Women's Health- Incontinence Flashcards
1
Q
Brief Screen questions (3)
A
- Do you ever leak urine or feces?
- Do you ever wear a pad because of leaking urine?
- Do you have pain during intercourse?
2
Q
Full Screen: Stress Incontinence
A
- Do you leak urine when you cough, laugh or sneeze?
- Do you lose urine when you lift heavy objects such as baskets of wet clothes or furniture?
- Do you lose urine when you run, jump or exercise?
3
Q
Full Screen: Urge Incontinence
A
- Do you ever have such a uncomfortable strong need to urinate that you leak if you don’t reach the toilet, Do you sometimes leak with this strong urge?
- Do you develop an urgent need to urinate when you hear running water?
- Do you develop an urgent need to urinate when you are nervous, under stress or in a hurry?
- When you’re coming home can you usually make it to the door, but then you lose urine just as you put the key in the lock?
- Do you have an urge to urinate when your hands are in cold water?
4
Q
General Screening pelvic floor screening
A
- Do you find it necessary to wear a pad because of leakage?
- Does your bladder awaken you from sleep? How many times each night?
- How often do you leak urine or feces?
- How often do you inadvertently leak gas?
5
Q
Pelvic Organ Prolapse; Overactive PFMs, incoordination, obstruction or urinary retention
A
- Do you ever feel as though you are “sitting on a ball” or that there is something in the way when you’re sitting?
- Do you ever feel as though something is “falling out” of your perineal area?
6
Q
Symptoms of Obstruction
A
- Do you find it hard to begin urination?
- Do you have a slow urinary stream?
- Do you strain to pass urine?
Referral required
7
Q
Pelvic pain Questions
A
- Do you have pain during vaginal penetration, including intercourse, insertion of a tampon or vaginal examination?
- Do you have pelvic pain with sitting, wearing jeans or bike riding?
Needs specialist therapist (PT)
8
Q
What are two typical patient responses to urinary incontinence that may actually perpetuate or worsen the problem?
A
- Embarrassment and avoiding to talk with a healthcare provider about this problem that could also be associated with pelvic, perineal or genital pain. It makes it difficult to explain the reasons for activity limitations if pt do not disclose the location or the nature of pain. This perpetuates the problem and causes increased emotional stress.
- Disuse and decreased awareness of PFMs and abdominals lowers the chance of seeking help and trying to solve the problem (ex. Children brought up with the concept that genitalia is not to be touched or explored)
9
Q
Principles of strengthening to the PFM’s when designing a treatment for impaired PFM performance.
A
- Follow the principles of overflow (challenge the muscle at its fullest to improve strength) and specificity (exercise muscles correctly in isolation)
- Progress exercise from the appropriate level for each pt. If initially able to hold 3 sec. Progress to 3-4 sec hold, to max 8-12sec
- Twice as much rest as hold time is advised for a weak muscle; make sure they relax completely between contractions
- # of repetitions depends on how many the patient is able to perform before fatigue at evaluation
- Quick contractions (hold <2 sec), also progressed based on how many pt is able to perform at initial eval
- 3-4 sets/day up to 30-80 pelvic floor contractions per day
- Facilitation and overflow from the abdominals, adductors and gluteals should be encouraged for patients with 0-⅖ PFM strength, but at 3/5 pt. Should learn to isolate PFM and contract without the help of accessory muscles
10
Q
Sample Exercise prescription: strengthening of PFM
A
- Duration of endurance muscle contraction:5 sec
- Rest between endurance muscle contraction: 10 sec (double)
- Repetitions of endurance muscle contraction: 5X
- Repetitions of quick muscle contractions: 10X
- Sets/day: 4-6
- Position: gravity eliminated: supine or side-lying
- Accessory muscle use: not at this time
11
Q
Redundancy in anatomical and physiological mechanisms that help preserve continence. (12)
A
- Perineal membrane -Compressor urethra, Urethrovaginal sphincter, Sphincter urethra
- Supportive role of PFMs- resting tone
- Neurologic innervation (S2 -S4 and pudendal nerve)
- External and Internal Anal/Urethral Sphincter tone and reflexes- both autonomic and voluntary control of sphincters
- Central Nervous System Integrity
- Puborectalis- fecal continence- colorectal angle
- Organ position relative to outlet position
- Increased tone in response to increased IAP (intraabdominal pressure)
- Proximal urethra is within the IAP pressure zone
- Reflex inhibition of detrusor in response to PF contraction
- Compliance/ relaxation of detrusor to allow filling
- Spongy, viscoelastic urethral walls (related to estrogen levels)
12
Q
PFM Screening questions can also be categorized as
A
- Hyopactive
- Hyperactive
13
Q
Hypoactive screening questions
A
- Do you leak urine when you cough, laugh or sneeze
- Do you lose urine when you lift heavy objects such as baskets of wet clothes or furniture?
- Do you lose urine when you run, jump or exercise?
- Do you ever have such a uncomfortable strong need to urinate that you leak if you don’t reach the toilet? Do you sometimes leak with this strong urge?
- Do you develop an urgent need to urinate when you hear running water?
- Do you develop an urgent need to urinate when you are nervous, under stress or in a hurry?
