Physiotherapy in O&G Flashcards
when is physio need in O&G
pregnancy, labour and delivery related MSK problems (SI joint problems, pelvic girdle pain, pubic symphysis dysfunction)
pelvic floor dysfunction: bladder and bowel, prolapse, vulvodynia, chronic pelvic pain
what is included in pelvic floor dysfunction
incontinence (bladder and bowel)
difficulty in bowel emptying
pelvic organ prolapse
vulvodynia/ other male/ female pelvic pain (generally pain on intercourse e.g. vaginismus)
how is pelvic dysfunction assessed in Hx
Past medical history (lung disease, surgery, diabetes, neurological)
Lifestyle – smoking, weight etc
Drug history
Obstetric & Gynaecological history
Social history
Bladder symptoms – including bladder diary (ask about type on incontinence)
Bowel symptoms – including constipation (ask about incontinence and near misses)
Quality of life measures
Patient set goals
what Ix for pelvic flow dysfunction
bladder diary
urinalysis
post void residual
perineal, vaginal/ rectal exam
real time USS biofeedback (abdominal or translabial)
pelvic organ prolapse (cough)
pelvic floor assessment (weak/overactive)
how is pelvic strength graded
modified oxford scale & ICS
grade 0 absent power to grade 5 strong
who sets the treatment goals in incontinence Tx
patient- has huge impact on QOL
what lifestyle changed can be made to prevent prolapse
healthy BMI avoid constipation (eat breakfast early, gentle laxatives) smoking cessation avoid heavy lifting caffeine reduction
what lifestyle changes can be made to prevent bladder incontinence
caffeine and alcohol reduction bladder training (hold wee for longer each time) voiding/ double voiding techniques pelvic floor exercises constipation
how do you prevent faecal incontinence
regulate stools
pelvic floor exercises
if have difficulty wiping clean use lepicol (fibre supplement)
urge- holding on programme
frequency- holding on programme and caffeine reduction
avoid artificial sweeteners (wind and sticky poos)
how often should pelvic exercises be done
until muscle fatigue 3 times a day
when might you need to ‘down train’ the pelvic floor
if its overworking- e.g. people who have pain on intercourse
what is biofeedback training
EMG- computer/ hand held visual and/ or auditory training programme for pelvic strength, shows strength of contractions USS biofeedback (trans abdo, labial) can also be done via: Pelvic Educator Vaginal Cones Kegel Exerciser Pelvic floor trainers Muscle stimulators
when is electrical stimulation used to increase pelvic floor strength
muscle strength grade 2 or less
daily home use
what other excercises can be done to increase pelvic strength
lumbo-pelvic cylinder (works pelvic floor, transverse abdominis, diaphragm, lumbar multifidus)
pilates
gym ball
(good core strength helps pelvic strength)
when are pregnant women encouraged to do pelvic floor exercises
throughout pregnancy and after giving birth
if they have a forceps delivery/ a 3rd or 4th degree tear then have meeting where technique is discussed and assessment
