Women's Health 2

Question 1

Does the detrusor muscle contract or relax during voiding uring?

Answer 1

Contracts (relaxed expansion during filling)

Question 2

What is the closure of the urethra affected by?

Answer 2

1. Internal urethral sphincter
2. Exerternal urethral sphincter
3. Pelvic floor mm’s
4. Fascial support

Question 3

Describe the storage phase and the voiding phase of the LUT

Answer 3

Storage phase = 99% of the time
- detrusor is relaxed and urethral sphincter is contracted

Voiding phase = 1% of the time
- detrusor mm contracts and urethral sphincter relaxes

Question 4

What’s the difference between stress and urethral incontinence when relating it to urethra and bladder?

Answer 4

Stress incontinence = urethral closing issue

Urge incontinence = bladder relaxation issue

Question 5

What is stress incontinence?

Answer 5

• involuntary leakage of urine when exerting effort (sneezing/coughing/any sort of valsalva/IAP)
• bc urethral pressure too low

Question 6

What is urge incontinence?

Answer 6

• the sudden, compelling urge to void urine which is difficult to ignore
• caused by sudden spasms of the detrusor mm during the storage phase

Question 7

What is the prevalance of UI in nulliparous, elite athletes?

Answer 7

30-50%

- sports with hypermobility/high impact jumping have greater risk

Question 8

Whats the effect of UI on recreational exercisers?

Answer 8

• the more severe the incontinence the more women would be likely to list it as a barrier to PA
• women with severe UI = 2.64x more likely to be insufficiently active
• 1 in 7 experience UI during PA

Question 9

What is the relationship between UI and LBP? PGP and UI?

Answer 9

• young, mid age, and older women have about 2.3-2.5x the risk of developing LBP if they have UI
• more like to have UI if they have PGP and 4.6x more like to have PGP if they have UI!

Question 10

Describe the process of pelvic floor muscle training

Answer 10

1. Teach how to contract properly
   - 50% contract INCORRECTLY so worth teaching
   - lift the perineum inwards/squeeze around vagina/anus/urethra
   - “shouldn’t move your legs or tighten your buttocks)
2. Increase strength/tone of PFM
3. Increase functional use of PFM during raised IAP

Question 11

What do you do if pt is unable to contract the PFM?

Answer 11

1. Give them a week to practice it by trying to stop flow or teaching them how to co-contract with TA

OR

2. E-stim! (she says the upper half of the vagina has no sensation)
   - 35-50 Hz, intermittent

Question 12

How do you increase PFM strength?

Answer 12

• daily
• physio contact 2x/month
• consider how long the person can hold the contraction for and how many reps they can do
• 2 sets x 8-12 reps - hold 3-10 secs
• long prolonged holds OR short fast holds

Question 13

What is the ‘knack’?

Answer 13

• tension PFMs prior to and during the effort
• using the knack reduced pelvic leakage in strong coughs by 73%
• using the knack in medium strength coughs reduced leakage by 98%

Question 14

Does PFMT help with UI?

Answer 14

• more likely to report they were cured/improved
• better QoL
• fewer incontinence episodes/day
• less leakage
• few adverse effects/non serious

Question 15

What are some methods for symptoms management for UI?

Answer 15

• pessary/continence dish
• contiform
• vaginal sponge (tampon can also be a good option bc its hidden and when it expands it closes off teh urethra in front of it)

Question 16

What are the physio options for urge incontinence?

Answer 16

1. PFMT
   2, Advice
   - if bladder fills up too fast it spasms; if urine too concentrated - it acts like an irritant and stimulate detrusor spasm again
   - avoid irritants - caffeine, artificial sweeteners, carbonated drinks
2. E-Stim!
   - Vaginal = 5-10 Hz/15-20Hz
   - Sacral - esp good for kids - do it 1-2 hrs/month; 5-10 Hz
   - Tibial nerve 10Hz

Question 17

Explain why you can stimulate the tibial nerve to reduce bladder overactivity

Answer 17

The afferents from the tibial nerve converge with the afferents from the bladder at S2 level; activation of the tibial sensory afferents via estim thought o inhibit urgency signals via sensory gating mechanism

Question 18

What is bladder retraining in urge UI?

Answer 18

• teachng people NOT to run when they have sudden overhwhelming urge to pee - this is because the running/fast walking increases intravesicular pressure even more which makes it likely you will leak

1. explain normal bladder function (concept of urge relating to stretch on bladder walls)
2. educate on cause of detrusor overactivity/spasm
3. educate on why running to toilet makes it worse
4. provide other options
   - use urge supression strategies

Question 19

describe urge suppression strategies

Answer 19

1. Pressure to the perineum
   - pushing up here has a gating effect so sensatino from bladder can’t get up as strongly
   - can use hand or be creative and use arm of chair/corner of table etc
2. Pelvic floor contraction
3. Activation of posteior tibial nerve
   - nerve projects to same location as bladder in spinal cord
   - TOE CURLING/CALF CONTRACTION
4. Frontal lobe facilitation
   - DISTRACTION/RELAXED BREATHING
   - frontal lobe is inhibitory centre for micturition reflex

Question 20

Summarize the flow of suppression strategies you can explain to a patient if they ask about what they can do when they have the urge to pee

Answer 20

1. DON’T rush to the toilet
2. Apply perineal pressure
3. Immediately perform 10s pelvic floor contraction
4. Relaxed/slow breathing
5. Count backwards in 7
6. Try calf contraction/toe curling