Women's Health Flashcards
(76 cards)
1
Q
How much urine does the average bladder hold?
A
2 cups
2
Q
how often should you pass urine in a day
A
5-7 times
3
Q
how often should you urinate at night?
A
0-1 times per night
4
Q
good bladder habits
A
- dont strain
- fully empty
- go at least 4-5 hours
- avoid urinating just in case
5
Q
bladder health
A
- Maintain good fluid intake
- Limit caffeine u Limit alcohol
- Limit artificial sweeteners
- Avoid constipation
- Use of a bladder diary
6
Q
The prostate
A
- Produces fluid to carry the sperm through
the urethra and out - Fibrous or connective tissue outer shell that
protects the pulpy inner core - Some fibers go into the internal sphincter
and external sphincter - Enlarges with age
7
Q
Prostatectomy
A
- removal of prostate –> most common treatment for prostate cancer
- can result in damage to nerves, muscles, and circulation
- total or partial urinary incontinence as well as impotence
- DiVinci Robotic Surgery
- Increase in “watch and wait”
8
Q
PT Implications for Prostatectomy
A
o ADL considerations – avoiding Valsalva, lifting
o Strengthening the pelvic floor – post prostatectomy rely heavily on the external sphincter
o Biofeedback very helpful
o Also address core stability issues
o Diet
9
Q
Not being potty trained by what age is considered abnormal?
A
5 years old
10
Q
Do you do internal evaluation or treatment on pediatric pelvic floor dysfunction?
A
no
11
Q
Enuresis
A
- Nighttime wetting
- 5% of 10-year-olds still leak at night
- Twice as many boys as girls
- Constipation and overactive bladder are major
factors - Tends to run in families
- Pelvic muscles and bladder need to mature in tone and coordination
- Not a deliberate issue
12
Q
Enuresis Treatment
A
- Adequate fluid intake
- Treat constipation
- Exercises to quiet bladder
- Exercises to strengthen and tone the pelvis muscles
- Biofeedback (external sensors)
- Alarm system
- Desmopressin (over 5 yrs. old)-antidiuretic
- Support for parents/caregivers
13
Q
Pediatrics constipation
A
- Often creates holding of urine (large bladders) & reflux
- Impacts overactive bladder and enuresis
- Bowel Massage
- Diet - adequate fiber intake
- Comfort with their bodies & discussion of the topic
- Ability to relax pelvic floor - biofeedback
- Important for children to realize that defecation is a normal function
14
Q
Encopresis
A
- Fecal incontinence or soiling in absence of
underlying disease in a child who has learned voluntary control of bowels - Can occur with and without constipation
15
Q
What is the female athlete triad?
A
o Amenorrhea/Oligomenorrhea
o Eating disorders/Disordered eating/Energy deficit
o Osteopenia/Osteoporosis
16
Q
What is amenorrhea/oligomenorrhea
A
- absent or infrequent periods (3 months without period)
17
Q
What is amenorrhea/oligomenorrhea associated with?
A
athletes secondary to low body fat, physical stress of exercise and decreased caloric intake
18
Q
Eating disorders/ disordered eating/ energy deficit
A
o Insufficient caloric intake
o Anorexia or bulimia
19
Q
Osteopenia/ Osteoporosis
A
o Relationship between menstrual dysfunction and bone mass
o Adequate quantities of estrogen required to develop optimal peak bone mass
o Risk of bone loss increases with the duration of amenorrhea
o Risk of stress fracture (not all stress fractures triad related)
20
Q
Other considerations for female athlete triad
A
Energy deficit –> inhibits the hypothalamus –> decreases gonadotropin releasing hormone –> decreases luteinizing hormone and follicle stimulating hormone –> signals decreased estrogen release
21
Q
Who to contact if you suspect female athlete triad?
A
- physician
- patient
- parents
22
Q
MYTHSSSSSS!!!
