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Special Populations > Pelvic Health pt 1 > Flashcards

Pelvic Health pt 1 Flashcards

1
Q

List Diagnoses commonly treated by Pelvic Therapists

A
  1. Urinary and Fecal Incontinence
  2. Pelvic Pain
  3. Vulvar Pain Disorders
  4. Dyspareunia and Sexual Dysfunction
  5. Pre-/Post-Partum MSK pain
  6. Pelvic Organ Prolapse
  7. Pudendal Neuralgia
  8. Dysfunctional Voiding and Defecation
  9. Constipation
  10. Coccyx-Pain
  11. Post-surgical rehab
  12. The Female Athlete
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2
Q

list Vulvar Pain disorders

A
  1. vulvodynia
  2. vulvar vestibulitis
  3. vaginismus
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3
Q

List Pelvic Floor Anatomical bony landmarks

A
  1. Ilium
  2. Sacrum
  3. Coccyx
  4. Pubic Symphysis
  5. Ischial Tuberosity
  6. Ischial Spine
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4
Q

list ligamentous and fascial support of the pelvic floor

A
  1. ligamentous
    1. sacrotuberous
    2. sacrospinous
  2. fascial
    1. urogenital diaphragm
    2. obturator fascia
    3. ATLA
    4. ATFP
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5
Q

list the superficial perineal muscles (first layer of pelvic floor muscles)

A
  1. Bulbocavernosus
  2. Ischiocavernosus
  3. Superficial Transverse Perineals
  4. External Anal Sphincter
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6
Q

list the muscles that make up the deep urogenital diaphragm (second layer of pelvic floor muscles)

A
  1. compressor urethrae
  2. sphincter urethrae

this is a sandwich of tissue - fascia/muscle/fascia

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7
Q

list the muscles that make up the pelvic diaphragm (third layer of pelvic floor muscles)

A
  1. Levator Ani
  2. Piriformis
  3. Obturator Internus
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8
Q

what muscles collectively make up the levator ani?

A
  1. pubococcygeus
  2. iliococcygeus
  3. coccygeus
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9
Q

what is the function of the pelvic floor?

A

5 S’s

  1. Support
  2. Sphincteric
  3. Sexual
  4. Stability
  5. Sump pump
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10
Q

what are the functions of the pelvic floor within the UGT?

A
  1. closes and opens urethra
  2. closes vagina and vaginal opening
  3. maintains erection
  4. propels urine, semen in urethra
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11
Q

list the functions of the pelvic diaphragm

A
  1. support of the pelvis
  2. support of organs
  3. trunk stability
  4. muscle fibers both slow and fast twitch
    1. 30% fast
    2. 70% slow
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12
Q

define pelvic rehab

A

a non-surgical approach to rehab of dysfunctions in the pelvis that contribute to bowel, bladder, sexual health, and pain complaints.

Treatment may include, behavioral strategies, manual therapies, modalities, therapeutic exercise, education, and functional re-training

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13
Q

what are the pelvic evaluation components?

A
  1. Medical history, bowel, bladder and sexual
  2. External screening tests
  3. LQ flexibility and lumbar AROM
  4. External palpation
  5. Core and LE strength testing as needed
  6. perineal observation for skin, scar symmetry, resting position, lifting contraction, lengthening, coughing
  7. pelvic floor external palpation
  8. internal assessment of layers 2 and 3
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14
Q

anatomical and biomechanical considerations for the coccyx

A
  1. made up of 3-5 rudimentary vertebrae
  2. normal position in standing 20-45 degrees of flexion at sacro-coccyx joint
  3. movement available at SCJ
  4. Flex/ext 30 degrees
  5. sidebending 1 cm to each side
  6. rotation 10-20 degrees
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15
Q

describe the SCJ

A
  1. fibrocartilaginous joint
  2. movement occurs during
    1. defecation
    2. labor and delivery
    3. breathing
    4. positional changes
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16
Q

when can trauma occur at the coccyx?

