Physio in O&G

Question 1

What can pelvic floor dysfunction lead to?

Answer 1

Bladder and bowel dysfunction
Prolapse
Vulvodynia
Chronic pelvic pain

Question 2

Describe the history taken for pelvic floor dysfunction?

Answer 2

PMHx (lung disease, surgery, diabetes, neuro)
Lifestyle; smoking, weight
Drug history
O&G
Social history
Bladder; bladder diary
Bowel; constipation 
QOL
Patient set goals

Question 3

What is fibrogel useful for?

Answer 3

Faecal incontinence; bulks stool up

Question 4

What is a normal bladder capacity?

Answer 4

250-500 ml

Going 5-7 times a day

Question 5

What is a useful tip to help with nocturia?

Answer 5

Fluid restrict 2 hours before bed

Question 6

Describe the examinations performed for pelvic floor dysfunction

Answer 6

Urinalysis
Post void residual
Perineal, vaginal, rectal exam
Real time uss biofeedback; abdominal or translabial
Pelvic organ prolapse
Pelvic floor assessment

Question 7

What can occur alongside an anterior vaginal wall prolapse?

Answer 7

Issues with urethra

Question 8

How is pelvic floor muscle strength graded?

Answer 8

Modified oxford scale

ICS; absent, weak, normal or strong

Question 9

What are the lifestyle factors for improving pelvic floor dysfunction?

Answer 9

Healthy BMI
Avoid constipation
Smoking cessation
Avoid heavy lifting
Caffeine reduction (esp urge)

Question 10

What can be done to improve bladder symptoms assoc with pelvic floor dysfunction?

Answer 10

Caffeine reduction 
Bladder training
Voiding/ double voiding techniques
Pelvic floor exercises
Avoid constipation

Question 11

What should be done if there is a residual volume of over 200 ml?

Answer 11

Refer to urology for intermittent self catheterisation

Question 12

What can be done to improve the bowel symptoms assoc with pelvic floor dysfunction?

Answer 12

Regulate stool to goldilocks poo
Pelvic floor exercises
Difficulty wiping clean; lepicol 
Urge; holding on programme
Freq; holding on and caffeine reduction

Question 13

What is pelvic floor training?

Answer 13

Structured pelvic floor exercise programme
Individualised to work slow and fast twitch fibres
“Knack” prior to any rise in IAP

Question 14

How often and for how long should pelvic floor exercises be performed?

Answer 14

Performed until muscle fatigue several times a day

15-20 weeks

Question 15

What is the “knack” associated with the pelvic floor?

Answer 15

Precontraction of pelvic floor prior to a rise in IAP such as sneezing or coughing to prevent leakages

Question 16

What is biofeedback training?

Answer 16

Objective measure to see pelvic floor

With vaginal and anal electrode

Question 17

What are core stability exercises?

Answer 17

Lumbo-pelvic cylinder; pelvic floor, transversus abdominis, diaphragm, lumbar multifidus
Pilates
Gym ball

Question 18

Should women do pelvic floor exercises in pregnancy?

Answer 18

Yes; proven to have positive effects

Question 19

Describe the physio offered to women after childbirth?

Answer 19

Women who have had a forceps delivery or 3rd/4th degree tears have on-to-one contact where exercise technique is discussed
Follow up clinic for 3rd/4th degree tears at 10-12/52 PN