Physiotherapy in Obstetrics and Gynaecology Flashcards
When does the obstetric-MSK service provide support?
Related to MSK problems = available throughout pregnancy, labour and delivery
What patients does the Pelvic Health Service see?
Bladder and bowel dysfunction, prolapse and vulvodynia
What are some common MSK problems seen during pregnancy?
Back pain, DRAM, carpal tunnel, pelvic girdle or pubic symphysis pain
How can pelvic floor dysfunction present?
Incontinence of bladder or bowel, difficulty with bowel emptying, pelvic organ prolapse, vulvodynia or other female pelvic pain
How do you assess a patient with pelvic floor dysfunction?
PMH = diabetes, surgery, lung disease, O & G history
Bladder symptoms = including bladder diary
Bowel symptoms = including constipation
What are types 1-4 on the Bristol stool chart?
1 = separate hard lumps, hard to pass 2 = sausage shaped but lumpy 3 = like a sausage but with cracks on surface 4 = like sausage or snake but smooth and soft
What are types 5-7 on the Bristol stool chart?
5 = soft blobs with clear cut edges (passed easily) 6 = fluffy pieces with ragged ages 7 = watery, no solid pieces, entirely liquid
What does a bladder diary record?
Input and output, number of times they went to toilet and how many times they were up during the night
What are some investigations for pelvic floor dysfunction?
Urinalysis and post-voidal residual
US biofeedback = abdominal or translabial
Vaginal/rectal examination
What are grades 0-2 on the Modified Oxford score for pelvic floor dysfunction?
0 = no detectable contraction, ICS absent 1 = flicker, ICS weak 2= weak contraction, ICS weak
What are grades 3-5 on the Modified Oxford score for pelvic floor dysfunction?
3 = moderate contraction, ICS normal 4= good contraction, ICS normal 5 = string contraction against maximal resistance, ICS strong
Why is it important to manage urinary incontinence?
Significant negative effects on quality of life and detrimental effect on wider aspects of health
What lifestyle measures can be recommended?
Healthy BMI, avoid constipation, smoking cessation, avoid heavy lifting, caffeine reduction
What are some treatments for bladder symptoms?
Voiding/double voiding techniques, bladder training, pelvic floor exercises
What are some treatments for bowel symptoms?
Regulate stool to best consistency, good defaecation dynamics, good diet, pelvic floor exercises, holding on programme
What is pelvic floor training?
Structured pelvic floor exercise programme ensuring correct technique = practiced for 15-20 weeks
What are some features of pelvic floor training?
Individualised = slow and fast twitch fibres
“Knack” prior to any rises in IAP
Performed several times a day = do exercises until muscle fatigues
What is EMG biofeedback?
Computer or handheld visual and/or auditory training programme
What are some methods of biofeedback?
Pelvic educator, vaginal cones, Kegel exercises, pelvic floor trainers, muscle stimulators
What patients is electrical stimulation indicated in?
Recommended for Modified Oxford score of grade 2 or less = daily home use, active assisted
What are some examples of core stability exercises?
Lumbo-pelvic cylinder = pelvic floor, transversus abdominus, diaphragm, lumbar multifidus
May also use gym ball or do pilates
When are women encouraged to do pelvic floor exercises?
Throughout pregnancy and after giving birth
What women receive one-on-one contact to discuss exercise technique?
Women who have had forceps delivery
Women with 3rd or 4th degree tear involving anal sphincter complex
What is the management of women with 3rd or 4th degree tears?
Follow up clinic at 10-12 weeks postnatally = complete assessment and more tailored exercise programme