A
- It’s Ok not to menstruate
- Thinner is better for performance
- It is acceptable to follow a low carb diet or
exclude foods as an athlete - Multiple stress fractures are typical when
training
23
Q
PT role for female athlete triad
A
o Calorie Intake education
o Menstrual status
o Training programs – include rest cycle,
varying intensities
o Biomechanical/Musculoskeletal exam
24
Q
what is there a high prevalence of in female elite athletes
A
stress and urge urinary incontinence
25
Top 3 places female athletes report stress and urge urinary incontinence
- trampoline
- gymnastics
- volleyball
26
What factors are associated with urinary incontinence among elite athletes
constipation
family history of UI
history of UTI
27
What should you consider when screening female athletes for urinary incontinence
- high impact sports
- disordered eating
- details on SUI episodes
28
Changes during pregnancy:
- Increased blood flow by 40 – 50%
- Increased heart rate (10-15 beats/min
higher)
- Weight Gain 25+ pounds
- Distorted body image and impaired balance
29
Hormone changes during pregnancy
increase in estrogen which adds to joint laxity during pregnancy
30
Exercise implications during pregnancy
o As weight increases during pregnancy,
exercise produces a greater oxygen debt, and results in a longer recovery time
o After the 20th week recommend avoid supine activities
o Use left side lying when exercising or resting to decrease pressure on the inferior vena cava
31
How to prevent inferior vena cava compression when a pregnant patient is laying supine
place a folded towel under the right side of the pelvic so the patient is tipped slightly to the left
32
ACOG's Exercise Recommendations for Pregnancy
o Regular, moderate intensity, 30 min
o Avoid activities with a high risk of falling
o Avoid scuba diving
o Avoid exercising at a high altitude
o Competitive athletes must be closely
supervised
o Gradual return to exercise 4 – 6 weeks post
partum (may assist in decreased depression)
33
maternal musculoskeletal disorders
o Neck & Upper Back Strain
o Temporomandibular Joint Pain (TMJ)
o Carpal Tunnel Syndrome
o Diastasis Recti Abdominis (DRA)
o Sacroiliac Joint Pain
o Symphysis Pubis Separation
o Low Back
o Coccyx
34
Neck and upper back strain
o Mostly commonly due to posture
changes/muscle imbalances
o Enlarged breast tissue
o Increased forward head and kyphosis
o Tightening of pectoralis mm
o Strain on upper traps and lateral aspects of the neck
o Body mechanics for post-partum breastfeeding
35
TMJ Pain
o Caused by laxity of ligaments, hypermobility
- Relaxin surge immediately after
conception, relaxes connective tissue
- May make underlying condition problematic
36
Carpal Tunnel Syndrome
o Usually due to increased swelling
o Most prominent at night
o Splinting is the best option
o Majority of the cases resolve post-partum
o Mother’s who breast feed have longer
recovery
37
What is Diastasis Reci Abdominis?
- Separation of the rectus abdominis muscles at the uniting linea alba
- can be present in overweight adults
38
what should you do to avoid diastasis recti abdominis
avoid curl ups or pull on abdominals
39
Diastasis Recti Abdominis Evaluation
o Measured at rest & with head lift/curl up
o Measure at umbilicus, 4.5 cm above and 4.5 cm below
o Fingers perpendicular to the tissues
o Any separation of more than 2 fingers wide constitutes a positive DRA
o Consider depth
o Exercises can correct post-partum
o Abdominal support can be utilized
40
Exercise for correction of DRA
Transverse abdominis in a variety of positions
41
DRA Facts
o Check your patients for this especially if
they have back pain
o Can still exist (and be corrected) many
years after giving birth
o Most women are unaware they have this
o Can use abdominal binder or taping
o Men can have DRA
42
Recent research and treatment on DRA
- focus on creating tension across the linea alba with use of TA contraction
- Possible visceral component
43
Sacroiliac Joint Pain
o Possibly related to relaxin, posture, and/or weight gain
o Influenced by musculoskeletal changes
o Can use muscle energy and mobilization
to correct
o SI support belt helps o Focus on SIJ stability
44
Low back pain
o Caused by added weight, altered posture,
poor muscle tone, changes in the center of gravity and loose ligaments
o Treatment should emphasize posture, body mechanics, and strengthening
o Exercises in quadruped (careful DRA?) and/or aquatics can be helpful
45
Symphysis Pubis Separation
o Separation of the symphysis pubis
o Most often occurs during delivery
o Can occur during pregnancy
o Muscle energy techniques can help correct it
o Then binder, progressing to stabilization exercises
o May need an assistive device for ambulation
o Surgical repair in extreme cases
46
Coccyx
o Most commonly a problem post-partum
o Most common problem is the coccyx getting
‘stuck’ in extension, but can be ‘stuck’ in
flexion as well
o May be laterally deviated and/or become hypomobile
o If pain during pregnancy – usually
hypermobile
47
Treatment for Coccyx injury
cushion for sitting, mobilization and pelvic floor strengthening or relaxation
48
1st degree perineal laceration/tear
extends through the skin and superficial structures above the muscle
49
2nd degree perineal laceration/tear
extend through the muscles of the perineum
(urogenital triangle)
50
3rd degree perineal lacerations/tear
into the external anal sphincter
51
4th degree perineal laceration/tear
also a tear in the anterior rectum and the internal anal sphincter
52
why are perineal lacerations/tears slow to heal?
