Pelvic Health Flashcards
The pudendal nerve has both ___ and ____ components and is the only peripheral nerve with _____ and ____ fibers.
Sensory and motor
Autonomic and somatic
The vagus nerve provides what kind of innervation to the pelvic floor?
Parasympathetic
What are the 5 S’s of the Pelvic Floor muscles?
- Sphincter- keeps us continent
- Supportive- keeps organs in place
- Sexual
- Stabilization
- Sump pump- lymphatic fxn
What 5 muscles make up the first layer of the pelvic floor?
- superficial transverse perineal
- bulbospongiosus
- ischiocavernosus
- perineal body
- External anal sphincter
What is the 2nd layer of the pelvic floor?
urogenital diaphragm- connection between muscle and fascia
What 5 muscles make up the 3rd layer of the pelvic floor?
- puborectalis/pubovaginalis
- Pubococcygeus
- illioccygeus
- obturator internus
- coccygeus
Describe the two pelvic floor dysfunctions
- Underactive (droopy hammock)
-hypotonic
-inhibited - Overactive (tight hammock)
-hypertonic
-tense/guarded
What are some risk factors associated with pelvic floor dysfunction?
- surgery
- Trauma
-emotional
-physical
-sexual
-Adverse childhood experience - pregnancy childbirth
- hormonal
-menopause
-endometriosis - aging
- psychophysiological disorder
What doesn’t biofeedback tell you during a pelvic floor exam?
Specificity: location of sensitive nociceptors/ presence of muscle imbalances within the PF
Functionality: neuromuscular control/ length or excursion of the pelvic floor
What are Contraindications to internal assessments or treatments?
- Lack of consent (verbal and nonverbal)
- Active infection
- Post op (<6-12 weeks)
- Pediatric or patient without prior pelvic examination
- Severe vaginitis or vaginal atrophy
- First trimester of pregnancy
- Severe pain/allodynia
8 Special consideration
-pregnancy
-history of sexual abuse
What are you looking for during an internal manual assessment?
- muscle strength
-relaxation
-coordination
-muscle imbalance - palpation
-guarding tender points
-tone - Connective tissue
-scar
-mobility - Nerve
Explain ways of teaching a patient pelvic floor contraction and relaxation for an auditory learner
-tighten the muscles as if you are stopping the flow of urine or passing of gas
-the feel the muscles let go
Explain ways of teaching a patient pelvic floor contraction and relaxation for a visual learner
mirror
nuts to guts
Explain ways of teaching a patient pelvic floor contraction and relaxation for a kinesthetic/tactile learner
hand under towel under perineum
digital feedback
stop and pee test
Your new patient has neck pain but also TMJ, hip and Low back pain he has a very stressful job would you suspect overactive or underactive muscles
overactive
The storage phase of bladder control is controlled by what?
Sympathetic- stop and store
The emptying phase of bladder control is controlled by what?
Parasympathetic- Peeing
What is normal bladder function both frequency and quality?
Day: every 2-4 hours depending on fluid intake 5-8x in 24 hrs
night: 0-1x
Quality:
No pushing
normal capacity 500-600 cc
no hesitation-relaxed
no pain
What are some examples of not so normal bladder function?
hesitation
staccato peeing
post void dribble
urgency out of the ordinary
discomfort or pain during storage or emptying
leakage
is leakage normal?
No leakage is not normal but it is very common
What bladder habits should be avoided?
hovering
just in case peeing
power peeing
self dehydrating
What bladder issues are associated with underactive (droopy hammock) pelvic floor
stress urinary incontinence
pelvic organ prolapse
Orthopedic: lumbar, pelvic girdle, hip instability
What bladder issues are associated with an overactive pelvic floor/nervous system (tight hammock)
voiding dysfunction
incomplete emptying
urinary urgency/frequency
urgency incontinence
Dysuria
orthopedic
low back pain
SI pain
Hip Pain
What are some red flags
hematuria- blood in urine
persistant UTI
constitutional symptoms “fever nausea vomiting”
poor renal function
saddle anaesthesia
recent back trauma
night pain
urinary incontinence is associated with fall risk in the elderly true/false
true
What are the types of urinary incontinence
- Stress UI
- Urge UI
If its a mix of both which should you treat first?
urge urinary incontince
What are the symptoms of urgency urinary incontince?
sudden strong urges which may or may not lead to leakage
persistent or frequent sensation of urgency
increased urinary urgency/frequency (>8-10x a day)
nocturia
bathroom mappers
key in the door syndrome
just in case peers
declare they were born with a small bladder
triggers (water cold weather)
avoid drinking water
panic pee -ers
Urgency urinary incontinence common characteristics
Hx or abdominal pelvic surgery
neurologic (MS DM)
Hx of UTI
GAD- generalized anxiety disorder
clenchers
medication
risk factors for urgency urinary incontinence
What are some PT interventions for urgency UI?
education
-breathing
-urge suppression
-bladder retraining/mindful voiding
-voiding bladder diary
Mindful voiding/urge suppression
count the seconds of voiding
diaphragmatic breathing
brain inhibition: talk to the bladder or distract the bladder
What are some bladder irritants associated with nutrition?
caffeine
acidic food
alcohol
carbonated fluids
artificial sweeteners, coloring, flavoring
dairy, gluten, sugar, nicotine
What is stress urinary incontinence?
involuntary loss of urine with increased intra-abdominal pressure
activities that may cause SUI, coughing, laughing, sneezing, vomiting, bending, lifting, pushing, shouting
Interventions for stress urinary incontinence
forced exhalation training- inhale upon forced exhalation, tighten the pelvic floor and transverse abdominis
kegles/ PF strengthening
When do you refer to pelvic health PT
complex patient with multiple co-morbitites
patient has no clue on what the PF is doing
no improvement or worsening of sx after 4-6 visits
symptoms change
-pain
-pelvic pressure
What is normal bowel frequency?
normal: 3x a day to 3x a week
abnormal: 5 or more a day less than 3x a week
What is normal bowel quality?
normal: minimal strain 1-2 pieces
abnormal: straining hard and holding the breath
sitting on the toilet for more than 15 min
Fecal incontinence
fecal smearing
rectal prolapse
underactive pelvic floor
constipation
rectal pain
anal fissures
bowel urgency
irritable bowel syndrome
overactive pelvic floor
What are red flags associated with bowel function
blood in stool, black tarry stool
fever abdominal pain
constitutional symptoms
saddle anaesthesia
recent back trauma
recent pelvic surgery
night pain
unexplained weight loss
What are risk factors for constipation?
standard American diet
lack of activity
stress/anxiety
medication
elderly
PT interventions for chronic constipation
Education
-dietary
-toilet ergonomics
-nervous system calming
Manual Therapy
-I love you massage
Education the preached trio for constipation
- water- warm water in the morning can stimulate the gastrocolic reflex
- fiber- vegetable are the best berries too
- exercise
Toilet ergonomics
- squatty potty knees above hips so pelvic floor is at a better angle to relax
- neutral spine
- breathing with PF relaxation
- raised toilet seat
