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155 Selected Conditions > pelvic health > Flashcards

pelvic health Flashcards

1
Q

components of pelvic floor, describe (4) what is it marked by (2)

A

2 innominate (ischium, ilium, pubis), coccyx, sacrum
pelvic inlet (entrance), outlet (exit)
inlet cranial to outlet

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2
Q

differentiate false and true pelves (area, organs it holds)

A

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

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3
Q

main ms of pelvic diaphragm and innervation

A

levator ani (puborectalis, pubococcygeus, iliococcygeus); innervated by S2-S4, pudendal nerve
also coccygeus (not part of levator ani but ms of pelvic floor)

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4
Q

ms of levator ani and their attachments

A

pubococcygeus - pubic bone, coccyx
puborectus - pubic bone, rectal opening; tightens rectal sphincter
iliococcygeus - coccygeus and obturator internus (not ilium)

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5
Q

function of compressor urethrae, urethrovaginal sphincter, external anal sphincter

A

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

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6
Q

what ms of perineal pouch can be found in both sexes, and what are found in only females?

A

both: external urethral sphincter, deep transverse perineal membrane
females: urethrovaginal sphincter, compressor urethra

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7
Q

functions of pelvic floor ms (5)

A

support pelvic floor organs
withstand intra-abdominal pressure
stabilize spine and pelvis
continence thru control of sphincters
reproductive function

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8
Q

define incontinence, list types (4) differentiate

A

incontinence - involuntary loss of urine

  1. stress - bladder cant hold pressure
  2. urge - heightened sense of urgency; hypersensitive bladder
  3. overflow - bladder too full; or hyposensitive reflex
  4. mixed - both hypersensitive and unable to withstand much pressure (stress + urge)
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9
Q

anatomical changes in pregnancy

A
  1. weight gain
  2. postural changes - inc COG
  3. balance changes - weight gain, inc abdominal size
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10
Q

systemic changes in pregnancy (5)

A

CV, pulmo, posture & balance, genitourinary, MSK

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11
Q

genitourinary changes (3)

A
  • inc uterus size 25-36cm
  • inc kidney size by 1cm
  • ureter goes into bladder perpendicularly (increased risk for UTI)
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12
Q

pulmo changes (2)

A
  • breathes deeper later on becomes tachypneic; inc oxygen demand
  • rib cage goes up & pulmonary secretions; diaphragmatic pressure as baby grows
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13
Q

CV changes

A
  • inc blood volume 35-50%
  • inc cardiac output - 30-60%
  • dec BP d/t vein distensibility
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14
Q

MSK changes (3)

A
  • 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)
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15
Q

posture and balance (6)

A
  • 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
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16
Q

pregnancy induced pathology (7)

A
  1. pelvic floor muscle injury during childbirth
  2. diastasis recti
  3. posture related back pain
  4. sacroiliac/pelvic pain
  5. varicose veins
  6. joint laxity
  7. nerve compression
17
Q

effect of childbirth to pelvic floor ms

A
  1. overstretching of pelvic floor ms
  2. tearing/incision of pelvic floor ms
  3. vaginal prolapse (bladder, uterus, rectum)
18
Q

degree of lacerations

A

1st deg - skin
2nd deg - superficial ms layer
3rd - reaches sphincter
4th- sphincter to rectum

19
Q

classification of pelvic floor dysfunction (3)

A

incontinence, prolapse, pain/hypertonicity

20
Q

roles of PT in caring for pregnant women (6)

A
  • 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
21
Q

general interventions (2) and details of each (2-3)

A

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

22
Q

AVOID (pt. educ) [6]

A
  • 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
23
Q

ENCOURAGE (pt. educ) (3)

A
  • 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
24
Q

diastasis recti (ax and tx)

A

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

25
Q

precautions for exercise in pregnant women (8)

A

gestational diabetes, severe anemia, systemic infection, obesity/underweight, diastasis recti, MSK issues (e.g., jt laxity), overheating, extreme fatigue

26
Q

absolute CIs for pregnant women (10)

A

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

27
Q

signs of overexertion/complication (11)

A

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

28
Q

guidelines for exercise: stretching (3) fitness exercises (3)

A

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

29
Q

critical exercises for pregnant women (6)

A
  • 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
30
Q

pelvic floor awareness training (4) and volume, rationale

A
  1. contract-relax (hold for 3-5s, 10reps)
    - tighten pelvic floor
  2. quick contractions (15-20 reps)
    - develop T2 ms fibers, withstanding pressure
  3. elevator (start with a few floors then increase; practice control)
    - strengthen levator ani
  4. pelvic floor relaxation - start at 1st floor of elevator
31
Q

unsafe exercises/postures (7)

A
  1. (B) SLR -> uni is fine
  2. fire hydrant pose
  3. hip extension in quadruped -> knee flexed is fine
  4. lying in supine for longer than 5 mins
  5. quick posture changes -> OH
  6. unilateral WB exercises
  7. prolonged static standing
32
Q

exercises for postpartum (3)

A
  • strengthening and aerobic exercises
  • diastasis recti correction
  • pelvic floor awareness, strengthening
33
Q

oliviera 2007

A

Causes increase in PFM pressure and strength during pregnancy (olive pressure)

34
Q

price 2010

A

preventing leakage postpartum, managing urinary incontinence (stress, mixed) (price leakage)

155 Selected Conditions (5 decks)

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