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MSK LQ > Pelvic Floor Lecture > Flashcards

Pelvic Floor Lecture Flashcards

1
Q

History

A

● Chief Complaint
● PMH
● Obstetric History
● Urinary symptoms
● Bowel symptoms
● Pain (Vulvovaginal, penile, rectal)complaints
● Sexual dysfunction complaints
● Fluid Intake and diet
● Employment/Social (what are the patient’s
functional requirements)

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2
Q

MSK Exam

A

● Functional screening (gait, balance)
● Movement and posture analysis
● Breathing assessment
● Range of motion
● Flexibility testing
● Muscle testing
● Joint mobility
● Soft tissue assessment

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3
Q

goal examples for PF

A

○ Patient is able to run 3 miles without leakage
○ Patient is able to increase time between voids to 2 hours in order to reduce
interruptions at work

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4
Q

what % of PFM are fast twitch? slow twitch?

A

fast: 30%
slow: 70%

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5
Q

“wall” of the pelvic floor

A

obturator internus
piriformis

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6
Q

functions of PF

A

Support
Sphincter
Sexual
Stabilize
Sump Pump (blood/lymph)

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7
Q

normal input from kidney and which mm activates / relaxes

A
  • 1 mL/min input from kidney
  • pelvic floor relax
  • bladder contracts and empty all the way
  • bladder relax and pelvic floor / sphincter return to normal tone
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8
Q

normal voiding

A

4-8 voids / day
or
interval of every 3-4 hrs

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9
Q

night time voids

A

NONE

1x normal for over 65

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10
Q

poor bladder habits

A

“just in case” peeing
semi squat
straining
drive by peeing (pushing to pee)
pelvic floor exercise on the toilet
post partum nocturnal habit

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11
Q

○ Leakage of urine with increased intra-abdominal
pressure
○ Cough, sneeze laugh, exercise, change in position

A

stress incontinence

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12
Q

○ Leakage associated with a strong urge, often on the
way to the bathroom

A

urge incontinence

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13
Q

over active bladder

A

is urgency and frequency without leakage

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14
Q

Leakage from a full bladder, urge to void missed or
blockage to urethra

A

overflow

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15
Q

Patient with mobility issues preventing getting to the
bathroom in time

A

functional incontinence

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16
Q

what are bladder irritants?

A

● Caffeine
● Alcohol
● Carbonation
● Artificial sweeteners
● Citrus juices/foods
● Tomatoes
● Spicy foods
● Chocolate

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17
Q

“just do kegals”

A

● 40% women are unable to perform a pelvic floor muscle contraction with
verbal instructions alone
● Squeeze of posterior muscles, anterior muscles and cranial lift present for
correct contraction
● Full relaxation is important
● Where things go wrong
○ Preconceived ideas
○ Stop Test as practice

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18
Q

T/F strength train an overactive pelvic floor is recommended

A

FALSE

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19
Q

pt complains of:
Feeling of heaviness in pelvis, feeling of
something in the vagina (ball or stuck tampon)
● Tissue laxity assessed anterior, apical and posterior
● Associated Levator avulsion - 13% of births

A

prolapse

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20
Q

ways to treat prolapse

A

● PT trials 12-16 week: PFMT, behavioral modifications resulted in improved
symptoms and staging of prolapse
● PT + pessary (device to help with POP)

21
Q

Pelvic floor mm training

A

○ Coordination
○ Strength and endurance
○ Address breathing

22
Q

behavior modifs

A

○ Address poor voiding and defecation mechanics
○ Fluid Management and reduce bladder irritants
○ Bladder Diary
○ Timed Voiding
○ Weight Loss
○ Urge Distraction Techniques
○ Address constipation if present

23
Q

cueing for correct contraction

A

● General
○ Stop the flow of urine
○ Picture urethra as turtle head drawing back into shell
○ Try to stop from passing gas
○ Close the front passage / close the back passage
○ Tighten around the anus
● Female specific
○ Pick up marble/blueberry/raisin with your vagina
○ Try to close the labia as if they were saloon doors
● Male Specific
○ Shorten the penis
○ Contract the muscle like when you sit on a cold toilet seat
○ Lift the scrotum
○ Elevate the bladder

24
Q

urge mgmt techniques

A

○ Breathing
○ Quick Flicks
○ Distraction
■ Counting backwards by 7 from 100
■ Thinking of shopping list

as a PT choosing appropriate interval (if patient going to bathroom every 15 min then 2 hours
is not an appropriate interval, importance of building confidence in
themselves)

25
Q

normal bowel movement

A

3x/day to 3x/week

26
Q

favorable consistency of stool

A

Type 3,4,5 easiest to pass

27
Q

T/F stool form is a better indicator of transit time than defacation frequency

A

T

28
Q

fecal incontinence Tx

A

pelvic floor training especially EAS
normalizing bowel consistency
treat dyssnergia (coordination of the mm)
rectal pain
coccyx pain

29
Q

Unsatisfactory defecation due to infrequent stools, difficult stool passage or both

A

constipation
(considered part of aging but not caused by aging)

30
Q

constipation prevalence
● 1⁄5 of population
● 2-3 times more common in ____ and in____
● More common in non-caucasians and lower SES
● Common in ____ 0.7%-29.6%