A
  1. child birthing
  2. severe bowel problems
  3. compression injuries from superior forces
  4. postural dysfunctions with excessive flexed sitting
  5. direct trauma
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17
Q

describe coccydynia

A
  1. pain with sitting directly over coccyx
  2. moving from STS
  3. pain with bowel movements
  4. tenderness on external and internal palpation
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18
Q

describe treatment for coccydynia

A
  1. external coccyx mobilization
  2. internal coccyx mobilization
  3. gluteus maximus strengthening to self mobilize the flexed coccyx
  4. EMG biofeedback for hypertonic of coccygeus
  5. seating support
  6. posture education
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19
Q

list and briefly describe the 3 pillars of pelvic floor PT

A
  1. Pressures → trunk and pelvic pressures are constantly changing and managed in quiet posture and movement
  2. Breathing → has effects on spine, pelvis, organs, cardiorespiratory function, neurologic system and more
  3. Load Transfer → How each person manages movement is critical to evaluate
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20
Q

describe how the trunk is a pressure system

A

abdominal and erector spinae muscles and pressure control in thoracic and abdominal cavities are critical and rely upon coordination of postural stability and breathing mechanics

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21
Q

which muscles must work synergistically to modulate intra-thoracic and intra-abdominal pressures?

A
  1. intrinsic laryngeal
  2. intercostals
  3. respiratory diaphragm
  4. abdominal wall
  5. paraspinals
  6. pelvic floor muscles
22
Q

describe how and when the pelvic floor and respiratory diaphragm work in synergy

A

with eccentric relaxation during inhalation and concentric contraction during exhalation

**respiratory dysfunction frequently occurs with pelvic floor and low back dysfunction

23
Q

breathing difficulties, urinary incontinence and allergies are more associated with ________

A

LBP than inactivity and BMI

24
Q

what 3 things are required in order to have effective load transfer?

A
  1. motor control
  2. passive force closure
  3. active force closure
25
Q

what is required for active stabilization of the lumbar spine and pelvis?

A
  1. force closure/motor control
  2. co-activation and coordination of muscles which tension the anterior and posterior fascial systems
26
Q

what is included in the anterior system?

A
  1. transverse abdominis
  2. anterior fascia
  3. most important factors are timing and symmetry
27
Q

pubic symphysis dysfunctions may often be misdiagnosed as what?

A
  1. in female athletes:
    1. abdominal muscle strain
    2. adductor tendonitis
  2. usually associated with instability and pelvic girdle dysfunctions
  3. in non athletes it is associated with instability in pregnancy and childbirth
28
Q

pubic symphysis pain treatments

A
  1. muscle energy techniques are very helpful
  2. pelvic girdle stabilization is key
  3. often combined with SI dysfunction and mobilization is needed
29
Q

list common symptoms of pelvic floor dysfunction

A
  1. ask about pain w/intercourse
  2. history of traumatic childbirth
  3. urinary and/or fecal incontinence
  4. pain with prolonged sitting
  5. lower abdominal pain
  6. burning in the perineal or ischial area
  7. constipation
30
Q

list common conditions associated with pelvic pain

A
  1. coccyx pain
  2. groin pain
  3. SI pain
  4. pain with vagina penetration
  5. genital pain
  6. vulvar pain
  7. chronic pelvic pain
  8. prostatitis
  9. post hernia repair
31
Q

list diagnoses that fall under pelvic pain

A
  1. pelvic floor myalgia
  2. levator ani syndrome
  3. dyspareunia
  4. vaginismus
  5. vulvadynia
  6. vestibulitis
  7. interstitial cystitis
  8. pudendal neuralgia
32
Q

list red flags for orthopedic PT concerning pelvic pain

A
  1. chronic pain including:
    1. IBS
    2. fibromyalgia
    3. TMJ dysfunction
    4. migraines
  2. not responding to usual treatment techniques
  3. ask about incontinence and pain w/intercourse
  4. ask about constipation and pain w/bowel movements
  5. be aware of history of pelvic surgeries or past traumas to pelvis (includes sexual abuse)
33
Q

list common functional impairments with pelvic pain

A
  1. limited prolonged posture
  2. difficulty sleeping
  3. difficulty driving, sitting at a desk
  4. pain limited sexual function
  5. bowel dysfunction
  6. bladder dysfunction
34
Q

list common factors in pelvic pain treatment

A
  1. pelvic girdle and floor immobility
  2. postural dysfunctions
  3. dyscoordination of muscles
  4. weak pelvic muscles
  5. difficulty with relaxation of muscles
  6. trigger points
35
Q

what is pudendal neuralgia?

A

pain along the distribution of the pudendal nerve

pain is of severe throbbing or stabbing character

36
Q

describe the etiology of pudendal neuralgia

A
  1. tension → straining of the nerve from constipation, strenuous squatting, childbirth
  2. compression → cycling, horseback riding, prolonged sitting
  3. surgical insult → pelvic reconstruction, hysterectomy
  4. visceral-somatic interaction → chronic UTI, yeast infections, chronic bacterial prostatitis
37
Q

what are the pudendal nerve roots?

