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Geriatrics 2 > Pelvic Health/PT > Flashcards

Pelvic Health/PT Flashcards

1
Q

Who are pelvic health specialists?

A

PTs interested in treating pelvic health after graduating begin to continue this area of education while treating pts

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2
Q

Two pelvic health specialist certification

A
  1. Pelvic rehabilitation practitioner certification (PRPC)

2. Certificate of achievement in pelvic physical therapy (CAPP)

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3
Q

What can PT and OT both do?

A

Treat pelvic health problems and take continuing education

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4
Q

What can PT do that OT cannot

A

Treat the spine

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5
Q

Ability to treat the spine (PTs) is important for pt. who have pelvic pain involving…

A

The SI joints, coccyx, or pubic symphysis

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6
Q

Function of pelvic floor muscles

A
  • Support of pelvic organs
  • Coordination for bowel & bladder control
  • Trunk & pelvic mobility and stability
  • Sexual function
  • Lymphatic fcn
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7
Q

Three layers of pelvic anatomy

A
  1. Pelvic organs - bladder, bowels (rectum), prostate, uterus
  2. Supportive tissue - fascia, ligaments, connective tissue
  3. Pelvic floor muscles (3 layers)
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8
Q

Pelvic muscle layer one

A

Superficial perineal layer

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9
Q

Innervation of muscle layer one

A

Pudendal n.

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10
Q

What muscles are in layer one?

A
  • Bulbospongiosus
  • Ischiocavernosus
  • Superficial transverse perineal
  • External anal sphincter
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11
Q

Pelvic muscle layer two

A

Deep urogenital diaphragm layer

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12
Q

Innervation of muscle layer two

A

Pudendal n. and deep branch of the perineal n.

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13
Q

What muscles are in layer two?

A
  • Compressor urethra
  • Uretrovaginal sphincter
  • Deep transverse perineal
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14
Q

Pelvic muscle layer three

A

Pelvic diaphragm

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15
Q

Innervation of muscle layer three

A

Sacral n. roots S3-S5, levator ani n., pudendal n.

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16
Q

What muscles are in layer three?

A
  • Levator ani (iliococcygeus, pubococcygeus, puborectalis)

- Coccygeus

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17
Q

Other important pelvic floor muscles

A
  • Obturator internus

- Piriformis

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18
Q

Type 1 pelvic floor muscles are ____ twitch

A

Slow

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19
Q

Type 2 pelvic floor muscles are ____ twitch

A

Fast

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20
Q

Type 1 pelvic floor muscles account for ___% of the pelvic floor muscles, type 2 ___%

A

Type 1 - 70%

Type 2 - 30%

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21
Q

T/F: only type 1 muscles need to be trained

A

FALSE - both need to be trained

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22
Q

How do we train the pelvic floor muscles?

A

Kegel’s

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23
Q

Endurance kegels are useful for

A

Resisting urination

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24
Q

Quick kegel’s are useful for

A

Resisting a high degree of force/pelvic pressures (e.g. laughing, coughing, jump)

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25
Q

How to check if a pt. is doing kegel’s correctly

A
  • Have pt lay in hooklying
  • Palpate the ischial tuberosity (w/ consent)
  • Bring fingers medial (approx 1/2 inch into levator ani)
  • Have pt. perform a kegel
  • You should feel a lift upward away from your finger
  • Have them hold for a count of 5, then relax fully
  • Then, have them perform quick squeezes with 1 count hold, then relax
  • Watch for compensations
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26
Q

Common compensations pt. do while attempting to perform kegel’s

A
  • Holding breath
  • Squeeze gluts
  • Squeeze hip adductors
  • Contract abd muscles (transverse abdominus)
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27
Q

What can retraining the pelvic floor muscles help do?

A
  • Pelvic pain
  • Incontinence
  • Constipation
  • Pelvic organ prolapse
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28
Q

What else in important in addition to contracting pelvic muscles?

A

Fully relaxing them

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29
Q

What can you tell a pt. to do in regards to kegel’s?

A
  • Perform in many positions (e.g. lying down, sitting, standing)
  • Contract prior to activities that increase intraabd pressure (prevents urge or stress incontinenece)
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30
Q

Common locations for pelvic pain

A
  • Low back, pelvis, hips
  • Abdominal
  • Pain w/ urination, bowel mvmts, sexual activity
  • Vaginal or labial pain
31
Q

How many women worldwide have pelvic pain?

A

1/4

32
Q

Causes of pelvic pain

A
  • Bony changes
  • Muscle changes
  • Scars
  • Bowel & bladder dysfunction
  • Surgeries
  • Childbirth
  • Radiation, chemo
33
Q

Common evaluation findings with pelvic pain

A
  • Weakness or incoordination of core and pelvic floor muscles
  • Muscle tightness
  • Decreased muscle flexibility
  • Postural dysfunction
  • Poor body mechanics for mvmts
  • Poor positioning for sitting/standing/sleeping
  • Poor breathing patterns
34
Q

What can disturb/disrupt pelvic nerves?

A
  • Pregnancy
  • Childbirth
  • Surgeries
  • Muscle tightness
35
Q

Damage to pudendal nerve is assoc. w/ what type of pain?

A

Perineal and pelvic pain

36
Q

Damage to obturator nerve is assoc. w/ what type of pain?

A

Pelvic pain

37
Q

Damage to sciatic nerve is assoc. w/ what type of pain?

A

Back, gluteal, hip, leg pain

38
Q

Pelvic nerve pain can be treated w/

A

Manual therapy & exercise

39
Q

What can cause scars in the perineal/vaginal/anal region?

