sx’s are similar SO… people will wait too long to do anything or have it examined thinking its BPH
83
Q

PSA Density Test

Normal ==== ?

A

4-10 ng/mL

84
Q

Prostate Density Test

A

Normal= 4-10 ng/mL

  • Determines if elevated PSA is cancer or benign
  • **70-80% of cases w/ elevated PSA→ biopsy shows NO EVIDENCE OF Cx
85
Q

Digital Rectal Exam

A

Palpating for nodules/size

86
Q

Medical Mgmt of BPH

Methods to do so:

A
  • Medication
  • Prevention
  • Monitoring
  • Sx
  • Other
87
Q

Medical Mgmt of BPH

Medication

A
  • 5 alpha-reductase inhibitors→ Stops enlargement
  • Alpha 1-adrenergic blockers→ Relaxes smooth mm of prostate and bladder neck
  • Propecia/proscar→ blocks DHT? (she had an issue w/ this one in lecture so I wouldn’t memorize this one, just recognize its on list***)
88
Q

Medical Mgmt of BPH

Prevention

A
  • Diet
    • Anti-oxidants, LOW Fat
  • Vitamins
    • Anti-inflammatory***
89
Q

Medical Mgmt of BPH

Monitoring

A

IF blockage NOT severe

90
Q

Medical Mgmt of BPH

Surgery

A
  • Blockage IS SEVERE ENOUGH where bladder is NOT FULLY EMPTYING
    • TURP (GOLD STANDARD***)
    • Prostatectomy
91
Q

Medical Mgmt of BPH

Other Tx’s

A
  • Microwave, laser, stent placement
92
Q

GOLD STANDARD PROCEDURE FOR BPH MGMT

93
Q

TURP Procedure

*BPH

A
  • GOLD STANDARD PROCEDURE
    • TransUrethral Resection of the Prostate
    • Gen anesthesia, OP basis
    • Catheter 1-3d
    • Full recovery in 3 weeks
      • Retrograde ejaculation due to damage of bladder neck sphincter is a RISK!
94
Q

Prostate Cx

Can start as what ?

A

Can start as a tumor on prostate

Can enlarge to block urethra

95
Q

Prostate Cx

Causes/Dx

A

NO known causes

  • Diagnosis
    • Digital rectal exam
    • PSA*** (remember #’s will be elevated with BOTH BPH and prostate cx)
    • Transrectal US
    • Biopsy**
96
Q

Medical Mgmt: Prostate Cx

Methods:

A
  • Radiation
  • Hormone Therapy
  • Cryotherapy (outdated, painful)
  • Radical Prostatectomy
  • Laparoscopic Radical Prostatectomy
97
Q

Medical Mgmt: Prostate Cx

Radiation

A

External beam

Seed implants

98
Q

Medical Mgmt: Prostate Cx

Radical Prostatectomy

A

Suprapubic/perineal incision

99
Q

Medical Mgmt: Prostate Cx

Laparoscopic Radical Prostatectomy

100
Q

Prostate Cx: Radical Prostatectomy

A
  • Resection of prostate, ligaments, urethra
    • Urethra repaired and reconstructed
    • Urethra can narrow after healing
101
Q

Prostate Cx: Laparoscopic Radical Prostatectomy

A
  • Robotic arm
  • SAME resection and anastamosis (collateral blood supply)
102
Q

Post-Op Considerations: Prostatectomy

ALL:

A
  • Catheter 5-6d
  • Weak or absent urge
  • Continual leakage←→ leakage only w/ mvmt
  • **Can see a PT 6wks post-op
  • PSA rechecked
  • Erectile Dysfunction?
  • Post-Prostatectomy Incontinence (PPI)
103
Q

Post-Op Considerations: Prostatectomy

Can see a PT when????

A

6 WEEKS POST-OP******

104
Q

Post-Op Considerations: Prostatectomy

Erectile Dysf???

A

IF had it pre-operatively, MAY be present post-op

*depends on Sx and fibrosis of tissue

105
Q

Post-Op Considerations: Prostatectomy

Post-Prostatectomy Incontinence (PPI)

A

1.5-87%

Damage to sphincter can cause incont.

106
Q

REMEMBER…..

DO NOT PANIC IF PSA ELEVATED!!!

A

MAY be BPH****

107
Q

PT Interventions for Prostatectomy

A
  • SEE THEM BEFORE SURGERY!!!***
  • NO straining for BM and lifting: Breath work
  • Abdom wall mobilization
  • Bladder re-training
  • Biofeedback and strengthening
    • Coord. of pelvic floor WITH core mm’s***
108
Q

PT interventions for Prostatectomy

When should WE see them?

A

BEFORE SURGERY!!!

Then can see PT 6 weeks Post-Op***

109
Q

Examination of Pelvic Floor

Key Points*

A
  • Professional responsibility
    • Privacy & Consent*
  • Communication
  • Education
  • Internal exam? Why?
    • Decipher if mm’s are actually contracting, relaxing, or bearing down→ Specialized training***
110
Q

Pelvic Floor Exam

Key components*

A
  • Spine/hip evals
  • Functional mvmt screen (FMS)
  • EXT mm palpation
  • Perineum observ + sensory testing
  • INT mm palpation
    • Rectal and/or vaginal
111
Q

TRAINING the Pelvic Floor***

IMPORTANT!!!!

Goals/objectives

A
  • Goal: Move pt in an active-dynamic way
    • NO isometric stability
    • Use PFMC during functional acts→ squat, lifting, exercise
  • *INC awareness of PF w/in pt
    • “Clenching”
    • Once pt is aware of PF, it is MUCH EASIER to train**
112
Q

Pelvic Floor Dysfunctions

HypERtonic, discoord. and weak PF mm’s can contribute to:

A
  • Elimination deficits of GI system
  • Prolapse and pelvic organ descent
  • Chronic pelvic pain
  • Bladder disorders
  • Sexual dysf, pain (dyspareunia)
113
Q

Training the PF

Look @ the PF like a _________

A

CANNISTER ***

114
Q

Training the PF

Goal and what does it do?

A

Goal: Move pt in an active-dynamic way

*Promotes flexibility and function, NOT tension

115
Q

Training the PF

Treat the PF as an _______ issue

A

Orthopedic ****

116
Q

Training the PF

Look @ PF like a _______

And what is this made up of?

A

CANNISTER!!!

Diaphragm, PFM, abdominals and multifidi

117
Q

PF (Cannister) components

A

Diaphragm

PFM

Abdominals and Multifidi

118
Q

Training the PF

INC awareness where??

A

Awareness of the PF !!!

  • NOTE:
    • No mvmt, laziness, MSK prob bw hip/shoulder→ SCREEN “CANNISTER” !!!
119
Q

Other pelvic muscles to include in PF examination

A
  • Piriformis & Obturator Internus
  • Diaphragm, TA
  • Coccyx: Important muscle attachment
    • Insertion site for PF mms’
      • when PF mm’s contract→ coccyx pulls FORWARD

Medcon Rehab IV (18 decks)

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