S3L2: Types of Pelvic Floor Dysfunction, Diastisis Recti Abdominis, Female Athletic Triad, Other Considerations Flashcards
Due to deficiencies in the PFMs, urethra, bladder,
and/or sphincter that it is difficult to maintain
urethral closure pressure
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
a. STRESS URINARY INCONTINENCE
Loss of urine with increased intraabdominal
pressure such as coughing, laughing, sneezing,
or physical exertion
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
a. STRESS URINARY INCONTINENCE
Unable to maintain closed sphincters which
leads to spontaneous voiding with
increased intraabdominal pressure
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
a. STRESS URINARY INCONTINENCE
Etiology may be due to pregnancy, vaginal
delivery (overstretch), pelvic surgery, pelvic
organ prolapse, neurologic causes, active
lifestyle, obesity, and aging
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
a. STRESS URINARY INCONTINENCE
Modified T/F:
The pelvic area can be overstretched after birth and not
return to normal due to lack of exercise. Aging can produce unwanted stress, while obesity leads to wear and tear and causes overstretch and muscular weakness
T F
Involuntary leakage accompanied by or
immediately preceded by the sudden onset of
the urge to void that cannot be deferred easily
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
B
Can be caused by involuntary detrusor
contraction that overcomes the sphincter
mechanism
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
B
Can also be caused by poor bladder compliance
that is due to the loss of the viscoelastic
properties of the bladder
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
B
May be neurogenic in nature (spinal cord injury,
spinal stenosis, multiple sclerosis, and stroke
leading to catheter usage or idiopathic). Non-neurogenic may be caused by radiation
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
B
Occurs when the patient experiences both SUI
and UUI Sx
a. STRESS URINARY INCONTINENCE
b. URGE URINARY INCONTINENCE
c. MIXED URINARY INCONTINENCE
C
Due to increased abdominal pressure under stress (weak
pelvic floor muscles)
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
A
Due to involuntary contraction of the bladder muscles
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
B
Due to blockage of the urethra
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
C
Blockage may be caused by benign hypertrophy
sometimes
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
C
Due to disturbed function of the nervous system
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
D
overactive stretch reflex of bladder → slight stretch and the bladder will void immediately
a. STRESS INCONTINENCE
b. URGE INCONTINENCE
c. OVERFLOW INCONTINENCE
d. NEUROGENIC INCONTINENCE
D
How many % percent is the prevalence of UI?
34
Give 5 Risk Factors for UI
Race, hormonal status, obesity, history of pregnancy
or childbirth, chronic disease (e.g. DM), constipation,
family history, Risk increase with smoking, increased BMI, and increased parity
Modified T/F:
High-level male athletes have an SUI prevalence of 41.5%. Constipation is a risk factor for UI.
F T (high-level female athletes)
Modified T/F:
One of the treatments for UI are behavioral interventions like regulating fluid intake. Medications can be given to pts with UI
T T
Modified T/F:
UI pts are contraindicated to surgical procedures. A behavioral intervention may include diet change, bladder training, and increasing BW by 5%.
F F (UI pts may be treated c surgery, Reduction of BW by 5%)
Modified T/F:
Timed voiding and suppression plan should be for 12 wks. It should have a 3 hrs goal in between voiding, start by 30 min then progress.
T F (15 min)
Modified T/F:
A behavioral intervention may be to reduce BW by 5% & ↓ incontinence sx by 10%. Pt education alone can ↓ incontinence sx by 28%
F T (incontinence sx by 47%)
Give 2 Exercise-based treatments for UI
- PFM contraction or Kegel’s (Strengthen PFMs)
- Biofeedback (A probe is inserted to see if the muscles are contracting properly)
Modified T/F:
Urinary urgency is the complaint of a sudden desire to pass urine which is difficult to defer. Frequent urination for more than 1-2 hours is abnormal
T F (Frequent urination for more than 3-4 hours is abnormal)
Modified T/F:
Underactivity of the detrusor reflex attributable to the
disruption of the complex micturition reflex from
neurologic diseases (hyperactive stretch reflexes of
bladder). Urinary urgency and frequency may also be caused by UTI
F T (Overactivity)
Explain how UTI can cause urinary urgency and frequency.
Inflammation of the bladder → sensory afferent
upregulation → detrusor muscle instability
Modified T/F:
Lack of estrogen leads to vaginal and urethral irritation causing infection. Hypoactive PFMs and aging process can also be a culprit.
