Pelvic Health Flashcards
Functions of Pelvic Floor
Sphincteric
Support
Stability
Sexual
Sump pump
Sphincteric
prevents leakage
Support
support for pelvic organs, bladder, urethra, uterus, rectum
Stability
the floor of the core
attachments to pelvis and hip
Sump pump
lymphatic pump of the pelvis
Layers of Pelvic Floor
Layer 1: sphincteric and sexual function
Layer 2: compresses and supports
Layer 3: Levator ani, supports, lifts, aids in pressure
Perineum
inferior portion of the pelvic outlet
diamond shaped that connects coccyx, pubic bone, ischial tuberosities
Puborectalis
Pubic bone and rectum
slings around the rectum, relaxes for defacation
Chronic constipation…
tightness of puborectalis
Fecal incontinence…
weakness of puborectalis
Coccygeus
connects ischial spine to coccyx/sacrum
pulls coccyx anterior after defacation
responsible for tailbone pain
Urinary Stress Incontinence
Involuntary loss of urine with physical exertion or effort, pelvic floor muscles aren’t strong enough to keep bladder closed
coughing, sneezing, laughing, exercise
common in pregnancy/postpartum, crossfitters, prostatectomy
Urge Incontinence
contracting when not full
involuntary loss of urine with strong urge
associated with overactive bladder, urinary frequency, BPH in men
Mixed Incontinence
Combo of stress and urge
Bladder Norms
voiding every 2-5 hours
5-8 voids/day
0-1 voids a night
capacity is about 400-600 ml
Dysfunctional Voiding/Bad Habits
Going just in case
hovering/semi-squatting
straining
kegels mid stream
reducing fluid intake to reduce frequency
Stress Incontinence Treatment
pelvic floor strengthening
pelvic floor coordination retraining and diaphragmatic breathing, pressure management
Urge Incontinence Treatment
voiding behavior education
SCRUB technique
Behavioral Interventions
Avoid bad habits
limit bladder irritants
voiding schedule
SCRUB
helps to control urinary urgency
STOP
CONTRACT
RELAX and breathe
URGE assessment
BATHROOM
Age related bladder changes
Bladder capacity decreases
decreased bladder contractility
impaired emptying
increased residual volume
night urine production increases
pelvic organ prolapse
Pregnancy issues
pelvic girdle pain
LBP
round ligament pain
pubic symphysis dysfunction
diastasis rectus abdominus
Treatment for Pregnancy issues
contract vs relax of pelvic floor muscles
lumbopelvic stabilization
activity modification
belly support, KT tape
Treatment considerations for pregnancy
avoid supine after 20 weeks
ligamentous laxity
edema
postural and COG changes
Exercise guidelines for Pregnancy
150 mins/week mod intensity
minimum 3 days a week
do not exercise to point of breathlessness or exhaustion
avoid exercises that could contribute to falling, diastasis recti, pelvic obliquity
Postpartum
just because its COMMON doesn’t mean its NORMAL
pelvic girdle pain is the leading cause of disability postpartum
Postpartum return to running
screen for stress incontinence and pelvic organ prolapse
check for leaking, sensation for bulging, pain w/bathroom or period, can you walk 30 mins w/out pain
Constipation
most common GI complaint, has to be at least 3 times a week
screen in chronic low back pain
Commonly caused by lack of fiber, lack of PA, recent surgery, chronically ignoring urge to go
Treatment for Constipation
establish bowel routine
defection mechanics–>positional, relaxation of pelvic floor, breathing
abdominal wall massage
diet
Prolapse
descent of one or more of the pelvic organs
associated with connective tissue laxity, loss of nerve, muscle, ligament or fascial integrity
RF for prolapse
childbirth
surgery
chronic constipation or straining
chronic cough
S/S of prolapse
vaginal bulging
pelvic pressure
pelvic heaviness
LBP
constipation
urinary incontinence
Treatment for prolapse
activity modifications
IAP management
constipation management
pelvic floor and abdominal strengthening
Indications for internal exam
incontinence
voiding dysfunction
pelvic pain
prolapse
sexual dysfunction
Contraindications to internal exam
lack of consent
<6 weeks postpartum
<6 weeks postoperative
current infection
sexual abuse hx
pregnancy
pediatric client
What occurs during inhale?
diaphragm descends
abdominals relax/expand
pelvic floor lengthens/relaxes
What occurs during exhale?
diaphragm rises
abdominals contract/draw in
pelvic floor contracts/lifts
Cues for females for pelvic floor
Stop the flow of urine
squeeze a marble vaginally
pull pubic bone and tailbone together and in
Cues for males for pelvic floor
stop the flow of urine
lift the scrotum and retract the penis
“nuts to guts”
Tips for pelvic floor activation
ensure gluteals, abdominals, adductors are not gripping
no breath holding
relax AND contract are important
Indications for pelvic floor strengthening
PFM weakness
stress incontinence
pelvic organ prolapse
fecal incontinence
PFM overactivity
urge incontinence
incoordination
Contraindications for pelvic floor strengthening
overactive pelvic floor
pelvic pain
Dosage for pelvic floor strengthening
30-80 reps a day
submax contraction, 10 second hold, 8 week training
quick flicks and elevators
coordination training, fast twitch
Lifelong maintenance