decreased estrogen
53
PT treatment for perineal laceration/tears
- ice
- ultrasound
- sub max pelvic floor exercises
- scar mobilization
54
Urinary incontinence during/after pregnancy
- may occur immediately after giving birth
55
fecal incontinence after/during pregnancy
- Involuntary loss of fecal matter and/or flatus
- Often the result of injuries with childbirth
56
Post C section surgery care
- Decrease incision pain --> TENS
- Stimulate bowel activity
- Folding sheet or pillow as counter pressure
for sneeze or cough
- Protect incision with bed mobility, breast feeding and care of new-born
- Scar mobilization and desensitization
- posture
57
Screening for postpartum depression
o Whooley Questions
o During the past month have you often been bothered by feeling down, depressed or hopeless?
o During the past month have you been bothered by having little interest or pleasure in doing things
** sensitivity to predict depression 0.95
- refer to behavioral medicine specialist
58
If you suspect postpartum depression what should you say
o If you have ANY thoughts of harming
yourself or your baby, or you are having hallucinations please tell your doctor or midwife IMMEDIATELY, OR GO TO YOUR NEAREST HOSPITAL EMERGENCY ROOM
59
Postpartum care
o Increased emphasis on the 4 th trimester
o Core Stabilization – emphasis on abs,
especially transverse abdominis
o Pelvic Floor Strengthening
o Posture
o Body mechanics for nursing and childcare
o Balance/ Proprioception
o Hormones do not “normalize” until nursing
stops
60
What is perimenopause
o Marks the time the body begins its transition into menopause
o Lasts 2 -8 years
o The levels of reproductive hormones — estrogen and progesterone — rise and fall unevenly
o Usually during 40s, some mid-30s
61
what is menopause
o Menopause is the permanent end of menstruation and fertility
o Defined as occurring 12 months after your last menstrual period.
o average age is 51 in the United States
62
Perimenopause/ Menopause Body and skin changes
o As estrogen levels decline, muscle mass
decreases, body fat increases, and the waist and abdomen thicken.
o Lower estrogen levels also affect collagen in the skin, so it gradually becomes thinner and less elastic
63
Perimenopause/ Menopause Loss of Bone
As estrogen levels decline, bone loss may occur more quickly than it is replaced, increasing the risk of osteoporosis
64
Perimenopause/ Menopause Vaginal and Bladder Problems
o Progesterone and estrogen are gradually
decreasing and the ratio of testosterone to estrogen is increasing
o When estrogen diminishes: the vaginal tissues may lose lubrication and elasticity, the tissues of the pelvis become dry, thin and less elastic
o Consider the effects of previously damaged
tissues
65
What do pelvic muscles, the connective tissue, fascia, and ligaments in the pelvic region depend on
estrogen
66
what does estrogen help stimulate
tone and lubrication
67
result of perimenopause/menopause vaginal and bladder problems
- intercourse becomes uncomfortable or painful
- increase vulnerability to urinary infections
- decreased ability of the tissues to support the bladder, uterus, and bowel --> increase pelvic organ prolapse or descent
- The bladder, bladder neck and urethra become more mobile and irritable
- increase change of both urge and stress incontinence and pelvic organ prolapse
68
pelvic organ descent
abnormal descent or herniation of the pelvic
organs from their normal attachment
sites or their normal position in the pelvis
69
pelvic organ prolapse
a pelvic organ slides down its own “tube”
70
Treatment for prolapse/ descent
o Often do pelvic floor exercises on a
wedge or head down over a ball (as
tolerated)
o Avoid Valsalva
o Transverse abdominis strengthening o ADL training
o Diet consideration
71
Perimenopause/menopause self care - Good nutrition
- Increased osteoporosis and heart disease
risk
- Low-fat, high-fiber diet that's rich in fruits,
vegetables and whole grains. Add calcium-
rich foods or take a calcium supplement.
Avoid alcohol or caffeine, which can trigger
hot flashes
72
Perimenopause/menopause self care - regular exercise
Regular physical activity helps keep weight down, improves sleep, strengthens bones and elevates your mood. Exercise for 30 minutes or more on most days of the week.
73
Perimenopause/menopause self care - stress reduction
o Practiced regularly, stress reduction techniques, such as mindfulness or yoga. Increases relaxation and improves ability to tolerate symptoms
74
Is incontinence a natural consequence of aging?
no
75
what must you consider when evaluating incontinence
medication, physical capabilities, cognitive ability, environmental factors
76
as we age, what happens to bladder capacity
gets smaller
- increasing fluid intake can help maintain bladder size