T F (Hyperactive)
Give 4 symptoms of urinary urgency and frequency
Post Voiding pain
Urethral pain d/t inc tone
Hesitancy
Incomplete bladder emptying
T or F: History of sexual abuse and severe anxiety disorder must also be taken into consideration in pts c urinary urgency and frequency.
True
Identification:
Pelvic Floor Myofascial Pain is characterized by what 3?
pain, muscular taut bands, and trigger points that cause pain referral with pressure
Identification:
Pelvic Floor Myofascial Pain is caused by what 3?
Caused by overuse, dysfunctional postures, and weakness of PFMs
Identification:
Pelvic Floor Myofascial Pain can contribute to what 3?
Can contribute to dysparenuria, painful sexual intercourse, and chronic pelvic pain
Identification:
Pelvic Floor Myofascial Pain may have a hx of what 2?
History of birth trauma or sexual abuse
Modified T/F:
Pelvic Floor Myofascial Pain is present in 70% of women (14-79y/o) with CPP. Pelvic Floor Myofascial Pain is present in 22% of women with pregnancy related pelvic girdle pain
F F
22% of women (14-79y/o) with CPP
70% of women with pregnancy related pelvic girdle pain
Modified T/F:
Pelvic Floor Myofascial Pain is present in 52% of women with chronic lumbopelvic pain that began during pregnancy. Pelvic Floor Myofascial Pain is present in 22% of community dwelling adults
T F
25% of community dwelling adults
Modified T/F:
Pelvic PT is the mainstay of treatment for Pelvic Floor Myofascial Pain. This includes myofascial techniques combined with neuromuscular education.
T T
Modified T/F:
Soft tissue mob & exercises for pelvic girdle, hip, spine, and core muscles are contraindicated for Pelvic Floor Myofascial Pain. Obturator internus & piriformis help increase pain in pelvic floor d/t proximity to the pelvic
floor.
F T
we can also release pelvic floor muscles, do soft tissue mob for trigger points, & give exercises for pelvic girdle, hip, spine, and core muscles
Modified T/F:
NSAIDs & antidepressants can be given to Pelvic Floor Myofascial Pain. Myofascial techniques & neuromuscular education are contraindicated for Pelvic Floor Myofascial Pain
T F
NSAIDs, antidepressants, other medications can be given
Give 4 goals for Pelvic Floor Myofascial Pain treatment:
Restore muscle imbalances
Improve function
Improve posture
Reduce pain
T or F: A lot of pregnant women have bodily pains when it comes to their pregnancy d/t changes of the body
True
Give 5 changes of the body during pregnancy
↑ in body mass
Lengthening of the abdominal muscles
↑ in lumbar lordosis
↑ in anterior pelvic tilt
↑ in pelvic tilt
↑ in ligamental laxity
↑ demands for the hip extensors, hip abductors,
ankle plantar flexors, and PFMs.
Give 3 areas where pain may arise for pregnancy and post-partum pelvic floor dysfunction
lumbar spine, pelvic girdle, hip, and PFM
Modified T/F:
Pt may come to you with low back diagnosis but it
may be the hip or pelvic floor that is causing the
pain. Musculoskeletal pain during pregnancy can arise
from numerous areas: pelvic & shoulder girdle, lumbar spine, and PFMs.
T F
Musculoskeletal pain during pregnancy can arise
from numerous areas: pelvic girdle, lumbar spine,
hip, and PFMs.
Identification:
Most common cause of back and pelvic pain in
pregnancy
Pelvic Girdle Pain
Modified T/F:
Pelvic Girdle Pain is experienced between the anterior iliac crest and the gluteal fold. Etiologies include mechanical, hormonal, inflammatory, collagen abnormalities, and neural.
F T
Experienced between the posterior iliac crest and the
gluteal fold
Identify:
Hormone produced by the corpus luteum the relaxes
the uterine musculature and allows pelvic expansion
Relaxin
Modified T/F:
Relaxin may change the elasticity of the ligament by altering the collagen metabolism. When that happens, there is joint and ligament laxity of the pelvis and spine during the pregnancy which may account for the decrease of pain within the area.
T F
When that happens, there is joint and ligament laxity of the pelvis and spine during the pregnancy which may account for the increase of pain within the area.
PGP affects how many percent % of pregnant women?
