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Spine > Pelvic Health > Flashcards

Pelvic Health Flashcards

1
Q

Founder of Pelvic Health in PT

A

Elizabeth Noble in 1977

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2
Q

3 important ligaments on the anterior portion of the pelvis

A
  • Sacroiliac l.
  • Sacrospinous l.
  • Sacrotuberous l.
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3
Q

Where is the pelvic floor located? Why is it important?

A
  • Pelvic Floor is attached across the base of all things via fascia and ligaments
  • When trauma or pregnancy occurs results in dysfunction and strain, leading to pelvic floor issues
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4
Q

What are two anatomical similarities between males and females for pelvic floor?

A
  • Both have Urogenital Urethra and Genital Triangle
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5
Q

What 3 muscle compose the Levator Ani?

A
  • Puborectalis
  • Pubbococcygeus
  • Illicoccygeous

These three muscle function together!

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6
Q

Where is the puborectalis muscle? Why is it important?

A
  • Comes from the bone near pubic symphysis wrapping around the rectum
  • Squatting places muscle on slack making it easier for things to flow out
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7
Q

How does the puborectalis relate to hip precaution patients?

A
  • Having an elevated toilet seat to stay within precautions results in the muscle staying tight, making it harder to go
  • May need stool softener
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8
Q

Obturator Internus
- Attachments
- Motions
- Referral Pattern

A

Motions:
- In flexion is an abductor
- In extension is an external rotator

Referral Pattern
- Near butthole/coccyx
- Below right buttcheek, down back of thigh

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9
Q

Why is the Obturator Internus so important in regards to pelvic health?

A
  • It is a muscle attachment for the levator ani via fascia
  • Tear results in loss of foundational support for the pelvic floor muscles
  • Present with hip pain, muscle weakness, incontinence, prolapse of organs
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10
Q

What is a kegal?

A
  • Pelvic Floor Muscle Contraction
  • Upward and inward motion
  • Involved Levator Ani
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11
Q

Why is the pudendal nerve important?

A
  • Origin: S2-S4
  • Sensory and Motor to the Pelvic Floor Muscles
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12
Q

How can you test the Pudendal Nerve?

A
  • Perform a Tenel Test (Nerve Provacation Test)
  • Tap on the nerve
  • Normal: No Sx
  • Positive: Aggravated Sx
  • Test is performed medial to ischial tuberosity
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13
Q

Why is the Genitofemoral nerve important for pelvic floor?

A
  • Origin: L1-L2

Path:
* Pierces Psoas Muscle
* Splits into two branches: Genital (through inguinal canal to scrotum or labia majora) and Femoral (Fascia lata and femoral sheath to anterior aspect to upper thigh)

  • Action: Sensory and motor to cremaster muscle
  • Neurodynamic mobility: SB and then pull on strotum to perform gliding and tensioning
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14
Q

Sympathetic and Parasympathetic - micturition

A
  • Micturition = urination
  • Sympathetic = store urine
  • Parasympathetic: helps you pee; S2-4
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15
Q

Voluntary contraction of pelvic floor muscles provides reflex relaxation of the ____ muscle

A
  • Detrusor
  • Provides control over urge to pee
  • Pro tip for car rides: Squeeze muscles to result in storing more in bladder
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16
Q

Pelvic Floor Medical Screening Conditions

A
  • Cauda Equina Syndrome (Urinary retention, saddle anethesia, weakness/paralysis more than 1 nerve root) - ER
  • UTI (fever, chills, sweat, blood in urine, painful/frequenct urination, sense of incomplete bladder emptying, foul smelling urine) - Urinalysis
  • Pelvic Infection (abnormal discharge, vaginal itching/burning (Refer for cultures)
  • Kidney Infection (Previous UTI; Results in LBP, Flank Pain)
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17
Q

Impairments vs Pelvic Sx

A
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18
Q

What is pelvic floor prolapse?

A
  • Dropping down of organs
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19
Q

POP: Cystocele

A
  • Bladder develops a pouch when it prolapses down
  • Only in women
  • Often with chronic coughing
20
Q

When someone has POP you do not want to give them exercises that…

A
  • increase abdominal pressure
21
Q

POP: Uterus

A
  • Uterus comes out
  • Pain after stanfinf a long time or lifting, anything that causes pressure down
22
Q

POP: Rectocele

A
  • Prolapsed rectum
  • Buldges into vagina or up into rectum causing issues with bowels
  • Causes: Chronic coughing, straining, genetic history
23
Q

POP is ____ common.

