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Medical Conditions II > Pelvic Floor Rehab > Flashcards

Pelvic Floor Rehab Flashcards

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USMLE® Step 1 flashcards
1
Q

Pelvic Floor Overview

A
  • 3 layers of muscles

- layers of fascia surrounding

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2
Q

The pelvic floor is suspended

A

-from the pubis to the coccyx

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3
Q

Superficial (1st) Layer

A
  • pudenal nerve
  • sexual function
  • -contract to enlarge clitoris and penile erection
  • -vaginal sphincter assists in clitoral erection
  • -external anal sphincter
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4
Q

Middle (2nd) Layer

A
  • Pudenal nerve
  • sphincteric
  • -urethral sphincter
  • slow twitch
  • compress urethra and 1/3 of resting urethral closure pressure
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5
Q

Deep (3rd) Layer

A
  • nerve to levator ani
  • supportive (pelvic diaphragm)
  • constricts lower end of rectum, vagina
  • supports viscera (hammock)
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6
Q

6 Functions of Pelvic Floor

A
  • supportive
  • sexual
  • sphincteric
  • stabilizing
  • withstands intra-abdominal preSSure
  • Allows baby’s head to Slide out
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7
Q

Muscle fibers in pelvic floor

A
  • 70% slow twitch

- 30% fast twitch

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8
Q

Bony boundries

A
  • Ant: symphusis pubis
  • Anterolat: inferior pubic rami
  • Lateral: ischial rami
  • Lateral: ischial tuberosities
  • Posterolat: sacrotuberous ligament
  • post: coccyx
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9
Q

S2, S3, S4

A

Pudenal nerve

“S2, 3, 4 keeps the baldder off the floor”

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10
Q

3 First Layer Muscles

A
  • superficial transverse perineal
  • bulbocarvernosis
  • Ischiocavernosis
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11
Q

Muscles of the 3rd Layer

A
  • pubococcygeus
  • iliococcygeus
  • puborectalis

(levator ani muscles/pelvic diaphragm)

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12
Q

Muscles of 2nd Layer

A

sphincter urethrae

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13
Q

Other muscles of pelvic region

A
  • coccygeus
  • piriformis
  • obturatur internus
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14
Q

Coccygeus

A
  • flexes coccyx
  • supports viscera
  • stabilizes SI joint
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15
Q

Piriformis

A
  • lateral hip rotator

- assist abduction with hip in flexion

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16
Q

Obturator Internus

A
  • lateral hip rotator

- assist abd with hip in flexion

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17
Q

MMT of Pelvic Floor Muscles

A
  • levator ani
  • -index finger along vaginal wall, on thickest part of levator ani
  • ask pt to contract
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18
Q

Grading of MMT of PFM

A
  • 0=none, absent
  • 1=flicker, trace
  • 2=weak squeeze, no lift, weak
  • 3=fair squeeze, definite lift, moderate
  • 4=lift with squeeze, good
  • 5=strong squeeze with resistance, strong
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19
Q

Dynamic MRI

A

in upright position to understand PFM function

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20
Q

contraction of PFM is _____

A

-concentric

–moving coccyx in ventral, cranial direction

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21
Q

Coccyx pressed ___during straining

A

-dorsally

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22
Q

Real-Tie US to visualize PFM

A
  • trans abdominal US to assess PFM function

- assess PFM activity when invasive procedure not appropriate or possible

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23
Q

normal # times to go to urinate per day

A

4-7 times

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24
Q

Negative Effects of Incontinence

A
  • embarrassing (stop socializing due to fear of accidents)
  • depression
  • nursing home admits
  • cost ($11.2 bill spent on pads/diapers)
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25
Q

Why they don’t come in earlier

A
  • belief it’s expected part of aging
  • rely on incontinence products
  • embarrassed
  • healthcare provider never ask them
  • lack of awareness for treatment
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26
Q

Normal Voiding

A
  • every 2-4 hours
  • 4-7x/day
  • 0-1x/night
  • no just in case voiding
  • urine stream steady for 8 seconds
  • no straining
  • no leaking (even after pregnancy)
27
Q

Types of Incontinence

A
  • urinary stress incontinence (USI)
  • Urinary Urge Incontinence (OAB-overactive bladder)
  • Mixed Urinary Incontinence
  • Fecal Incontinence
28
Q

Urinary Stress Incontinence

A
  • involuntary loss of urine with activities: laugh, cough, sneeze, run, jump, lift
  • incr IAB + weak PFL = leakage
29
Q

Urinary Urge Incontinence

A
  • invol loss of urine associate with strong urge to urinate
  • running water, can’t get pants down in time, key in door
  • bladder instability causes contraction of bladder + weak pelvic floor = leakage
30
Q

Male Incontinence

A
  • most common after prostate surgery
  • prostate adds support to bladder
  • male pelvis narrow
  • internal pelvic floor muscle exam (rectally)
31
Q

Bladder muscle

A

-detrusor muscle (smooth muscle)

32
Q

Micturition

A

-urination

33
Q

When male contracts PFM:

A

-penis will lift upward

34
Q

causes of incontinence

A
  • weak PFM
  • abdominal weakness
  • pregnancy
  • vaginal delivery
  • episiotomy
  • estrogen depletion
  • meds
  • infections
  • high impact activity
  • diabetes
  • stroke
  • obesity
  • pelvic nerve injury
  • prior surgeries
  • organ prolapse
  • neuro conditions (MS)
35
Q

POP

A
  • Pelvic Organ Prolapse

- tested in supine with bearing down

36
Q

Exam of POP

A
  • 2 fingers into vagina and bear down
  • observe/feel for displacement of tissue
  • -anterior: bladder (cystocele)
  • -apical: uterus (uterine prolapse)
  • -posterior: rectum (rectocele)
37
Q

Cystocele

A

-displacement of bladder creating bulge into ant vaginal wall

38
Q

Rectocele

A

-displacement of rectum creating a bulge into posterior vaginal wall

39
Q

Uterine Prolapse

A

-displacement of uterus downward into vaginal vault

40
Q

Grades of Organ Prolapse

A

Grade I: mild bulge (25%)
Grade II: mod bulge (50%)
Grade III: severe bulge, into vaginal opening (introitus)
Grade IV: bulge completely out

PT for grade I and II

41
Q

Precautions/Contraindicatoins for Internal PFM Exam

A
  • pregnancy
  • immediate post-partum (6 weeks)
  • active infections
  • severe pelvic pain
  • history of sexual abuse
  • inadequate training of PT
  • absence of pt agreement
  • menses not necessarily a contraindication
42
Q

PFM Contraction

A
  • accessory muscle use
  • hold time (endurance)
  • repetitions
  • Fast contraction (how many fast before fatigue)
  • PERFECT Score
43
Q

PERFECT Score

A
  • power
  • endurance
  • repetitions
  • fast
44
Q

Anal Wink Reflex

A
  • stroke side of anal sphincter
  • should contract

Rectal branch of pudenal nerve

45
Q

PT for Incontinence

A
  • muscle re-ed (kegel, abdominal)
  • biofeedback
  • diet (avoid bladder irritants–acidic)
  • postural education/ortho
  • E-stim
  • diaphragmatic breathing
46
Q

Vaginal Weights

A
  • sensory feedback to muscle contraction
  • progressive resistive exercise
  • 5 progressive weights (20-70g)
  • progress supine to standing
47
Q

Bladder Irritants

A
  • alcohol
  • carbonated
  • caffeine
  • artificial sweeteners
  • dairy
  • coffee, tea, (even decaf)
  • tomatoes
  • tomato based products
  • spicy foods
  • citrus
  • chocolate
  • sugar/honey
48
Q

bladder training technique

A
  • scheduled voiding
  • pt education for urgency control
  • self monitoring with bladder diary
  • reinforcement
49
Q

Pelvic floor exercises

A
  • contract: close sphincters, vagina and rectum
  • Rela: open sphincters, vagina, rectum
  • Bulge/expand/drop: for bowel movements/voiding
50
Q

Kegel Exercises

A
  • ID correct muscle
  • do not contract abdominal, gluteal or hip addcutors
  • pull up and in with PFM
51
Q

Quick Flicks

A

-PFM hold 1 sec

52
Q

Slow Holds

A

-PFM 10 second hold

53
Q

Pelvic Floor Instruction

A
  • life, draw up and in, squeeze and close
  • wink the anus, move the penis
  • pull underwear/tampon in
  • lift your perineum off the chair
  • hold back gas
54
Q

Pelvic Floor Educator

A
  • device to improve pt understanding and motivation
  • used with HEP
  • plastic piece with stick so pt can see it move with contraction
55
Q

When doing Kegels:

A

-push to limit and a little beyond but never to fatigue

56
Q

to make a change

A

-do 40-60 PFM contractions per day

57
Q

Average ____ visits over ____

A

4-8 visits

2-3 month period

58
Q

2nd most common complaint in GYN

A

-pelvic floor pain

59
Q

Levator Ani Syndrome

A

-spasming of levator ani Mm

60
Q

PFM Disorders

A
  • levator ani syndrome
  • coccyodynia
  • connective tissue dysfunction
  • vaginismus/vulvodynia
  • pelvic floor tension myalgia
61
Q

Vaginismus

A

-can’t open vaginal opening bc muscles too tight

62
Q

Organic Diseases

A
  • interstitial cystitis (painful bladder syndrome)
  • endometriosis
  • pelvic inflammatory disease

-subsequent pelvic floor pain

63
Q

Typical Complaints

A
  • feels like insides falling out
  • pressure in pelvis
  • constipation/trouble starting urine
  • vagina aches deep inside
  • feels like sitting on golf ball
64
Q

Questions to ask?

A
  • prior injuries
  • surgeries/childbirth
  • pn with or after sexual intercourse
  • pain/pressure/aching in suprapubic, vaginal or rectal area
  • abuse

Medical Conditions II (34 decks)

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