20
Give 4 Risk Factors of PGP
History of low back pain
History of pelvic trauma
Parity
Workload
Give 4 subgroups of PGP
Double-sided SIJ syndrome (most common) - 6.3%
Pelvic girdle syndrome - 6%
One-sided SIJ syndrome - 5.5%
Symphysiolysis or pubic symphysis pain - 2.3%
What is the most common subgroup of PGP
Double-sided SIJ syndrome
Modified T/F:
6.3% of PGP patients experience the Double-sided SIJ syndrome. 3.2% of PGP patients experience symphysiolysis or pubic symphysis pain.
T F
2.3% of PGP patients experience symphysiolysis or pubic symphysis pain.
Modified T/F:
5.5% of PGP patients experience pelvic girdle syndrome. 6.3% of PGP patients experience one-sided SIJ syndrome.
F F
6.3% of PGP patients experience pelvic girdle syndrome. 5.5% of PGP patients experience one-sided SIJ syndrome.
Modified T/F:
Treatments for PGP includes core activation, hip, lumbar spine, and pelvic movements and realignment. It is always good to consider that they have pelvic floor dysfunction whenever they are pregnant d/t the
increase in stresses in their pelvic floor muscles
T T
Give 5 Treatments for PGP
Individualized PT for realignment and stabilization
Pelvic floor PT
Pelvic manipulation and SIJ belts have shown to be
beneficial
Bed rest, ice, and acetaminophen
NSAIDs may be done after the pregnancy
Modified T/F:
Pelvic manipulation and SIJ belts are contraindicated for PGP patients. Acetaminophen is technically not in the realms of NSAIDS as its mechanism of action is different
F T
Pelvic manipulation and SIJ belts have shown to be
beneficial
Modified T/F:
FDA recommends avoiding the use of NSAID in
pregnancy at 10 weeks or later because they can
result in low amniotic fluid (which may be detrimental to the child). Pelvic nerve injuries can be a source of CPP and can co-exist with all other pelvic floor dysfunctions such as PFD and PMPS.
F T
FDA recommends avoiding the use of NSAID in
pregnancy at 20 weeks or later because they can
result in low amniotic fluid (which may be detrimental to the child).
Give 4 nerves affected in Pelvic nerve injuries
Iliohypogastric
Ilioinguinal
Genitofemoral
Pudendal
Identify: Innervation to the levator ani muscles (can also
have weakness)
Pudendal Nerve
Modified T/F:
Pudendal Neuropathy may cause urinary incontinence and sexual dysfunction. Iliohypogastric and ilioinguinal nerves in Pfannenstiel or high transverse incision (during CS), 2-3% incidence.
T F
Iliohypogastric and ilioinguinal nerves in Pfannenstiel or low transverse incision (during CS), 2-3% incidence.
Modified T/F:
The pudendal nerve may be compressed during
gynecologic surgery. Genitofemoral Nerve Injury may cause urinary incontinence & sexual dysfunction.
F F
The Genitofemoral nerve may be compressed during
gynecologic surgery. Pudendal Nerve Injury may cause urinary incontinence & sexual dysfunction.
Modified T/F:
Pudendal Nerve is Commonly injured during vaginal delivery. It may also be injured d/t pelvic trauma, bicycle riding, and anal intercourse
T T
Give 5 Treatments for Pudendal Nerve Injuries
Pelvic PT and medications
Corticosteroids
Creams with ketamine or other pain medication
Radiofrequency ablation or Pulsed radiofrequency
treatment
Neuromodulation at the sacral plexus or spinal cord
Modified T/F:
Diastasis Recti Abdominis is characterized by the separation of the two rectus abdominis muscles along the linea alba. This increased inter rectus distance (IRD) is not seen congenitally, but most commonly develops during pregnancy and in the early post-pregnancy period.
T F
This increased inter rectus distance (IRD) is seen congenitally, but most commonly develops during pregnancy and in the early post-pregnancy period.
Modified T/F:
A widening of >7.2 cm at the level of the umbilicus is
considered a pathological diastasis of the rectus
abdominis muscle. It usually happens during the second or third trimester.
F T
A widening of >2.7 cm at the level of the umbilicus is
considered a pathological diastasis of the rectus
abdominis muscle.