A

S2, 3, 4

38
Q

list common symptoms of pudendal neuralgia

A
  1. pain with sitting (decreases with standing)
  2. urinary dysfunction (urgency/frequency, hesitancy, pain)
  3. bowel dysfunction (pain before)
  4. sexual dysfunction
  5. genital and/or anal pain
  6. feeling of fullness in the rectum/vagina
  7. burning, shooting, stabbing pain
  8. decreased pain when sitting on the toilet
39
Q

what is a subcutaneous panniculosis?

A

increased texture thickness with acute tenderness upon pinch-rolling in the subcutaneous tissue

40
Q

list physical exam findings with pudendal neuralgia

A
  1. connective tissue → subcutaneous panniculosis
  2. myofascial trigger points
  3. adverse neural tension
  4. pelvic floor dysfunction
  5. structures and biomechanics → orthopedic considerations such as SIJD, hypermobility/instability
41
Q

pudendal neuralgia PT treatment

A
  1. pt edu, self-care training, lifestyle modification
  2. coordination w/medical providers (med reviews)
  3. desensitization (compression bike shorts, warming lubricants)
  4. connective tissue manipulation
  5. myofascial trigger point release
  6. pelvic floor treatment (internal techniques)
  7. gradually introduce neural mobilizations as tolerated
  8. after pain controlled, address structure and biomechanics
  9. appropriate stretching and aerobic exercise introduced as symptoms reduce and MTrPs have been eliminated
42
Q

describe urinary incontinence

A
  1. a condition with involuntary loss of urine
  2. it is a S/S not a disease
  3. present in 25% of young women
  4. 44-57% of middle-aged and post menopausal women
  5. 75% of older women in nursing homes
43
Q

list risk factors for urinary incontinence

A
  1. childbirth
  2. obesity (abdominal girth)
  3. smoking
  4. caffeine and alcohol
  5. high impact physical activity
  6. menopause
  7. neurological conditions
  8. pelvic surgery
  9. pelvic floor muscle weakness/prolapse
44
Q

what are the different types of incontinence?

A
  1. stress
  2. urge
  3. mixed
45
Q

describe stress urinary incontinence

A
  1. involuntary loss of urine with physical exertion
  2. weak pelvic floor
  3. mechanical efficiency of the pelvic floor muscles
  4. altered motor control
  5. overactive abdominal muscles
  6. hypermobility of bladder and urethra and/or urethral sphincter deficiency
  7. leakage with coughing, sneezing, laughing exercise
46
Q

describe urge incontinence

A
  1. urine loss which occurs with a strong desire to void
  2. associated with overactive bladder (sense of incomplete voiding with or w/o pelvic pain)
  3. detrusor instability → the bladder contracts when you do not want it to (uninhibited)
  4. not considered a pelvic floor muscle problem
  5. can have triggers like cold, running water, “key in the door”
47
Q

described mixed urinary incontinence

A

symptoms of both stress and urge incontinence

48
Q

list treatment options for urinary incontinence

A
  1. meds
  2. surgery
  3. behavioral/physical therapy
  4. urethral bulking procedures
  5. pessary
49
Q

behavioral and lifestyle changing for treating urinary incontinence

A
  1. bladder re-training
  2. treating constipation
  3. elimination of dietary irritants
  4. weight reduction
  5. fluid management
50
Q

list PT treatment options for urinary incontinence

A
  1. Pt edu
  2. MSK interventions
    1. pelvic obliquity, lumbar dysfunction, hip weakness
  3. Motor Control
    1. overactive abdominals, muscle incoordination
  4. Breathing/relaxation techniques, physiological quieting
  5. pelvic floor muscle rehab → restore normal length, strength, tone
51
Q

what can be included in pt edu for PT treatment of urinary incontinence?

A
  1. bladder fitness
  2. vulvar skin care
  3. pelvic floor function and anatomy
  4. bladder retraining
  5. bladder irritants
  6. constipation
52
Q

describe pelvic floor muscle rehab

A
  1. use of biofeedback
  2. emphasize lifting contractions, muscle isolation
    1. holding for 10 seconds
    2. 30-80 reps
    3. 8 weeks of training
    4. teach functional use
  3. E-stim can be helpful

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