A
  • Episiotomy
  • Tearing during vaginal birth
  • Surgical procedures
40
Q

What can cause scars in the abd region?

A
  • C section

- Other surgeries

41
Q

Sx r/t scars

A
  • Decreased sensation @ scar site
  • Local pain, tenderness
  • Referred pain
42
Q

Tx of scar tissue

A
  • Manual therapy helps remodel tissue
  • Desensitization technique decreases pain, sensitivity of scars
  • Visceral mobilization (organs, ligaments)
43
Q

Scar tissue is best treated

A

Immediately - resolves faster

44
Q

What is pelvic organ prolapse?

A

When a pelvic organ drops from its normal position and pushes against the walls of the vagina

45
Q

What causes pelvic organ prolapse?

A

Muscles that pelvic organs in place get weak or stretched (esp. after surgery)

46
Q

Signs of pelvic organ prolapse

A
  • Pressure, fullness or heaviness
  • Pain
  • Painful intercourse
  • Feeling of something falling out
  • Leaking of urine or constant feeling of need to urinate
47
Q

Why does constipation increase with age?

A
  • Scar tissue or immobility or organs
  • Slowing of metabolism
  • Decreased movement in general
  • Dietary changes
  • Decreased water intake
  • Comorbidities
  • Medications
48
Q

Treatment of constipation

A
  • High fiber diet (fruit, veggies, whole grains)
  • Increase fluid intake
  • Exercise
  • Defecate at the same time everyday
  • Do not strain; use stool or squatty potty
  • Abd massage
  • Kegels provide relaxation of pelvic floor
49
Q

Types of incontinence

A
  • Stress
  • Urge
  • Mixed
50
Q

Is incontinence normal?

A

NO

51
Q

What is stress incontinence?

A

Involuntary loss of urine with physical exertion

52
Q

What is urge incontinence?

A

Urine loss that occurs with a strong desire to urinate

- Can have triggers such as running water, key in the door

53
Q

What is mixed incontinence?

A

Stress + urge

54
Q

What is required for normal urination?

A

Bladder contraction + pelvic floor muscle relaxation

55
Q

Normal # of daytime urination

A

4-6x

56
Q

Normal # of nighttime urination

A

0-1x (<65)

1-2x (>65)

57
Q

How long is normal urination?

A

8-10 sec

58
Q

Normal fluid intake should be ___oz and not exceed ___oz

A

64; 96

59
Q

Limit bladder irritants to ____ per day

A

0-1

60
Q

What increases risk of incontinence?

A
  • Venous insufficiency
  • Heart meds
  • Lung dz, chronic cough
  • DM
  • GI dysfcn
  • Surgeries (e.g. hysterectomy, C section)
  • Dementia
  • Obesity
  • Competitive athletes, aged 18-25
  • Aging
  • Childbirth (increase w/ # of vaginal births)
61
Q

Bladder tips

A
  • Stay hydrated
  • Avoid irritants (e.g. coffee, tea, caffeine, sparkling water)
  • Sit when you void to allow muscles to relax
  • No “just in case” voiding
  • Don’t rush to void
62
Q

Why does nighttime voiding increase with aging?

A
  • Produce less of a hormone that allows us to retain fluid

- Bladder loses its holding capacity

63
Q

What is it called when there is a separation between the two sides of the rectus abdominis

A

Diastasis recti abdominis

64
Q

Diastasis recti abdominis commonly occurs

A

After pregnancy d/t weakness of transverse abdominis

65
Q

Diastasis recti abdominis increases risk of what

A

Back pain d/t incomplete ability to brace w/ lifting, carrying, prolonged positions, housework, and exercise

66
Q

How to contract the transverse abdominis

A

Draw belly button toward spine while keeping neutral spine

- Coughing while palpating above and inside the ASIS to feel muscles engage

67
Q

Pelvic health specialist can be used…

A
  • Prior to testing to help with diagnosis
  • After testing to help with symptoms
  • Instead of medications to control sx, use muscles and habits
  • Pre-surgery
  • Post-surgery
  • After oncology tx -> decrease sx
  • Identify pt who does or doesn’t need more testing or surgery
68
Q

Examples of pelvic pain syndromes that are appropriate for referral

A
  • Pelvic floor dysfcn
  • Vulvodynia/provoked vestibulodynia
  • Vaginismus
  • Painful scars
  • Endometriosis
  • Dyspareunia
  • Pudendal neuralgia
  • Levator ani syndrome
  • Coccydynia
  • Dysmenorrhea
  • Male pelvic pain
69
Q

Examples of pelvic organ prolapse that are appropriate for referral

A
  • Pre & post surgical
70
Q

Examples of colorectal syndromes that are appropriate for referral

A
  • Constipation
  • Fecal incontinence
  • IBS
71
Q

Examples of bladder dysfcns that are appropriate for referral

A
  • Urinary incontinence
  • Urgency/frequency
  • Interstitial cystitis
  • Dysuria/painful urination
  • Incomplete emptying
  • Chronic abacterial prostatitis
  • Post prostatectomy rehabilitation
72
Q

Examples of pregnancy & post-partum mgmt that are appropriate for referral

A
  • MSK pain
  • Diastasis recti
  • Painful episiotomy, C section scars
  • Carpal tunnel
  • Thoracic outlet
73
Q

Other conditions that are appropriate for referral

A
  • SI dysfcn
  • Post hysterectomy rehabilitation
  • Hip joint/thigh/groin pain

Geriatrics 2 (4 decks)

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