Pelvic Health Flashcards
common dysfunctions
LUTS (lower urinary tract symptoms);bladder dysfunction
painful sexual intercourse/organ prolapse/vaginismus
bowel dysfunction
pelvic pain - endo
LUTS - where does it originate from and 4 examples
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
- urinary incontinence (UI) -
def + 3 main types
def: any involuntary leakage of urine.
a. stress incontinence - on effort/exertion
b. urgency incontinence - leakage w desire to void
c. mixed incontinence
Normal voiding cycle
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
Overactive bladder OAB - def, results
overactive detrusor (efferent and afferent) sending messages to brain when starts to fill.
1. increased voiding frequency/day
2. urinary urgency
3. nocturia
UI risk factors
diet - caffeine
fluid volume
obesity
pregnancy - type of delivery
meds - HRT
high impact activities
age
neurlogical conditions
diabetes/prostate cancer
LUTS symptoms - subj assessment
storage, urgency, incontinence, nocturia, intermittency, incomplete emptying, straining
LUTS obj assessment
PFM
PFM relationship with obturator internus, piriformis
PFM synergic muscles: ext rotatoes, adductor, glutes, TA
bladder beahaviour
pad test
PFM assessment - 4 aspects
- palpation (internal, EMG)
- self report - not as reliable
- motor (strength, endurance, power, control, coordination, tonus)
- sensory (light touch, pain)
4 management strategies
behavioural therapy
lifestyle
baldder training
PFM training
Behavioural therapy - 5 lifestyle modifications
- fluid management
- diet changes
3.bowel management - weight management
- smoking cessation
Behavioural therapy - 5 lifestyle modifications
- fluid management
- diet changes
3.bowel management - weight management
- smoking cessation
- Fluid management
24ml/kg body weight
decrease/stop intake before bedtime
avoid high volume intake at once
change voiding routine
- Diet changes
avoid/eliminate some things - caffeine, acidic fruits, alcohol, fizzy drinks, spicy, tomato
decrease/avoid 3-4h before bed
avoid high volume at once
- Bowel management
control constipation ( it increases intra ab pressure).
diet - protein/fibre..
bowel mvmt routine
positioning on toilet - knees up
- weight management
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
- smoking cessation
also increases intra ab pressure from chronic cough
increases bladder detrusor activity
Bladder training - aim, how
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
PFM training - aim, components
aim: equilibrate intra-abdominal and urethral pressures.
components:
- strength, endurance, control, coordination, power, tonus, sensation, pain
PFM training - control + coordination
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
PFM training - strength, endurance, power (recommendation)
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
bladder diary - order of reading
1.outcomes
2. bladder sensation
3. type
4. amount
5. volume
6. intake time
obytavi
