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msk 2 > Pelvic Health & Incontinence > Flashcards

Pelvic Health & Incontinence Flashcards

1
Q

how many times a day is it normal to pee

A

</= 7x/day

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2
Q

at what age is it normal to have to get up 1x at night to pee

A

78.4yo

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3
Q

what is the main thing that impacts male UI

A

prostate CA

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4
Q

what mechanism is delayed in stress UI

A

feedforward mechanism of TrA and pelvic floor

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5
Q

what athletes had a higher incidence of UI

A

gymnasts
runners
power lifters
track and field (emphasis on field)
dancers

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6
Q

what are 3 demographics of pts that are inc risk for incontinence

A

older pts
females
athletes

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7
Q

why are older pts at higher risk for incontinence

A

dec in collagen

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8
Q

what is the most common type of incontinence for women

A

stress
- then mixed
- then urge

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9
Q

what are risk factors for incontinence

A

age
pregnancy and childbirth
menopause
depletion of estrogen
pelvic surgery
smoking
DM
eating disorders
obesity / high BMI
high impact physical activities
family hx
white
constipation
neuro conditions
prolapse
female anatomy
chronic coughing

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10
Q

what is functional incontinence

A

someone was totally continent previously, then have some injury that slows them down getting to the bathroom

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11
Q

stress vs urge incontinence

A

stress
- involuntary loss of urine during coughing, sneezing, laughing, or other physical activity that inc intra-abdominal pressure

urge
- involuntary loss of urine associated w strong desire to void

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12
Q

what is mixed incontinence

A

sx of both stress and urge

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13
Q

what are examples of some triggers for urge incontinence

A

running water
stepping into tub
rushing to toilet
key in door

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14
Q

what are causes of stress incontinence

A

hyper-mobility of urethra/bladder neck during exertion/poor urethral control

weakness / laxity of ms
- impaired pelvic supports

pregnancy/delivery surgery and or injury/menopause

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15
Q

what are causes of urge incontinence

A

bladder/urethral instability

detrusor over activity, local bladder irritation, bladder stones

cystitis - inflammation of anything in bladder/urethra

meds

over-pressure on bladder from abs

autonomic dysfunction

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16
Q

difference in ms between stress and urge incontinence

A

stress = weakness
- poor motor control/coordination
- use of big ms not pelvic floor which inc IAP w activities

urge = inc tone
- inability to relax pelvic floor quickly and/or fully
- related to mind body control
- can result from autonomic dysfunction

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17
Q

interventions for stress vs urge UI

A

stress = weakness in pelvic floor ms
- kegels

urge = inc tone
- kegels will only make tone worse as ms have a low threshold for stress placed on it
- work more on mind body relaxation control

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18
Q

how is mixed UI treated

A

address tone first, then strengthen

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19
Q

what are the 4 types of UI

A

stress
urge
mixed
overflow

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20
Q

what is urinary retention

A

failure to empty

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21
Q

what people can PT improve the sx and QOL in

A

non-surg candidate
pelvic pain
urinary/fecal incontinence

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22
Q

what analogy is made to how the pelvic floor ms sit

A

like a hammock

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23
Q

how does the male pelvic floor differ in its structure to the female

A

male tends to be more narrow and compact
- hammock doesn’t have to stretch as far

obturator internus is huge, IR hip and supports the pelvic floor

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24
Q

where can people get a lot of prolapses

A

urogenital hiatus

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25
Q

what 3 ms make up the levator ani ms group

A

puborectalis
pubococcygeus
ilio-coccygeus

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26
Q

what is the pelvic floor innervated by

A

S3-5 and pudendal nerve

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27
Q

what combined function do all levator ani ms have

A

counter-nutation of sacrum

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28
Q

pubococcygeus function

A

co-contract of TrA

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29
Q

puborectalis structure and function

A

pubic to midline sling posterior to rectum, “lifts”

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30
Q

iliococcygeus insertion

A

at internal surface of obturator internus (oblique)

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31
Q

coccygeus structure and function

A

thin flat ms inserts on coccyx from ischial spine (oblique ms)

“wags”

32
Q

pubovaginalis structure and function

A

medial part attaches to vagina

supports vagina

33
Q

what are 2 associated ms that originate in pelvis/pelvic wall but attach externally to leg

A

obturator internus
piriformis

34
Q

what are functions of the levator ani group

A

closes pelvic floor
- lifts up and closes

carries weight of abdominal cavity

prevents constant strain on visceral ligs/passive supports

assists w closing sphincters and maintaining proper angles/positions for bladder/bowel

35
Q

what type of fiber is the majority of pelvic floor ms and why do ms need both types

A

type 1 = slow twitch

need some quick acting ms (type 2) if you were to jump and land - quick force and inc pressure
- sphincter ms need to be quick
- pelvic floor is anticipatory, feed forward

36
Q

what changes in pelvic floor ms are seen in 3-4wks

A

see changes in motor control and NM re-ed

37
Q

what changes in pelvic floor ms are seen by 6-8wks

A

true changes in strength
- need intensive consistent training to get here

38
Q

what are 4 mechanisms that a pelvic prolapse can occur

A

downward mvmt of organs (ie bladder, rectum, uterus)

internal “hernia”

passive and active supports no longer support organs
- gravity takes over

prolapse can occur thru urogenital hiatus

39
Q

what are 4 types of pelvic prolapses

A

cystocele = bladder
rectocele = rectum
uterine prolapse = uterus
enterocele = small bowel

