pelvic health Flashcards
components of pelvic floor, describe (4) what is it marked by (2)
2 innominate (ischium, ilium, pubis), coccyx, sacrum
pelvic inlet (entrance), outlet (exit)
inlet cranial to outlet
differentiate false and true pelves (area, organs it holds)
false pelves - iliac crest to pelvic inlet; liver, intestine, uterus, when urinary bladder is full
true pelves - inlet to outlet; sex organs, rectum, urinary bladder
main ms of pelvic diaphragm and innervation
levator ani (puborectalis, pubococcygeus, iliococcygeus); innervated by S2-S4, pudendal nerve
also coccygeus (not part of levator ani but ms of pelvic floor)
ms of levator ani and their attachments
pubococcygeus - pubic bone, coccyx
puborectus - pubic bone, rectal opening; tightens rectal sphincter
iliococcygeus - coccygeus and obturator internus (not ilium)
function of compressor urethrae, urethrovaginal sphincter, external anal sphincter
compressor urethra - compresses urethra and ventral wall of vagina
urethrovaginal sphincter - supports perineal body and introitus ( external opening of vagina)
external anal sphincter - closes anus
what ms of perineal pouch can be found in both sexes, and what are found in only females?
both: external urethral sphincter, deep transverse perineal membrane
females: urethrovaginal sphincter, compressor urethra
functions of pelvic floor ms (5)
support pelvic floor organs
withstand intra-abdominal pressure
stabilize spine and pelvis
continence thru control of sphincters
reproductive function
define incontinence, list types (4) differentiate
incontinence - involuntary loss of urine
- stress - bladder cant hold pressure
- urge - heightened sense of urgency; hypersensitive bladder
- overflow - bladder too full; or hyposensitive reflex
- mixed - both hypersensitive and unable to withstand much pressure (stress + urge)
anatomical changes in pregnancy
- weight gain
- postural changes - inc COG
- balance changes - weight gain, inc abdominal size
systemic changes in pregnancy (5)
CV, pulmo, posture & balance, genitourinary, MSK
genitourinary changes (3)
- inc uterus size 25-36cm
- inc kidney size by 1cm
- ureter goes into bladder perpendicularly (increased risk for UTI)
pulmo changes (2)
- breathes deeper later on becomes tachypneic; inc oxygen demand
- rib cage goes up & pulmonary secretions; diaphragmatic pressure as baby grows
CV changes
- inc blood volume 35-50%
- inc cardiac output - 30-60%
- dec BP d/t vein distensibility
MSK changes (3)
- ms elasticity, jt laxity -> to help in delivery (separation of pubic bone etc)
- abdominal wall gets stretched, weakness (possible: diastasis recti)
- pelvic floor drops d/t inc weight (1in)
posture and balance (6)
- inc COG
- inc BOS when walking
- cervical and lumbar lordosis
- genum recurvatum (knee hyperextension)
- changes can’t automatically be corrected after childbirth
- rounded shoulders and upper back
pregnancy induced pathology (7)
- pelvic floor muscle injury during childbirth
- diastasis recti
- posture related back pain
- sacroiliac/pelvic pain
- varicose veins
- joint laxity
- nerve compression
effect of childbirth to pelvic floor ms
- overstretching of pelvic floor ms
- tearing/incision of pelvic floor ms
- vaginal prolapse (bladder, uterus, rectum)
degree of lacerations
1st deg - skin
2nd deg - superficial ms layer
3rd - reaches sphincter
4th- sphincter to rectum
classification of pelvic floor dysfunction (3)
incontinence, prolapse, pain/hypertonicity
roles of PT in caring for pregnant women (6)
- preparing for childbirth
- improving fxal ROM
- improving posture and trunk stabilization
- prevent LBP/pelvic pain
- improve pelvic floor awareness, strenght and training
- improve overall health, quality of life, overall well-being
general interventions (2) and details of each (2-3)
pt. educ - pelvic floor anatomy, exercise instruction
neuromuscular facilitation - facilitate pelvic floor activation, isolate pelvic floor contraction, integrate pelvic floor contraction into ADLs, fxal activity
AVOID (pt. educ) [6]
- avoid valsalva
- do not lie in supine for more than 5 mins; if supine, look to left at an angle
- avoid prolonged motionless standing
- avoid single leg exercises
- stop exercises if there is pain
- dont exercise in high temperature/humidity
ENCOURAGE (pt. educ) (3)
- adequate caloric intake (eat enough)
- movement is important; position changes
- complete bladder emptying -> avoid downward pressure on pelvic floor
- do warm-up and cool-down activities
diastasis recti (ax and tx)
ax: hook lying, towel or brace abdominals, partial curl-up
- place fingers over umbilicus (3 parts- above, around, below) , see if there’s separation of rectus abdominis/tearing of linea alba
- (+) 2in width
tx: partial curl-ups with bracing
precautions for exercise in pregnant women (8)
gestational diabetes, severe anemia, systemic infection, obesity/underweight, diastasis recti, MSK issues (e.g., jt laxity), overheating, extreme fatigue
absolute CIs for pregnant women (10)
premature birth, other factors implying premature birth (multiple gestation, incompetent cervix/early dilation), placenta comes first before baby, vaginal bleeding 2nd or 3rd term, water break, preeclampsia (pregnancy HTN), maternal thyroid/heart/resp disease, maternal T1 diabetes, intrauterine growth retardation
signs of overexertion/complication (11)
vaginal bleeding, leakage of amniotic fluid (water leak), dizziness, pain, SOB, tachycardia, dec fetal mvmt, irregular heartbeat, swelling/pain in calf, persistent pain in pelvic girdle/chest/low back, hard to walk
guidelines for exercise: stretching (3) fitness exercises (3)
stretching: dont go past normal range, go for single ms groups instead of compound, avoid overstretching hip and pelvic muscles
fitness: RPE=12-14; dont use HR, go for low reps low intensity, NEVER exercise to exhaustion, avoid sports/exercises with high risk of abdominal trauma/falling
critical exercises for pregnant women (6)
- postural exercises
- diastasis recti activities (head lift - w pelvic tilt)
- stabilization exercises (supine-cervical; quadruped-thoracolumbar)
- dynamic trunk exercises (pelvic tilt, pelvic clock, trunk curls)
- modified strengthening exercises (push-ups, squats, bridging, leg raises, scaps retract)
- perineum adductor flexibility
pelvic floor awareness training (4) and volume, rationale
- contract-relax (hold for 3-5s, 10reps)
- tighten pelvic floor - quick contractions (15-20 reps)
- develop T2 ms fibers, withstanding pressure - elevator (start with a few floors then increase; practice control)
- strengthen levator ani - pelvic floor relaxation - start at 1st floor of elevator
unsafe exercises/postures (7)
- (B) SLR -> uni is fine
- fire hydrant pose
- hip extension in quadruped -> knee flexed is fine
- lying in supine for longer than 5 mins
- quick posture changes -> OH
- unilateral WB exercises
- prolonged static standing
exercises for postpartum (3)
- strengthening and aerobic exercises
- diastasis recti correction
- pelvic floor awareness, strengthening
oliviera 2007
Causes increase in PFM pressure and strength during pregnancy (olive pressure)
price 2010
preventing leakage postpartum, managing urinary incontinence (stress, mixed) (price leakage)