A
  • Not
  • 2.9%
24
Q

Risk Factors for POP

A
  • Parity (more children)
  • Advancing age
  • Obesity
  • Hysterectomy (Uterus takes up space so taking it out leaves space)
  • Race/ethnicity
    – Latina and Caucasian > African American
  • Chronic constipation
  • Connective tissue disorders
    – Ehlers-Danlos syndrome (hypermobile)
  • Family history
  • Heavy lifting
  • Chronic coughing
25
Q

Screening questions for POP

A
  • Do you have a sense of pelvic pressure/heaviness or a sense of things “falling out”?
    – Is it worse after prolonged standing, or near the end of the day?
  • Have you ever felt something bulge out of your vaginal area?
  • Do you ever experience post-void dribble?
  • Do you have a chronic cough?
  • Were/are you a gymnast/ trampolinist?
  • Do you struggle with constipation or strain to complete BMs?
  • Do you regularly participate in heavy lifting?
26
Q

Common questionairres for POP

A
  • Pelvic Floor Distress Inventory (PFDI) - this is more responsive
  • Pelvic Floor Impact Questionnaire (PFIQ)
27
Q

POP Tx

A

Behavioral modifications
* Limit straining
* Limit heavy lifting
* Establish a regular bowel routine

Exercise prescription
* Kegels
* Gravity dependent vs. eliminated
* Limit jumping and overhead lifting
* Discourage continuous abdominal bracing
* Breathing

28
Q

Give examples of exercises for POP, taking into account effects of force and gravity

A
  • DO NOT have them jumping
  • DO: have then do a leg press and hip bridge
29
Q

Pelvic Floor muscle training for POP resulted in…

A
  • Decreased reports of POP symptoms
  • Improvement in pelvic organ support/staging
30
Q

Kegels: Verbal Cueing and Prescription

A

Urine Stop Test
* Hold back gas
* Pull tip of urethra toward belly button
* Lift your “trunk”

Reps: 10 second hold 24 reps a day or 2 x 12 reps. Depends on individual. OR quick flicks for fast quick to overcome urgency, sneezing, coughing 5-7 reps in 10 secs.

31
Q

Why is diaphragmatic breathign important?

A
  • Improves parasympathtic
  • Reduces Sympathetic
  • Increases QoL (Decreasing anxiety and depression)
  • Decreases inflammation (decreases C-reactive protein levels in blood)
  • As you breath out you create more power and core control
  • As you breathe in deep you expand down and around
32
Q

Diaphragmatic Breathing Exercise Positions

A

Note: If obese, supine is likely not yout best option.

33
Q

When should you refer someone with POP to an MD?

A
  • Prolapse outside of the vagina
34
Q

When to refer someone with POP to Pelvic Health PT

A
  • Urine Stop Test: Pt unable to voluntarily stop or slow urine flow
  • Pt reporting discomfort/inability to participate in traditional PT HEP due to pelvic heaviness/discomfort
  • Pts needs exceed your level of skill, training or comfort.
35
Q

What are the 5 types of incontinence

A
  • Stress Urinary (Involuntary loss of urine with effort; typically with an increase in abdominal pressure. Lifting, sneezing, cough
  • Urge (involuntary urinary loss due to environment; associated with triggers)
  • Mixed (Stress and Urge)
  • Functional (same urge to urinate but takes them to long to get to bathroom and can’t get there in time)
  • Giggle (loss of urine during intense laughter; mostly children)
36
Q

What is the #1 cause of bed wetting?

A

Constipation

37
Q

Risk Factors for Urinary incontinence

A
  • Post abdominal surgery
  • Prostatectomy
  • Hysterectomy: less support
  • Increased age
  • Obesity
  • Diabetes Mellitus: sugar in urine can irritate the bladder
  • Depression
  • Sedentary lifestyle
  • Constipation: as bowels get full, press on bladder
  • Chronic respiratory problems
  • Parity
38
Q

What is a normal urinary frequency?

A
  • Normal voids per 24 hours: 5-7
  • Normal nocturnal voids: Under 65 0-1; Over 65 1-2
  • Average time between vois 2-5 hours
39
Q

Screening questions for urinary incontinence

A
  • Do you lose urine with coughing, laughing, sneezing, exercise or heavy lifting?
  • Do you lose urine with or preceded by urgency?
  • Key in the door, running water
  • Do you wear a pad?
  • Frequency: How many times/day do you empty your bladder?
40
Q

Drinking ____ before consuming a bladder irritanct will decrease the number of times you go to the bathroom

A

water

Good irritants: coffeee, carbonated beverages, alcohol, fruits

41
Q

UI Tx

A
  • Weight loss
  • Kegels
  • Encourage regular BMs
  • Strengthen hip rotatiosn (ADD/IR and ABD/ER)
  • Break association with peeing by doing alternative movements when about to approach trigger
  • E-stim
42
Q

Weighted Kegels are NOT recommended for people with:

A
  • Prolapse
  • Cosntipation
  • Pelvic Pain (Muscle tension)
43
Q

NMES for neuromuscular reeducation - UI

A
  • 50 Hz
  • Pulse duration: 300 us
  • Amplitude: 60-80 mA
  • Duty cycle 5 sec on/10 sec rest
  • 15 -30 min, 2x/day, 16 weeks

Can use Biofeedback for this!

44
Q

NMES for urge suppression

A
  • 12 Hz
  • Pulse duration: 300 us
  • Amplitude: 60-80 mA
  • Duty cycle 5 sec on/10 sec rest
  • 15 -30 min, 2x/day, 16 weeks
45
Q

Pelvic floor exercises, E-stim and vaginal cones are ____ treatments for women with UI

A

equally effective

46
Q
A

Spine (19 decks)

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