A

women and elderly
peds

31
Q

contributing factors to constipation

A

● Metabolic Problems
● Fiber Deficiency
● Anorectal problems
● Medications

32
Q

dysnergia / outlet constipation

A

puborectalis unable to relax or is contracting when attempting to defecate

work on coordination

33
Q

Chronic pelvic pain defined as pain in abdomen and /or pelvis that has
lasted longer than ____, and is not caused by diseases or conditions
such as dyspareunia, dysmenorrhea or endometriosis

● 90% pain with intercourse
● 50% depressed
● 1 in 7 American women
● 61% no diagnosis
● Vulvodynia 3-15% of women

A

3 months

34
Q

vulvovaginal pain

A

● Post-delivery scar pain (sulcus, periurethral, perineal tears)
● Overactivity
● Vaginismus
● Shortened pelvic floor muscles due to pathology
○ Lichen Sclerosis, Planus, Simplex
○ Radiation
○ Surgery

35
Q

● Pain in vulva not related to a specific, identifiable disorder
● Pt c/o discomfort with sensations of burning, irritation or rawness, knife-like
pain
● Many contributing factors
○ Hormonal (including OCP use)
○ Neuroproliferative factors
○ Abnormalities of embryonic development
○ genetic/immune factors
○ infection

A

vulvodynia and vestibulodynia

36
Q

pain treatment

A

● Pain Neurophysiology Education
● Downtraining of pelvic floor
○ Biofeedback
○ Breathing instruction
○ Physiological quieting/ progressive relaxation
● Graded exposure
○ Manual treatment
○ Speculum training
○ Sensate focus
● Dilator program
● Stretching
● Manual therapy
○ Joint mobilizations/manipulations
○ Soft tissue (muscle or connective tissue) mobilization

37
Q

T/F you can do manips and mobs during first trimester

A

FALSE (b/c that’s when most miscarriges happen)

38
Q

patient c/o pain with transition from STS and feels a stretching sensation that causes the pain

A

round ligament pain

39
Q

normal BP for pregnant women

A

140/90

40
Q

PT tx during pregnancy

A

● Body Mechanics training
● Specific exercise
● Cardiovascular Exercise
● Manual Therapy
● Pain Science Education
● Sacroiliac belts, support bands, kinesiotaping

41
Q

What is Diastasis Recti?

● How much separation is normal?
● DRA or hernia?
● How do I know if I have one?

A

● Abdominal wall separation between rectus muscle bellies at the linea alba
- 1-2 finger separation normal. 2 1/2 indicates consult w/ MD
- DRA is a separation of the abdominal muscles with no organ protrusion, while a hernia involves an actual protrusion of abdominal contents through a weakness in the wall.
- perform a DR check test

42
Q

DRA associated with

A

LBP
Incontinence
prolapse
constipation

43
Q

DRA risk factors

A

Female
○ Age > 33
○ Multiparity or multiple gestation
○ Large baby
○ Greater weight gain
○ C-section birth
● Male
○ Obesity
○ Abdominal straining
○ Post abdominal aortic aneurysm surgery

44
Q

Orthopedics

-
-
-
● LBP with UI
● Orthopedic considerations for Intercourse
● Exercise Prescription

A
  • proalpse
  • diastasis
  • incontinence
  • labral and pelvic floor issue
45
Q

PEDIATRICS

● ____ is the primary cause of urinary accidents and bedwetting
● May have neurological conditions such as spina bifida or tethered cord that
contribute to bowel or bladder dysfunction
● Questions to ask:
○ Do they have a history of reflux, abdominal pain, pain with bowel movements,
bloating, poor appetite or fear of the toilet?
○ Do they ever have any leakage of any kind during the day or at night (including a
smear or poop in their underwear?)
○ Are they wearing pull ups past the age of ____?
○ Do they wet the bed or notice peeing while laughing or playing?
○ “I don’t ever want you to touch the poop, but if you were to pretend to smoosh it into a ball, would that ball of poop be bigger than your child’s fist?”

A

constipation
4

46
Q

GERIATRICS

● ____ is the 2nd reason for nursing home admissions
● Many older people have accepted their ____ because they have not
been presented with treatment options
● Many may have already had a failed surgery
● ____ is embarrassing and many people are not forthcoming with
information
● Screen for fecal ____

A

incontinence

47
Q

Low back and hip pain

A

always ask urinary, constipation, pain with sexual activity, abdominal pain

48
Q

Specific Screening questions

A

● Older adults - Are you having any loss of urine or stool beyond your control?
● Patients on pain medications - How often are you having a bowel
movement? Are you straining or do you have pain with a bowel movement?
● Patients with Diabetes with peripheral neuropathy: Erectile dysfunction,
increased urgency, frequency, nocturia, weak stream, incomplete emptying

49
Q

primary care screening ROS

A

● Do you ever have any urinary leakage (even a small amount)?
● Do you feel a strong urge to urinate or have to rush to the bathroom?
● How frequently do you urinate? / Do you urinate more than 10 times/day?
● Are you able to have a bowel movement at least 3 times / week without
pain or excessive straining or pushing?
● Do you have pelvic, vulvar or vaginal pain, or penile pain?
● Do you have any pain in the pelvis or pain with sexual activity
● If you are sexually active, are you able to be intimate the way you want to
be without pain?

MSK LQ (15 decks)

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