Pelvic Health- Second Half Flashcards
Constipation
- most common GI complaint
- affects women more frequently than men
Constipation-Muscular problem
Weak abs- decreased pushing force
Prior Abdominal Surgery- scar tissue
PFM weakness- changes snore tall angle
PFM in-coordination- closing sphincter instead of opening
Post-partum Constipation
Perineum- painful
PFM/Nerves- may be damaged
Fluid levels- changes with breastfeeding
Daily routine- disrupted
Fecal Incontinence
Loss of stool External anal sphincter is weakened Occurs with brisk increases in IAP Obstetric trauma is a typical cause Radiation TX for Prostate cancer
Pelvic Pain- Levator Ani Syndrome
Vaginal or rectal pain
Spasm and trigger points in deep layer of PFM
Pain with defecation and prolonged sitting
“Sitting on a golf ball”
Pelvic Pain- Dyspareunia
Painful penetration
Superficial of deep
Altered tone of PFMs
Scar Tissue
Pelvic Pain-Vulvodynia
pain in external genitalia and vestibule Stabbing pain in vagina Unable to have penetration Increase in pain with sitting and tight clothing Causes are complex
Coccydynia
Causes include childbirth, sports injury, fall
Poor posture (Television Bottom)–coccyx can get pulled into more flexed position if PFM are tight ended and shortened over time
Fear, anxiety, stress
Pelvic Floor Dysfunction- Mobility vs. Stability
Too much mobility= prolapse and/or incontinence
Too much fixation/stability= pain
Midstream Test
Try to stop urine flow during urination; ability to stop it quickly correlates with muscle function–never use as a regular exercise though! Also, not a measure or strength
Therapist Exam of Pelvic Floor
External- observation, clock
Internal- tone, muscle symmetry, sensation (pain), strength (MMT)
Biofeedback Definition
Neuromuscular re-education
Based on the principles of learning; acquire new motor skills by processing responses
Gives feedback about performance!
Biofeedback Measurement
Surface or Internal EMG
Baseline resting tone, timing of contraction, recruitment, fast and slow twitch fibers, endurance, etc.
Biofeedback Interpretation
Hypertonic Dysfunction- pain; elevated baseline, delay returning to baseline after contraction
Supportive Dysfunction- poor Proprioception, trouble initiating or sustaining contraction, fatigue easily
PFM exercise
Awareness-find and feel Differentiation- avoid global contraction Effect of Gravity- body position Breathing- diaphragmatic Number and Type of Reps
Resisted Hip Rotation
Exercise for newly trained PTs not specializing in women’s health; may be used for women who find kegels hard to perform
Bladder Re-training
Bladder control was learned through training
Need to relearn how to use reflex inhibition of destrusor muscle
Bladder Diary
Voiding frequency, fluid intake, accidents, pad use?
Modalities for PFM exercise?
Biofeedback, electrical stimulation, vaginal cone weights, home units
