Pelvic Health Flashcards
Functions of Pelvic Floor
Urination, sex and reproduction, evacuation of stool and gas
“S” Functions of Pelvic Floor
Supportive, Sphincteric, Sexual, Stabilization
Anterior Anatomy
Symphysis Pubis
Posterior Anatomy
Coccyx
Lateral Anatomy
Ischial Rami and Tuberosities
Anterolateral Anatomy
Inferior Pubic Rami
Posterolateral Anatomy
Sacrotuberous Ligament
Urogenital Triangle
Anterior, superficial muscle, first layer
Anal Triangle
Posterior, second and third layers of muscle, external anal sphincter
Levator Ani and Coccygeus
Largest muscle in group in PF
Responsible for most function/dysfunction
Innervated by S3-S5
Contract as a unit to support viscera and compress urethra, vagina, rectum
Third Muscle Layer
Includes 2 PF muscles and 2 LE muscles
Impairments in piriformis or OI muscles contribute to PFM issues and vice versa
PC fibers interdigitate with the OI, therefore hip problems may be related to bladder/bowel issues
Piriformis Problems
Muscle pads are posterior wall of pelvis, so they form a bed for the sacral plexus–sacral nerve roots can become affected
PF Muscle Fiber Types
Tonic- Type 1 (support, 70%-Levator Ani)
Physic- Type 2 (act intensely, fatigue quickly, 30%, decrease with aging)
Hip Adductors
Fibers interdigitate with Levator muscle
Can facilitate action of Levator muscles
Gluteals
Frequently tightened with Levator muscles
Abdominals
Play a role in IAP (pressure changes what is happening in the pelvic floor!)
Connection between PF and Breathing
As you exhale, PF rises
As you inhale, PF comes down
PF and Abdominal Connection
Transversus Abdominis is recruited to perform full PF contraction
Contraction of TA assists the pelvic floor to pull the bladder and urethra up and in
PFM Function
Support pelvic organs using ligaments above and PFM function below
Increase IAP and force of gravity encourage protrusion of pelvic organs –> PFM activity should increase with increased IAP
PFM Voluntary Contraction
PFM shortens moving cranial lay (upward)
Voluntary Relaxation
PFM lengthens moving caudally (downward)
Involuntary Contraction of PFM
PFM shortens before increase in IAP during cough, laugh, “knack”
Involuntary Relaxation of PFM
Automatic PFM lengthening before defecation
Risk Factors for PFM Dysfunction
Pregnancy and vaginal childbirth (also C-section)
Obesity
Chronic or repetitive coughing, vomiting, straining
Pelvic Surgery
Pain
History of sexual abuse
Muscle imbalance- trunk ad pelvis
Childbirth
Vaginal- nerve compression and traction
Cesarean- record high, causes implications for PT
Low Tone PFM Dysfunction
Under-active Pelvic Floor Laxity, loss of support- weakness Urinary Incontinence Fecal incontinence Pelvic organ prolapse
High Tone PFM Dysfunction
Overactive PF Shortened muscle-weakness Trigger points- connective tissue restrictions Muscle guarding- poor relaxation Constipation Urinary urgency and frequency Incomplete Emptying Pain
Sensitive Issues with PFM Dysfunction
Cultural, religious Possibility of past sexual abuse Ability to interpret nonverbal info Terms for genitalia Forms of sexual expression/identity
Urinary Tract -Lower
Bladder, urethra, internal and external sphincters
Urinary Tract- Upper
Kidneys and Ureters
Continence Principle
Urethral Resistance pressure must be greater than bladder pressure
Storage Phase- Adult Voiding
Bladder is relaxed, bladder files 15 drops/min, PFM are contracted
Emptying Phase- Adult Voiding
At critical level of filling, strong sensation of dissension, PFM relax, bladder contracts
Micturition Facts
Bathroom “just in case” is a bad habit
Squatting over toilet may result in incomplete emptying
Each urination street should last about 10 seconds
Micturition Facts- Fluids
Decreasing fluids does not decrease incontinence and may increase urgency
Some fluid can irritate the bladder–causes urgency!
Urinary Incontinence Treatment Categories
Behavioral, Pharm, surgical
Recommend the conservative option first!
Prevalence of Incontinence
More than 15 million women in U.S. have SUI and 16 million have overactive bladder
1/10 women suffer from anal incontinence
11% of women likely to have pelvic surgery for UI and/or prolapse
29% will have multiple surgeries for PF dysfunction
Urinary Incontinent Prevalence
25% of young women
57% of middle-aged women
75% of older women
Urinary Incontinence in Athletes?
Athletes report significantly greater frequency of UI; must consider physical activity frequency and intensity related to UI
Psycho-social Impact of Incontinence
QOL issues- avoidance, fear, limitations
Self-esteem, emotional, relationships, activity, safety, cost
Urinary Incontinence Types
Stress- outlet problem Urge- bladder problem Mixed- combo Overflow- over-distension of bladder Functional- inability to get to bathroom
Stress Incontinence
Occurs with increase in IAP
Loss of small amount of urine associated with physical exertion
Cough, sneeze, lift, exercise, sex, position change
Urge Incontinence
Associated with abrupt sense of urgency "Key in the Door" May be triggers Worsened by bladder irritants Leads to frequency
Overflow Incontinence
Destructor muscle is under active (low SCI, DM, Meds)
Urethral Obstruction (tumor, prolapse)
Functional Incontinence
Inability to get to bathroom or remove clothing in time
Result of gross or fine motor impairment
Male Urinary Incontinence
Radical Prostatectomy, damage to internal untether all sphinchter during surgery, stress UI, dependent on pads
