Pelvic Health Flashcards
True or false: Pelvic Health includes muscles, viscera, nerves, joints, emotions, nutrition, hormones, fascia, and lymph.
True
True or false: The pudendal nerve only has sensory components.
False; motor and sensory
True or false: Pudendal nerve is the only peripheral nerve to have autonomic and somatic fibers.
True
What are the 5 S’s of the pelvic floor muscles?
Sphincteric
Supportive
Sexual
Stabilization
Sump Pump
Voluntary Skeletal Muscles are:
65% slow twitch fibers & 35% fast twitch fibers
70% slow twitch fibers & 30% fast twitch fibers
35% slow twitch fibers & 65% fast twitch fibers
30% slow twitch fibers & 70% fast twitch fibers
65% slow twitch fibers & 35% fast twitch fibers
The first layer of the pelvic floor includes what 6 structures?
Superficial Transverse Perineal
Bulbospongiosus
Ischiocavernosus
Perineal Body
External Anal Sphincter
Pudendal n.
The second layer of the pelvic floor includes what?
Urogenital diaphragm
The third layer of the pelvic floor includes what 5 structures?
Puborectalis/Pubovaginalis
Pubococcygeus
Iliococcygeus
Obturator Internus
Coccygeus
A droopy pelvic floor is ______active, ______, and _______.
Underactive, hypotonic, inhibited
A taut pelvic floor is ______active, and _______.
Overactive, taut
Risk factors for pelvic floor dysfunction are Surgery, trauma, hormonal, pregnancy/childbirth, central sensitization/Psychophysiological disorder, & ________________.
Aging
Why might we assess the abdominal canister for someone with pelvic dysfunction?
To see how well they can access their diaphragm and breathe. Also to look for scars, tension, contraction and relaxation.
Pelvic Floor muscle local assessment is done by biofeedback, manual, and which of the following:
MRI
Xray
Real Time Ultrasound
Real time ultrasound
Which of the following is not a Contraindication for Internal Assessment:
Lack of consent
Active infection
Post-op (<6-12wks)
Pediatric pt or pt w/o previous pelvic exam
Severe Vaginitis/vaginal atrophy
Third trimester of pregnancy
Severe pain/allodynia
First trimester of pregnancy
Third Trimester of pregnancy
Fill in the blank:
Internal Manual Local Assessment involves:
M______ F_______
P________
C_________ T_____
N____
Muscle Function
Palpation
Connective Tissue
Nerve
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they have full motion against gravity?
3
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they have no active contraction?
0
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they have full motion against strong resistance?
5
Parasympathetic of Urination involves what nerve roots and what plexus?
S2-S4, Pelvic Plexus
Sympathetic of Urination involves what nerve roots and what plexus?
T10-L2; Hypogastric Plexus
Somatic of Urination involves what nerve roots and what plexus?
S2-S4; Pudendal
Parasympathetic is the ______ phase and Sympathetic is the _______ phase.
Storage; Emptying
During the storage phase the Cerebral Cortex says it is not time to go, the Pons inhibits the cortex, the Hypogastric n T10-L2 inhibits the ______ and stimulates the _____ ______, while the pelvic nerve is quiet and the pudendal nerve stimulates the external sphincter.
Detrusor, internal sphincter
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they have a trace or a “flicker”?
1
During the emptying phase the cerebral cortex says it’s good to go, the Pons stimulates the pelvic nerve center, the Hypogastric nerve is ______, the Pelvic Nerve stimulates the _________ contraction, and the pudendal nerve relaxes the external sphincter.
quiet; detrusor
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they a very slight or weak contraction?
2
Using the Modified Oxford Scale for the Pelvic Floor, a person scores what on a scale from 0-5 if they have full motion against slight resistance?
4
“Normal” bladder function is voiding every __-__ hours or __-__ times a day and ___time(s) a night.
