women's health Flashcards
1
Q
the pelvic floor
A
PFM contract with an inward lift and squeeze; pelvis and spine should remain stationary
- 30% fast twitch and 70% slow twitch: need to be able to hold longer and keep continence during sneeze, laugh, bump
- PFM contraction proceeds active abd contractions to provide stability to pelvic girdle and to prevent perineal descent during increased abd pressure
- innervated by S2-S4
2
Q
pelvic floor function
A
- support pelvic organs
- postural stabilizer that contracts prior to or with most movements to assist with postural core stabilization
- mass PFM contraction for sphincter
- contraction during orgasm
3
Q
normal urination
A
- bladder fills
- first sensation to void
- normal desire to void
- micturation
4
Q
normal and good urinary habits
A
- 5-8x/day adn 0-1x/night (1-2x/night above 65yo)
- general guideline: urinate every 2-5hours
- 8-10sec length of urination
5
Q
bladder health
A
- drink water! 1/2oz per lb of body weight
- avoid bladder irritant like caffeine, acid foods/drinks, alcohol
- water sandwich
6
Q
pelvic flood disorders
A
- PFM dysfunction classified by
- symptoms: lower urinary tract, bowel, sexual function, vaginal, pain
- signs: external obs and internal measurements
- conditions: normal, underactive, overactive, non-functioning PFM
7
Q
urinary incontinence (stress)
A
any involuntary loss of urine with increased intraabdominal pressure and activity, related to PFM weakness
8
Q
urinary incontinence (urge)
A
any involuntary loss of urine on the way to the bathroom
- frequency: >7-8x/day
- urgency: intense, uncontrolled
9
Q
urinary incontinence (mixed)
A
both stress and urge, usually started by stress and followed by urge from poor habits
10
Q
fecal incontinence
and
incidence
A
- any involuntary loss of stool, usually large and full evacuation
- related to PFM weakness and/or anal sphincter defect (childbirth perineal tear)
- incidence: 9% community, 20-90% elderly
- related to PFM weakness
11
Q
pelvic organ prolapse
A
named by area
- apical uterus
- procidentia: complete protrusion of uterus
- cystocele: anterior bladder pressing into vaginal wall
- rectocele: posterior rectum pressing into vaginal wall
12
Q
underactive PFM symptoms
A
- urinary or fecal incontinence
- pelvic organ prolapse (posterior, anterior, apical)
- caused by: childbirth, chronic increased pressure, chronic cough/asthma/smoking, repetitive valsalva, constipation/straining, high impact exercise, surgery, aging
13
Q
treatment for underactive PFM
A
- strengthening: knack and squeeze before you sneeze
- abdominal mm training/core stabilization
- behavior retraining
14
Q
causes overactive PFM
A
- joint malalignment - habitual postural dysfunction - childbirth - surgery - sexual abuse - pelvic inflammation = hemorrhoids - bowel/bladder disorders - SCI - MS - parkinsons
15
Q
overactive PFM treatments
A
- joint alignment/mobs/manips - mm re-ed - biofeedback - functional training/strengthening - posture and body mechanics - modalities - STM
16
Q
exercise considerations
A
- 40% of women attempting to perform PFM contraction do so incorrectly even with proper verbal instruction
- contraction of TA without PFM will cause increased intra-abd pressure which will cause excessive pressure in pelvic floor and increase risk for prolapse
- exercise application
17
Q
PFM and TA
A
- pair naturally co-contract
- submax contraction of PFM can sometimes be used to facilitate abd contraction and vice versa
- most important mm for SI stability are TA and PFM
18
Q
retraining co-contraction
A
- maintain normal breathing (contract during exhale)
- minimal contraction 5-10% effort (to avoid recruitment of global mm)
- no movement of pelvis or spine during contraction
- slow, controlled contraction
- cue to encourage re-establishment of brain-body connection
- stability with mobility, no rigidity
19
Q
musculoskeletal changes during pregnancy
A
- rib cage, thoracic diameter
- sacroiliac joint (pelcis ligaments loosen, SI locking mechanism becomes less)
- pubic symphysis joint (cartilage w/ am interpubic disc; softens, possible separation
- coccyx: increased weight and positional changes predispose the patient to coccygeal dysfunction (plop)
20
Q
diastasis rectus abdominus
A
DRA: separation of the rectus abdominis mm
- due to stretching of the linea alba
- noted at the level of the umbilicus or along the entire abdomen
- caused by hormonal changes, increased weight, elongation of RA
- occurs 3rd trimester in 66% of women
21
Q
DRA testing
A
- assess in hooklying, measure distance between contracted recti
- significant separation > 2.0cm
- suggests impaired force closure of abdominal mm resulting in impaired load transfer and instability with vertical loading tasks
22
Q
PT treatment of DRA
A
- abdominal binder
- TA strengthening
- education: avoid bearing down while holding breath, exhale during bowel movement, exhale during BLT/pushing/pulling, proper body mechanics with log roll, avoid sit ups, proper contractions of TA with PFM during ADLs
23
Q
typical changes in pregnancy
A
- weight gain 25-35lbs
- increased respiratory volume with greater ability to expel CO2
- increased O2 consumption
- increased blood volume (35-50%) wiht increased cardiac output (30-60%)
- anemia: decreased RBC/vol leading to iron deficiency
- PB decreases slightly during pregnancy and is lowest by 28wks (rises to pre-pregnancy levels by 36wks)
- orthostatic hypotension
- stretching of abdominal mm, skin, connective tissue
- compression of internal organs
- ligamentous laxity
- postural changes (COG, increased lumbar lordosis, BOS)
24
Q
inferior vena cava
A
- lies anterior to L3-L5
- occlusion of vessels with supine
- laterally displaces aorta, reduces maternal cardiac output
- **avoid prolonged supine >3min
- LEFT IS BEST
25
Q
Supine hypotensive syndrome
A
- Signs:
- SOB - dizziness - restlessness - nausea - numbness/paresthesia in limbs - visual distrubances - Symptoms:
- increased RR - cyanosis - syncope - fainting - mm twitching or weakness - vomiting - diaphoresis - cold, clammy skin/legs - pupil changes or changes in eye movements
26
Q
avoid positions during pregnancy
A
- abdominal compression
- inversion
- activities involving rapid, uncontrolled bouncing or swinging movements, or sharp twists
27
Q
caution with positions during pregnancy
A
- buttocks higher than hips (bridging) due to risk of air embolism and disengaging fetus from pelvis
- supine longer than 3 min after 4mo
- positions that strain pelvic floor or abdominal mm (quadruped)
- positions that encourage vigorous stretching of hip adductors
- extreme asymmetrical LE positions
- extreme end range of motion positions hip joints
