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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
what 3 ms make up the levator ani ms group
puborectalis pubococcygeus ilio-coccygeus
26
what is the pelvic floor innervated by
S3-5 and pudendal nerve
27
what combined function do all levator ani ms have
counter-nutation of sacrum
28
pubococcygeus function
co-contract of TrA
29
puborectalis structure and function
pubic to midline sling posterior to rectum, "lifts"
30
iliococcygeus insertion
at internal surface of obturator internus (oblique)
31
coccygeus structure and function
thin flat ms inserts on coccyx from ischial spine (oblique ms) "wags"
32
pubovaginalis structure and function
medial part attaches to vagina supports vagina
33
what are 2 associated ms that originate in pelvis/pelvic wall but attach externally to leg
obturator internus piriformis
34
what are functions of the levator ani group
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
what type of fiber is the majority of pelvic floor ms and why do ms need both types
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
what changes in pelvic floor ms are seen in 3-4wks
see changes in motor control and NM re-ed
37
what changes in pelvic floor ms are seen by 6-8wks
true changes in strength - need intensive consistent training to get here
38
what are 4 mechanisms that a pelvic prolapse can occur
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
what are 4 types of pelvic prolapses
cystocele = bladder rectocele = rectum uterine prolapse = uterus enterocele = small bowel
40
what direction does a cystocele often happen in and what is the significance of this
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
what might pts w a prolapse c/o
feel something there painful heavy/pressure can't fully empty can't insert tampon
42
how are prolapses graded in women
how quickly they come out of the vagina
43
what tells your body you need to go
stretch receptors in visceral detrusor ms
44
what ms are contracted when the urine stays inside the body
sphincter and pelvic floor ms have a tonic contraction detrusor bladder ms is relaxed
45
describe the guarding reflex
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
what happens during bladder filling
as bladder fills, pelvic nerve is stim and norepinephrine is released to relax the bladder and contract urethral smooth ms
47
sympathetic vs parasympathetic in filling or emptying bladder
sympathetic = stores pee parasympathetic = pee - parasympathetic is rest and digest, and pee
48
what is an overactive bladder
damaged nerves may send signals to bladder at the wrong time, causing ms to squeeze w/o warning
49
when nerves work poorly, what are 3 types of bladder control problems
urinary frequency urinary urgency urge incontinence
50
what is urinary frequency
urination > 9x/day or 2+ times at night
51
what is urinary urgency
sudden, strong need to urinate immediately
52
what is urge incontinence
leakage of urine that follows sudden strong urge (parasympathetic system)
53
what happens during bladder emptying
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
_______ training is key to improvement
breathing
55
what makes up the pelvic pyramid
multifidi pelvic flow transverse abdominis
56
what are 3 modifiable factors when it comes to managing UI
behavioral factors MSK factors motor control factors
57
what are 3 structural systems contributing to the management of urinary incontinence
urethral support system intrinsic urethral closure system lumbopelvic stability system
58
what motor control factors can contribute to UI (4)
PFM dysfunction posture LBP/pelvic pain breathing disorders
59
a dec in what MSK factors can contribute to UI (3)
ROM strength endurance
60
what behavioral factors can contribute to UI (4)
chronic elevated IAP physical inactivity abnormal fluid intake/void habits poor psychosocial health
61
what are pt education points
anatomy type risk factors/behaviors
62
what are lifestyle/behavior changes to make for UI
timed voiding bladder diary < caffeine intake fluid intake
63
what are breathing instructions to give
diaphragmatic/lateral (segmental) - relaxation / physiological quieting - autonomic nervous system
64
what are general POC interventions for UI
pt ed lifestyle modification breathing posture re-training stretching inhibition manual interventinos
65
what are 3 examples of manual interventions
quick stretch/facilitation scar massage joint mob / MET
66
what is your first line of defense w ther-ex
pelvic floor exercises/kegel teach isolation of PFM focus on timing and co-activation
67
what activation should be avoided if you are teaching them to isolate PFM
rectus IO/EO/gluts
68
what co-activation should you teach when isolating PFM
isolation of PFM + proper breathing isolation of PFM + TrA + breathing
69
what is a typical prescription for kegals if the goal is to strengthen and inc force production of PFM
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
what is "the knack"
protective contracture prior to inc abdominal pressure - timing of urethral closure and PFM contraction has been critical
71
what has estim found to be helpful in
<3/5 and gravity assisted
72
what are nearby ms to treat as PFM isolation has been achieved
multifidi LE rotation glut max/med - proper breths pelvic/lumbo stability/posture
73
what outcomes have been found w intensive PFM strength training
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
what are components to include when setting goals
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
success rates of pelvic PT?
good outcomes largely depends on pt

MSK 2 (20 decks)

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