Pelvic Health

Question 1

common dysfunctions

Answer 1

LUTS (lower urinary tract symptoms);bladder dysfunction
painful sexual intercourse/organ prolapse/vaginismus
bowel dysfunction
pelvic pain - endo

Question 2

LUTS - where does it originate from and 4 examples

Answer 2

can come from baldder, prostate, urethra, adjacent PFM, pelvic organs OR referred from areas of similar innervation (lower ureter)
1. urinary incontinence
2. urinary urgency
3. urinary frequency
4, nocturia

Question 3

1. urinary incontinence (UI) -
   def + 3 main types

Answer 3

def: any involuntary leakage of urine.
a. stress incontinence - on effort/exertion
b. urgency incontinence - leakage w desire to void
c. mixed incontinence

Question 4

Normal voiding cycle

Answer 4

1.bladder fills up:
- detrusor relaxes
- PFM contract
2. get 1st voiding sensation
- (1/2 full) can still drink
3. get normal voiding sensation
- PFM relax
- detrusor contracts
- sphincter relaxes
4. urination

Question 5

Overactive bladder OAB - def, results

Answer 5

overactive detrusor (efferent and afferent) sending messages to brain when starts to fill.
1. increased voiding frequency/day
2. urinary urgency
3. nocturia

Question 6

UI risk factors

Answer 6

diet - caffeine
fluid volume
obesity
pregnancy - type of delivery
meds - HRT
high impact activities
age
neurlogical conditions
diabetes/prostate cancer

Question 7

LUTS symptoms - subj assessment

Answer 7

storage, urgency, incontinence, nocturia, intermittency, incomplete emptying, straining

Question 8

LUTS obj assessment

Answer 8

PFM
PFM relationship with obturator internus, piriformis
PFM synergic muscles: ext rotatoes, adductor, glutes, TA
bladder beahaviour
pad test

Question 9

PFM assessment - 4 aspects

Answer 9

1. palpation (internal, EMG)
2. self report - not as reliable
3. motor (strength, endurance, power, control, coordination, tonus)
4. sensory (light touch, pain)

Question 10

4 management strategies

Answer 10

behavioural therapy
lifestyle
baldder training
PFM training

Question 11

Behavioural therapy - 5 lifestyle modifications

Answer 11

1. fluid management
2. diet changes
   3.bowel management
3. weight management
4. smoking cessation

Question 12

Behavioural therapy - 5 lifestyle modifications

Answer 12

1. fluid management
2. diet changes
   3.bowel management
3. weight management
4. smoking cessation

Question 13

1. Fluid management

Answer 13

24ml/kg body weight
decrease/stop intake before bedtime
avoid high volume intake at once
change voiding routine

Question 14

2. Diet changes

Answer 14

avoid/eliminate some things - caffeine, acidic fruits, alcohol, fizzy drinks, spicy, tomato
decrease/avoid 3-4h before bed
avoid high volume at once

Question 15

3. Bowel management

Answer 15

control constipation ( it increases intra ab pressure).
diet - protein/fibre..
bowel mvmt routine
positioning on toilet - knees up

Question 16

4. weight management

Answer 16

most important but can be the hardest
BMI >30 is a risk factor fro OAB + incontinence
chronic overloading of PFM causes structural damage and neurodysfunction

Question 17

5. smoking cessation

Answer 17

also increases intra ab pressure from chronic cough
increases bladder detrusor activity

Question 18

Bladder training - aim, how

Answer 18

aim: restore normal bladder function via progressive programme w techniques to control/eliminate urgency. (overall, decrease bladder sensitivity)

by:
- improving cortical inhibition over involuntary detrusor contractions
- improving cortical control over urethra in storage phase.
- improving control modulation of afferent input

Question 19

PFM training - aim, components

Answer 19

aim: equilibrate intra-abdominal and urethral pressures.
components:
- strength, endurance, control, coordination, power, tonus, sensation, pain

Question 20

PFM training - control + coordination

Answer 20

can they contract it and in isolation?
- teach anatomy an function of PFM
- increase sensation - swissball, palpation..
- breathing
- urine stream interruptions
- vaginal cone
- biofeedback/US
- synergist muscles

Question 21

PFM training - strength, endurance, power (recommendation)

Answer 21

like all other muscles, think specificity, progressive overload, rest, recovery

recommendation:
3x/day
50-70% intensity
8-12 contractions
rest: 3-10 secs, 2min
duration: 6 months

Question 22

bladder diary - order of reading

Answer 22

1.outcomes
2. bladder sensation
3. type
4. amount
5. volume
6. intake time

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