- When you’re coming home can you usually make it to the door, but then you lose urine just as you put the key in the lock?
- Do you have an urge to urinate when your hands are in cold water?
- Do you find it necessary to wear a pad because of leakage?
- Does your bladder awaken you from sleep? How many times each night?
- How often do you leak urine or feces?
- How often do you inadvertently leak gas?
- Do you ever feel as though you are “sitting on a ball” or that there is something in the way when you’re sitting?
- Do you ever feel as though something is “falling out” of your perineal area?
Prolapse included in hypoactive
Urge incontinence is a nerve problem but the nerve problem affects the muscles
14
Q
Hyperactive screening questions
A
- Do you ever feel as though you are “sitting on a ball” or that there is something in the way when you’re sitting?
- Do you have pain during vaginal penetration, including intercourse, insertion of a tampon or vaginal examination?
- Do you have pelvic pain with sitting, wearing jeans or bike riding?
The prolapse questions also could pertain to this too bc sitting on the ball could be the muscles
15
Q
When to refer pts with incontinence issues?
A
- Signs of obstruction
- Doesn’t respond to behavioral or front line interventions
16
Q
What is the gold standard for pts with PFM issues?
A
Internal examination
PTs need dditional training to be able to do this
17
Q
How to perform an External Examination
A
External palpation- Pts do not have to take off their pants
- Patient in a side-lying position palpate up between ischial tuberosities as the patient contracts
- Should feel a lift up or lift away from your hand
- If you don’t feel anything, you could change your explanation around, move your hands (you may be in the wrong spot), pt may be too weak for you to feel a palpable contraction
- Pt may be performing a valsalva (common mistake)
18
Q
How to teach pt to perform a self assessment
A
- Have pt pt their hand on their pelvic floor
- Can do external or a digital self assessment
- Duration, number of reps, slow, number of reps, fast
- Jumping Jack test
- Do 5 jumping jacks, if no leakage, wait an hour and a half and do 5 more
- Pt should be able to do 5-10 jumping jacks in 2-3 hours without leaking
- Only for advanced patients
37
Q
Functional Incontinence
A
Mostly affect the transition phase
- Loss of urine because of gait and locomotion impairment.
- Long or difficult trip to the toilet with leaking on the way.
- Incontinence is a secondary condition in pure functional incontinence.
Primary impairment: gait and locomotion impairment and inability to get to the toilet quickly enough.
PT Treatment: gait and locomotion and adjustment of the environment can improve function.
38
Q
Stress Incontinence- sometimes called urethral hypermobility
A
- Small urine leak with cough, sneeze, exercise
- In stress incontinence, pt laughs, abdominal cavity pressure increases placing pressure on bladder. If urethral pressure is low the urethra is forced open slightly, a small amount of urine leaks out
Cause of SI- similar to cause of underactive PFM
Impaired body functions include:
- Impaired PFM performance
- Shortened endurance
- Coordination impairments
Treatment
- PFM exercises
- Vaginal weights
- E-Stim
39
Q
Types of urinary incontinence
A
- Stress
- Urge
- Mixed
- Functional
- Overflow
40
Q
Urge Incontinence- sometimes called overactive bladder syndrome
A
- Largely about triggers
- Moderate / large urine leaks with strong urge to urinate
- The underlying cause of urge incontinence is often unclear and may include PNS and CNS nerve damage.
- Linked to poor bladder habits (going frequently to the bathroom) and bladder irritants (coffee, nicotine, alcohol)
- PFM weakness with impaired muscle performance and endurance impairment is often found in these pts.
Primary tx for urge incontinence can include:
- Bladder retraining
- Avoiding bladder irritants,
- PFE
- Low frequency E-stim and
- Medications
41
Q
Mixed Incontinence
A
- A combination of stress & urge incontinence symptoms and is thought to be a progression of incontinence symptoms over time.
- Pts report leaking urine with increases in intra-abdominal pressure and with a strong urge to urinate.
Causes: similar to the causes of underactive PFMs.
- The PFMs are usually weak.
Treatment: similar to urge incontinence-
- Bladder incontinence
- Avoiding bladder irritants
- PFM exercises
- E-stim
- Vaginal weights, and in some cases medications.
42
Q
Overflow incontinence
A
- Results from failure to empty the bladder fully.
- Small amounts of urine leaking constantly with cough and sneeze, straining to start urinating, feeling of incomplete emptying.
Obstruction is caused by:
- Tumor,
- Scar tissue around the urethra
- Enlarged prostate
- Overactive PFM, or
- other mechanical blockage
- Decreased contractility of the bladder from a neurological deficit, such as peripheral nerve injury assoc. with radical pelvic surgery, cauda equina injury, or diabetes, also may contribute to overflow incontinence.
- Pt impairments may include pain and altered tone from spasm of the PFMs. Mobility impairment may be caused by adhered scars.
- Many cases involve neurologic incoordination of the PFMs or primary visceral dysfunction and require medical intervention.
- A full medical evaluation is essential. Therapists should refer pts to the doctor if overflow incontinence is suspected.
- PT treatment by pelvic floor specialists may include biofeedback, E-stim, myofascial release, PFEs and bladder training
45
Q
Treatment of stress incontinence
A
- PFM exercises
- Vaginal weights
- E-Stim