Modified T/F:
Natural resolution and greatest recovery of DRAM occurs
between 1 day and 8 weeks after delivery, after which
time recovery plateaus. Incidences of DRAM has been reported ranging from 66% to 100% during the third trimester of pregnancy, and up to 53% immediately after delivery.
T T
Modified T/F:
This may result in altered trunk mechanics, impaired
pelvic stability and changed posture, which leave the
lumbar spine and pelvis more vulnerable to injury. This may also result in herniation of abdominal contents.
T T
Modified T/F:
Diastisis Recti can result to upper back pain and strain
due to lower back muscles being overworked or compensating from the lack of integrity of the muscles. It can also lead to uterine prolapse and/or distention.
F T
Diastisis Recti can result to lower back pain and strain
due to lower back muscles being overworked or compensating from the lack of integrity of the muscles.
Modified T/F:
Diastisis Recti can lead to weak pelvic floor. It can increase libido.
T F
Lower libido
Give 4 Treatments for Diastasis Recti
Bracing
Facilitation, concentric activation, and stabilization of the
abdominals
Pelvic floor muscle exercises
Maintenance of stability and mobility of the trunk
Identify:
What are the 3 interrelated components in the female athletic triad
Energy deficiency
Menstrual dysfunction
Impaired bone health
T or F: All three components of the female athletic triad do not have to be present in an athlete simultaneously to be affected by the condition or diagnosed with it
T
Modified T/F:
Numerous short-term laboratory experiments have
shown energy deficiency to be the end point of severe health implications. Its four pathways are: Clinical eating disorders, Disordered eating (DE) patterns, Inadvertent under eating due to for example high energy expenditure sports or intentional weight loss.
F T
Numerous short-term laboratory experiments have
shown energy deficiency to be the starting point of severe health implications.
Identify:
Eumenorrhea leads to what?
amenorrhea
Modified T/F:
Primary amenorrhea is when menstrual periods are absent for 3 months or 90 days. Secondary amenorrhea is when a girl has not started her first period by age 15.
F F
Secondary amenorrhea is when menstrual periods are absent for 3 months or 90 days. Primary amenorrhea is when a girl has not started her first period by age 15.
Give three different components can lead to HPG
suppression
psychological stress, intense exercise, and
or disordered eating
Identify:
A systemic skeletal disease characterized by low
bone density and microarchitectural deterioration of
bone tissue with consequent increase in bone
fragility
OSTEOPOROSIS
Modified T/F:
Formation and absorption rates are affected by aging,
estrogen levels, vitamin A and calcium intake. Importance of proper nutrition in athletes as this is
where cascading of events starts that may lead to
Female Athletic Triad.
F T
Formation and absorption rates are affected by aging,
estrogen levels, vitamin D and calcium intake.
Modified T/F:
Medical consequences of the Female Athlete Triad could
reach other systems such as endocrine, gastrointestinal,
renal, neuropsychiatric, musculoskeletal, and
cardiovascular. Persistent amenorrhea or luteal deficiency leaves women infertile since there is no follicular development, ovulation, or luteal function
T T
T or F: Osteoporosis makes bones more fragile and more prone for fracture.
T
Modified T/F:
First line treatment is addressing the elements that cause LEA and restoring normal energy balance. Early detection and intervention provide an opportunity for optimizing bone health.
T T
Outcome: ↑ energy status will stimulate anabolic hormones (IGF-1) and bone formation
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
A
Days or Weeks
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
A
Outcome: ↑ energy status will reverse energy conservation adaptations
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
A
Better energy production for the body means better metabolic outcomes
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
A
Months
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
B
Outcome: ↑ reproductive hormones
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
B
↑ estrogen exerts an anti-resorptive effect on bone
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
B
Protects the bones from resorption or damage
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
B
Years
a. Recovery of Energy Status
b. Recovery of Menstrual Status
c. Recovery of Bone Mineral Density
C
Identify: commonly referred to as menstrual cramps
Primary Dysmenorrhea
Identify: Defined as the pain occurring in the lower abdomen before or during the menstrual cycle, in the absence of any other pelvic pathology (e.g., endometriosis
Primary Dysmenorrhea
Outcome: ↑ energy status will stimulate anabolic hormones (IGF-1) and bone formulation
Outcome: ↑ estrogen continues to inhibit bone resorption
Modified T/F:
Dysmenorrhea is not caused by etiologies other
than cramps alone. Pt may present with endometriosis or PCOS which may cause menstrual pain (Secondary
Dysmenorrhea)
F T
Dysmenorrhea can be caused by etiologies other
than cramps alone.