40
Q

what direction does a cystocele often happen in and what is the significance of this

A

falls posteriorly into vagina

bladder might not fully empty on toilet and will stay partly full and will feel it when you change positions

41
Q

what might pts w a prolapse c/o

A

feel something there
painful
heavy/pressure
can’t fully empty
can’t insert tampon

42
Q

how are prolapses graded in women

A

how quickly they come out of the vagina

43
Q

what tells your body you need to go

A

stretch receptors in visceral detrusor ms

44
Q

what ms are contracted when the urine stays inside the body

A

sphincter and pelvic floor ms have a tonic contraction

detrusor bladder ms is relaxed

45
Q

describe the guarding reflex

A

stress activities (coughing or lifting) produces sudden bladder pressure

pelvic n. or brain stimulates the pudendal motor neurons which releases Ach causing the urethral sphincter to contract

46
Q

what happens during bladder filling

A

as bladder fills, pelvic nerve is stim and norepinephrine is released to relax the bladder and contract urethral smooth ms

47
Q

sympathetic vs parasympathetic in filling or emptying bladder

A

sympathetic = stores pee
parasympathetic = pee
- parasympathetic is rest and digest, and pee

48
Q

what is an overactive bladder

A

damaged nerves may send signals to bladder at the wrong time, causing ms to squeeze w/o warning

49
Q

when nerves work poorly, what are 3 types of bladder control problems

A

urinary frequency
urinary urgency
urge incontinence

50
Q

what is urinary frequency

A

urination > 9x/day or 2+ times at night

51
Q

what is urinary urgency

A

sudden, strong need to urinate immediately

52
Q

what is urge incontinence

A

leakage of urine that follows sudden strong urge (parasympathetic system)

53
Q

what happens during bladder emptying

A

bladder full and sending strong stretch impulses to SC via pelvic n.

-> pontine micturation center activated and impulses sent to sacral parasympathetic nucleus

Ach released by pelvic n. causing bladder contractions and inhibits sphincter contractions

54
Q

_______ training is key to improvement

A

breathing

55
Q

what makes up the pelvic pyramid

A

multifidi
pelvic flow
transverse abdominis

56
Q

what are 3 modifiable factors when it comes to managing UI

A

behavioral factors
MSK factors
motor control factors

57
Q

what are 3 structural systems contributing to the management of urinary incontinence

A

urethral support system
intrinsic urethral closure system
lumbopelvic stability system

58
Q

what motor control factors can contribute to UI (4)

A

PFM dysfunction
posture
LBP/pelvic pain
breathing disorders

59
Q

a dec in what MSK factors can contribute to UI (3)

A

ROM
strength
endurance

60
Q

what behavioral factors can contribute to UI (4)

A

chronic elevated IAP
physical inactivity
abnormal fluid intake/void habits
poor psychosocial health

61
Q

what are pt education points

A

anatomy
type
risk factors/behaviors

62
Q

what are lifestyle/behavior changes to make for UI

A

timed voiding
bladder diary
< caffeine intake
fluid intake

63
Q

what are breathing instructions to give

A

diaphragmatic/lateral (segmental)
- relaxation / physiological quieting
- autonomic nervous system

64
Q

what are general POC interventions for UI

A

pt ed
lifestyle modification
breathing
posture re-training
stretching
inhibition
manual interventinos

65
Q

what are 3 examples of manual interventions

A

quick stretch/facilitation
scar massage
joint mob / MET

66
Q

what is your first line of defense w ther-ex

A

pelvic floor exercises/kegel
teach isolation of PFM
focus on timing and co-activation

67
Q

what activation should be avoided if you are teaching them to isolate PFM

A

rectus
IO/EO/gluts

68
Q

what co-activation should you teach when isolating PFM

A

isolation of PFM + proper breathing
isolation of PFM + TrA + breathing

69
Q

what is a typical prescription for kegals if the goal is to strengthen and inc force production of PFM

A

quick contractions 5 pre/post
slow contractions 5-10 sec hold
- 25-50reps/day, 5-10sec rest b/w
3-5x/wk
for 15-20wks
- then maintenance after

70
Q

what is “the knack”

A

protective contracture prior to inc abdominal pressure
- timing of urethral closure and PFM contraction has been critical

71
Q

what has estim found to be helpful in

A

<3/5 and gravity assisted

72
Q

what are nearby ms to treat as PFM isolation has been achieved

A

multifidi
LE rotation
glut max/med - proper breths
pelvic/lumbo stability/posture

73
Q

what outcomes have been found w intensive PFM strength training

A

hypertrophy and inc stiffness of PFM connective tissues to improve recruitment efficacy

elevate levator plate position to higher position in pelvis

facilitate an automatic PFM contraction during rises in IAP

74
Q

what are components to include when setting goals

A

ms isolation/coordination
urinary/fecal control
pelvic floor strength/response time
dec accessory ms contractions
dec hyperactivity of ANS
dec pain

pt goals obvi

75
Q

success rates of pelvic PT?

A

good

outcomes largely depends on pt

msk 2 (20 decks)

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