2-4; 5-8; 1
“Normal” bladder function is having no: ________, __________, or _____ for storing or for emptying.
pushing, hesitation, pain
Abnormal bladder function is:
Hesitation
Post void dribble
Difficulty delaying urge
Discomfort/pain
Leakage
_________ peeing
Staccato
What are 4 Bladder habits to avoid:
Just in case peeing (JICCING)
Hovering
Self Dehydrating
Power Peeing
Voiding dysfunction, pelvic organ prolapse, incomplete emptying, urinary urgency/frequency, urinary incontinence, Dysuria, and Painful Bladder Syndrome are all bladder issues with an overactive or underactive pelvic floor?
overactive
List the 7 Red Flags for pelvic dysfunction.
H________
P________ UTI
C________ Symptoms
Poor R_____ Function
S____ Anaesthesia
R______ B___ T_____
N____ P____
Hematuria
Persistent UTI
Constitutional Sx (malaise, fever)
Poor renal function
Saddle anaesthesia
Recent back trauma
Night pain
True or false: Urinary Incontinence is associated with fall risk in the elderly.
True
What are the 4 types of Urinary Incontinence?
Stress
Urge
Mixed
Functional
True or false: If someone has mixed Urinary Incontinence, you must treat the Stress Incontinence first.
False; Urge first
Nocturia is defined as voiding more than ___ times a night.
2
Common Characteristic of Urinary Incontinence:
B_______ Mappers
K__ I_ T___ Door Syndrome
Claim to have S___ B____ers
J____ers
T_____ers
A___ D____ Water
P_____ Pee-ers
Bathroom Mappers
Key in the door syndrome
Claim to have Small bladders
JICCERS
Triggers
Avoid drinking water
Panic Peers
Which of the following is not a Risk factor for Urinary Urge Incontinence:
Hx of abdominal/pelvic surgery
Neurological
Sexually Active
Hx of UTI
General Anxiety Disorder
Clenchers
Medications
Sexually active
What are 3 ways to suppress an Urge?
Diaphragmatic Breathing, Kegel, Brain inhibition
Caffeine, Alcohol, Acidic Foods, Carbonated Fluids, Artificial flavors, Dairy, Gluten, Sugar, Nicotine are all…
Bladder irritants
Bladder retraining includes:
Urge suppression techniques, Bladder diary
What type of incontinence is involuntary loss of urine with increased intra-abdominal pressure
Stress Urinary Incontinence (SUI)
Female genitalia Risk Factors for incontinence.
A_______
H_______
P______ & L____
P_____ S_____
Anatomical
Hormonal
Pregnancy and Labor
Pelvic Surgery
Male Genitalia Risk Factors for Incontinence.
Post P_________
S_______
Post Prostatectomy
Surgeries
ALL GENDERS Risk Factors for Incontinence
C_____ Constipation
A_____
A_____s
High B___
Chronic Constipation
Asthma
Allergies
High BMI
KNACK Intra-Abdominal pressure Management involves
“SHHHHH” and what other 5 noises/actions?
Cough
Hahaha
Achoo
blow nose
Yell
True or false: The following are all reasons to refer to a pelvic health PT?
Pt with multiple comorbidities
Pt doesn’t think you understand
No improvement/Worsening after 4-6 visits
Symptoms change (Pelvic pressure & pain)
True
T or F:
There are more neurotransmitters in the gut than in the brain and spinal cord combined?
T
“Normal” Bowel function is __times a day to __ times a week.
3;3
Abnormal bowel function is __+ times a day or less than ___ times per week.
5;3
The poop chart goes from a 1-7. What is “normal” on this chart? and describe them.
3-4
3= sauage-shaped, better formed, visible cracks
4= smooth sausage, well formed, easy to pass
Stools that are very difficult to pass and resemble small nuts or hard lumps are what on the scale of 1-7 of the Poop Chat?
1
“Normal” stool is _______ strain and __-___ pieces.
Minimal strain, 1-2
Stool that is almost entirely liquid with no solid pieces is what on the Poop chart 1-7?
7
Abnormal stool is:
_____ hard
H____ your B______
Sitting on the toilet more than ___ Minutes.
Straining hard, holding your breath, 15 minutes
Stools that are easy to pass but have many soft blobs with clear edges is what on the Poop Chart 1-7?