Modified T/F:
Dysmenorrhea has a prevalence rate of 50 to 90%. Systematic Sx of primary dysmenorrhea may include
nausea, vomiting, diarrhea, fatigue, fever, headache or
light-headedness
Dysmenorrhea has a prevalence rate of 20 to 90%.
Modified T/F:
Dysmenorrhea is thought to be caused by decreased levels of prostaglandins and vasopressin. It may be caused by uterine contraction which may cause Sx of
dysmenorrhea.
F T
Thought to be caused by increased levels of
prostaglandins and vasopressin
Give 3 Treatments for Dysmenorrhea
NSAIDs
Modalities (Heat therapy and TENS)
Several studies have reported beneficial effects of
exercise, including stretching, aerobic exercise (e.g.
jogging), yoga and kegel exercises, to treat primary
dysmenorrhea
Identify: Gender-affirming surgery for transgender women
Vaginoplasty
Identify: Gender-affirming surgery for transgender men
Phalloplasty
Modified T/F:
Both Vaginoplasty and Phalloplasty surgeries require reconstruction of the genitals and require dissection through only the deep pelvic floor musculature. Surgical disruption can cause problems with the urethral sphincter and may affect bowel and continence as well.
F T
Both Vaginoplasty and Phalloplasty surgeries require reconstruction of the genitals and require dissection through the superficial and deep pelvic floor musculature.
Modified T/F:
SUI (Stress Urinary Incontinence) from vaginoplasty has
been reported as high as 16-44%. Pelvic floor PT has been shown to help with pelvic pain and pain-related sexual dysfunction and can help treat
urinary incontinence
F T
SUI (Stress Urinary Incontinence) from vaginoplasty has
been reported as high as 16-33%
Modified T/F:
PTs can also evaluate and educate patients
preoperatively for better functional outcomes. PTs are prohibited to assist with neovaginal dilation as some not are trained to use dilators.
T F
PTs can assist with neovaginal dilation as some are trained to use dilators.
The higher prevalence of pelvic floor dysfunction
(preoperatively) maybe attributed to what (4)?
tucking (for transgender women), avoidance of public restrooms, hormone replacement therapy, and sexual assault (trauma may cause pelvic dysfunction)
Give 5 PT Evaluations of Gender Affirming Surgery
Postural Assessment (looking at your posture);
Muscle Testing;
Internal muscle and fascial palpation of the pelvic floor
muscles (seeing if the muscles inside your pelvic floor
move correctly);
EMG testing
Checking for scars and soft tissue restrictions, gait,and
movement patterns
Give 3 Goals for Gender Affirming Surgery
Having fewer bathroom accidents (incontinence);
Having less pain when urinating or go to the bathroom
Having less pain while sitting, walking, standing, and
during sex.
Force closure is the stability of the pelvis because of the
compressive forces of the muscle and the stability of the
fascia.
a. True
b. False
False
The female pelvis had 3 orifices.
a. True
b. False
a. True (anus, vagina, urethra)
Pelvic ligaments help support the internal anatomy of the pelvis and have structures similar to that of the ligaments of the joints in our body.
a. True
b. False
b. False (Made out of thickenings of fascia found in the
pelvis & contain nerves & blood vessels)
What is the innervation of the levator ani muscles?
Pudendal nerve, S3-S5
The gynecoid pelvis allows for a normal spontaneous
vaginal delivery.
a. True
b. False
a. True
i. Female pelvis: optimal pelvis for normal
childbirth
ii. Hardest: male type pelvis - inlet and outlet not
suitable
- One of the functions of the pelvic floor muscles is to
contribute to the continence of urine and feces
a. True
b. False
a. True
i. Pelvic floor muscles: situated on orifices
ii. Puborectalis: naka-ikot sa anal sphincter: acts
as another external support
The pubococcygeus, puborectalis, and the coccygeus
make up the levator ani muscle.
a. True
b. False
b. False
If the pelvic floor is relaxed or damaged, the PFMs cannot actively support the pelvic organs.
a. True
b. False
a. True
Pelvic floor dysfunction can lead to problems with
urination and defecation.
a. True
b. False
a. True
Stress incontinence is when there is involuntary leakage
of urine followed by a sudden onset of the urge to void.
a. True
b. False
b. False
