Pelvic & Obstetric Physiotherapy

Question 1

What can happen as a result of pelvic floor dysfunction?

Answer 1

• Bladder & Bowel Dysfunction
• Prolapse
• Vulvodynia
• Chronic pelvic pain

Question 2

How can pelvic floor dysfunction present?

Answer 2

• Incontinence of bladder/bowel
• Difficulty with bowel emptying
• Pelvic organ prolapse
• Vulvodunia or other male/female pelvic pain

Question 3

What is included in an assessment of pelvic floor dysfunction?

Answer 3

• PMHx (lung disease, surgery, diabetes, neurological)
• lifestyle- smoking, weight
• Drug history
• Obstetric and gynaecological history
• Social history
• Bladder symptoms- bladder diary
• Bowel symptoms- including constipation
• QOL measures
• patient set goals

Question 4

What testing/examination is done in assessment of pelvic floor dysfunction?

Answer 4

• urinalysis
• post void residual
• perineal, vaginal/rectal examination
• real time US biofeedback- abdominal or translabial
• pelvic organ prolapse
• pelvic floor assessment (weak/overactive)

Question 5

What is the modified oxford scale & ICS?

Answer 5

• Grade 0- No discernable contraction ICS- absent
• Grade 1- Flicker ICS- Weak
• Grade 2- Weak Contraction ICS- weak
• Grade 3- Moderate contraction ICS- normal
• Grade 4- Good contraction ICS- normal
• Grade 5- Strong contracgtion against maximal resistance ICS- strong

Question 6

What lifestyle modification should be made for treatmnet of pelvic floor dysfunction?

Answer 6

• healthy BMI
• avoid constipation
• Smoking cessation
• Avoid heavy lifting
• Caffeine reduction

Question 7

What advice should be given to improve bladder symptoms?

Answer 7

• reduce caffiene intake
• avoid constipation
• Do bladder training
• Use voiding/double voiding techniques
• Do pelvic floor exercises

Question 8

What advice should be given for bowel symptoms?

Answer 8

• regulate stool to goldilocks poo
• do pelvic floor exercises
• difficulty wiping clean-lepicol or similar
• urge: holding on programme
• Frequency: holding on programme, caffiene reduction

Question 9

What is pelvic floor training?

Answer 9

Structured, individualised (Fast twitch and slow twitch) pelvic floor exercise programme ensuring correct technique.

Knack (contraction) prior to any rises in IAP.

Performed until muscle fatigue several times per day

Practised for 15-20 weeks

Then maintenance programme.

Question 10

What can be done if PF is working too hard at the wrong time?

Answer 10

Biofeedback training- EMG- handheld visual and/or auditory training programme

Question 11

What are the OTC biofeedback devices available?

Answer 11

• pelvic educator
• vaginal cones
• kegel exerciser
• pelvic floor trainers
• muscle stimulators

Question 12

Who is electrical stimulation recommended for?

Answer 12

Patients with muscle strength grade 2 or less

Question 13

What core stability exercises can be helpful?

Answer 13

• Exercises for lumbo-pelvic cylinder
  
  • pelvic floor
  • TVA
  • diaphragm
  • lumbar multifidus
• pilates
• gym ball

Question 14

When should women be encouraged to do PF exercises?

Answer 14

Throughout pregnancy and after giving birth

Question 15

Which women have one-to-one contace where exercise technique is discussed?

Answer 15

Women who have had a forceps delivery or third/fourth degree tear (involving anal sphincter complex)

Question 16

Which patients recieve follow up 10 weeks after birth?

Answer 16

Women who have had third/fourth degree tears

Complete assessment and more tailored exercise programme provided