5
Stools shaped like sausage , visible lumps, and somewhat difficult to pass are what on poop chart 1-7?
2
Soft stools, fluffy and mushy with ragged edges are what on the poop chart 1-7?
6
Underactive Pelvic Floor causes these Bowel issues:
F____ Incontinence
F_____ Incontinence
F_____ Smearing
Rectal P______
Rectocele
Fecal Incontinence
Flatus Incontinence
Fecal Smearing
Rectal Prolapse
Rectocele
Rectocele is when B_____P _____ falls into the vaginal wall rather than the rectum.
Bowel Prolapse
Overactive Pelvic Floor causes these Bowel issues:
C________
R____ Pain
Anal F_______
B______ Urgency
F____ Incontinence
I____B____ S_____
Constipation
Rectal Pain
Anal Fissures
Bowel Urgency
Fecal Incontinence
Irritable Bowel Syndrome
What are the two types of IBS (Irritable Bowel Syndrome)?
Constipation and Diarrhea
Is it “normal” to have a bowel movement during the middle of the night?
no
What are the Red Flags for Bowel issues?
B____ in Stool
B____ T____ S____
F_____
A_________ Pain
Constitutional Sx
Saddle Anaesthesia
Recent B___ trauma
Recent P____ surgery
N____ pain
U_______ W____ Loss
Blood in stool
Black tarry stool
Fever
Abdominal pain
Consitutional Sx (Malaise)
Saddle Anaesthesis
Recent back trauma
Recent pelvic surgery
Night pain
Unexplained weight loss
T or F: Women struggle with constipation more than men.
T
Rome IV Criteria for Constipation involves what 5 things in 25% of your defecations?
And less than ___ spontaneous defecations per week.
Straining
Lumpy hard stools
Sensation fo incomplete evacuation
Sensation of anorectal obstruction
Manual maneuvers to facilitate defecation
3
What are the 5 risk factors for Constipation?
Standard american diet
Lack of activity
Stress/anxiety/depression
Medication
Elderly
What type of constipation is it when your stool is difficult to pass? What usually causes it?
Normal transit constipation; poor diet
What type of constipation is it when stool moves at decreased rate? What usually causes it?
Slow transit constipation; medications, thyroid, neuro
What type of constipation is it when stool is difficult to pass due to pelvic floor dysfunction?
Outlet constipation
What manual therapy technique can you use as intervention for constipation?
I Love You Massage
What 3 things can you educate a patient with constipation on?
Diet, Toilet Ergonomics, Nervous System Calming
What 3 lifestyle modifications can people make if dealing with constipation?
more sleep, manage stress, nutrition
What is the trio to avoid constipation ?
Water, Fiber, Exercise
Recommended water intake to avoid constipation
1/2 your bodyweight in ounces
___-___ mg of fiber/day is recommended to avoid constipation
25-30
The Reverse Knack helps avoid Valsalva and includes:
N_____ Spine
Lean S____ F_____
R____
D______ B______
Jaw and Face R_____
M__ Breathing
Neutral spine
Lean slightly forward
Relax
Diaphragmatic breathing
Jaw and face relaxed
Moo Breathing
Does the penis or the clitoris have more nerve endings?
clitoris (8000) compares to 4000
The following list represents what?
Premature Ejaculation
Erectile dysfunction
Dyspareunia
Pain w orgasm
Persistent genital arousal disorder (PGAD)
Sexual issues for Assigned male at birth
The following list represents what?
Dyspareunia
Pain w orgasm
Post coital pain
PGAD (Persitent genital arousal disorder)
Sexual issues for Assigned female at birth
5 Risk factors for Sexual Dysfunction
Sexual Trauma
Surgical Trauma
Neurological Hx
Psychological Hx
Hormonal Imbalance
The following is a list of Treatment Approaches for Pelvic Pain. Explain what each mean:
Top Down
Inside Out
Bottom Up
Top down= neuroscience, parasympathetic relaxation
Inside out= Food, nutrition
Bottom up= hands on, exercise
