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MSK III & IV > Pelvic Health > Flashcards

Pelvic Health Flashcards

1
Q

The pudendal nerve has both ___ and ____ components and is the only peripheral nerve with _____ and ____ fibers.

A

Sensory and motor
Autonomic and somatic

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2
Q

The vagus nerve provides what kind of innervation to the pelvic floor?

A

Parasympathetic

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3
Q

What are the 5 S’s of the Pelvic Floor muscles?

A
  1. Sphincter- keeps us continent
  2. Supportive- keeps organs in place
  3. Sexual
  4. Stabilization
  5. Sump pump- lymphatic fxn
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4
Q

What 5 muscles make up the first layer of the pelvic floor?

A
  1. superficial transverse perineal
  2. bulbospongiosus
  3. ischiocavernosus
  4. perineal body
  5. External anal sphincter
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5
Q

What is the 2nd layer of the pelvic floor?

A

urogenital diaphragm- connection between muscle and fascia

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6
Q

What 5 muscles make up the 3rd layer of the pelvic floor?

A
  1. puborectalis/pubovaginalis
  2. Pubococcygeus
  3. illioccygeus
  4. obturator internus
  5. coccygeus
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7
Q

Describe the two pelvic floor dysfunctions

A
  1. Underactive (droopy hammock)
    -hypotonic
    -inhibited
  2. Overactive (tight hammock)
    -hypertonic
    -tense/guarded
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8
Q

What are some risk factors associated with pelvic floor dysfunction?

A
  1. surgery
  2. Trauma
    -emotional
    -physical
    -sexual
    -Adverse childhood experience
  3. pregnancy childbirth
  4. hormonal
    -menopause
    -endometriosis
  5. aging
  6. psychophysiological disorder
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9
Q

What doesn’t biofeedback tell you during a pelvic floor exam?

A

Specificity: location of sensitive nociceptors/ presence of muscle imbalances within the PF
Functionality: neuromuscular control/ length or excursion of the pelvic floor

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10
Q

What are Contraindications to internal assessments or treatments?

A
  1. Lack of consent (verbal and nonverbal)
  2. Active infection
  3. Post op (<6-12 weeks)
  4. Pediatric or patient without prior pelvic examination
  5. Severe vaginitis or vaginal atrophy
  6. First trimester of pregnancy
  7. Severe pain/allodynia
    8 Special consideration
    -pregnancy
    -history of sexual abuse
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11
Q

What are you looking for during an internal manual assessment?

A
  1. muscle strength
    -relaxation
    -coordination
    -muscle imbalance
  2. palpation
    -guarding tender points
    -tone
  3. Connective tissue
    -scar
    -mobility
  4. Nerve
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12
Q

Explain ways of teaching a patient pelvic floor contraction and relaxation for an auditory learner

A

-tighten the muscles as if you are stopping the flow of urine or passing of gas
-the feel the muscles let go

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13
Q

Explain ways of teaching a patient pelvic floor contraction and relaxation for a visual learner

A

mirror
nuts to guts

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14
Q

Explain ways of teaching a patient pelvic floor contraction and relaxation for a kinesthetic/tactile learner

A

hand under towel under perineum
digital feedback
stop and pee test

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15
Q

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

A

overactive

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16
Q

The storage phase of bladder control is controlled by what?

A

Sympathetic- stop and store

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17
Q

The emptying phase of bladder control is controlled by what?

A

Parasympathetic- Peeing

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18
Q

What is normal bladder function both frequency and quality?

A

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

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19
Q

What are some examples of not so normal bladder function?

A

hesitation
staccato peeing
post void dribble
urgency out of the ordinary
discomfort or pain during storage or emptying
leakage

20
Q

is leakage normal?

A

No leakage is not normal but it is very common

21
Q

What bladder habits should be avoided?

A

hovering
just in case peeing
power peeing
self dehydrating

22
Q

What bladder issues are associated with underactive (droopy hammock) pelvic floor

A

stress urinary incontinence
pelvic organ prolapse

Orthopedic: lumbar, pelvic girdle, hip instability

23
Q

What bladder issues are associated with an overactive pelvic floor/nervous system (tight hammock)

A

voiding dysfunction
incomplete emptying
urinary urgency/frequency
urgency incontinence
Dysuria

orthopedic
low back pain
SI pain
Hip Pain

24
Q

What are some red flags

A

hematuria- blood in urine
persistant UTI
constitutional symptoms “fever nausea vomiting”
poor renal function
saddle anaesthesia
recent back trauma
night pain

25
Q

urinary incontinence is associated with fall risk in the elderly true/false

A

true

26
Q

What are the types of urinary incontinence

A
  1. Stress UI
  2. Urge UI
27
Q

If its a mix of both which should you treat first?

A

urge urinary incontince

28
Q

What are the symptoms of urgency urinary incontince?

A

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

29
Q

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

A

Urgency urinary incontinence common characteristics

30
Q

Hx or abdominal pelvic surgery
neurologic (MS DM)
Hx of UTI
GAD- generalized anxiety disorder
clenchers
medication

A

risk factors for urgency urinary incontinence

31
Q

What are some PT interventions for urgency UI?

A

education
-breathing
-urge suppression
-bladder retraining/mindful voiding
-voiding bladder diary

32
Q

Mindful voiding/urge suppression

A

count the seconds of voiding

diaphragmatic breathing
brain inhibition: talk to the bladder or distract the bladder

33
Q

What are some bladder irritants associated with nutrition?

A

caffeine
acidic food
alcohol
carbonated fluids
artificial sweeteners, coloring, flavoring
dairy, gluten, sugar, nicotine

34
Q

What is stress urinary incontinence?

A

involuntary loss of urine with increased intra-abdominal pressure

activities that may cause SUI, coughing, laughing, sneezing, vomiting, bending, lifting, pushing, shouting

35
Q

Interventions for stress urinary incontinence

A

forced exhalation training- inhale upon forced exhalation, tighten the pelvic floor and transverse abdominis

kegles/ PF strengthening

36
Q

When do you refer to pelvic health PT

A

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

37
Q

What is normal bowel frequency?

A

normal: 3x a day to 3x a week

abnormal: 5 or more a day less than 3x a week

38
Q

What is normal bowel quality?

A

normal: minimal strain 1-2 pieces

abnormal: straining hard and holding the breath
sitting on the toilet for more than 15 min

39
Q

Fecal incontinence
fecal smearing
rectal prolapse

A

underactive pelvic floor

40
Q

constipation
rectal pain
anal fissures
bowel urgency
irritable bowel syndrome

A

overactive pelvic floor

41
Q

What are red flags associated with bowel function

A

blood in stool, black tarry stool
fever abdominal pain
constitutional symptoms
saddle anaesthesia
recent back trauma
recent pelvic surgery
night pain
unexplained weight loss

42
Q

What are risk factors for constipation?

A

standard American diet
lack of activity
stress/anxiety
medication
elderly

43
Q

PT interventions for chronic constipation

A

Education
-dietary
-toilet ergonomics
-nervous system calming
Manual Therapy
-I love you massage

44
Q

Education the preached trio for constipation

A
  1. water- warm water in the morning can stimulate the gastrocolic reflex
  2. fiber- vegetable are the best berries too
  3. exercise
45
Q

Toilet ergonomics

A
  1. squatty potty knees above hips so pelvic floor is at a better angle to relax
  2. neutral spine
  3. breathing with PF relaxation
  4. raised toilet seat

MSK III & IV (10 decks)

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