Women's Health- Pelvic Floor Flashcards
What are the four primary layers of the pelvic floor muscles (PFM’s)? Superficial to deep
ASP2 or A Sweet Potato Pie
- Anal sphincter (continence)
- Superficial genital (sexual functioning)
- Perineal membrane (continence)
- Pelvic diaphragm (continence and pelvic support)
Anal Sphincter Muscles (Most superficial muscle)- IE
- Internal anal sphincter (smooth M)
- External anal sphincter (skeletal M)
The sphincters fuse superiorly with the
- Puborectalis component of pelvic diaphragm muscle.
Function of Anal Sphincter muscles
To provide fecal continence
Neurologic innervation Anal Sphincter muscles
4th sacral N and inferior branch of the pudendal N
Superficial Genital muscles - SIB
- Superficial transverse perineal
- Ischiocavernosus
- Bulbocavernosus
Function of Superficial Genital muscles
Aid in sexual functioning of the peroneal membrane & part of the continent mechanism
Muscles of the Perineal membrane CUSp
- Compressor Urethra
- Urethrovaginal sphincter
- Sphincter Urethra
Muscles of the Pelvic Diaphragm P2ICo
4 muscles of the levator ani are:
- Puborectalis
- Pubococcygeus muscles
- Iliococcygeus
- Coccygeus
The largest skeletal muscle group in the pelvic floor
Pelvic Diaphragm or the levator ani muscles
What are the “3 S’s” of pelvic floor function?
- Support- Organ & Trunk (prevents pelvic floor from prolapsing
- Sphincter
- Sexual
Pelvic Floor Function- Organ Support
- The PFMs provide support to the pelvic organs.
- Normal pelvic organ support is achieved by ligamentous support from above, PFMs functions from below and the structural geometry achieved by normal function of both.
- Recovery of organ support requires attention to restoring PFM functions (i.e. PFM rehabilitation) firstly and in some cases, restoring ligament support (surgery).
- Women with pelvic organ prolapse more often have deficits in the levator ani and generate less vaginal closure force than women with good organ support.
- At rest, the PFMs maintain a minimal resting tone. The forces of gravity and increased intr-abdominal pressure. (laugh, cough, sneeze, vomit, lift, strain) encourage prolapse or protrusion of the pelvic organs.
- Strong PFMs help to support the organs against increased intra=abdominal pressure and enhance normal functioning.
- The supportive funtion is primarily performed by the tonic, slow twitch muscle fibers.
Pelvic floor function- Trunk Support
- PFM and transverse abdominis muscles have been shown to co-contract.
- This co-contraction along with contraction of the deep multifidus muscles appears to enhance trunk stability.
- In addition, the PFMs have been shown to increase muscle activation before movement as pre-contraction to assist the abdominals in stabilizing the trunk.
- Many studies have documented bladder dysfunction in assoc with LBP.
Pelvic floor function- Sphincter control
(Slow and fast twitch work together)
- Prevents involuntary loss of feces, urine and gas from the urethra and rectum
- PFMs provide closure of the urethra and rectum for continence. During normal function
- Quick closure of the orifices is provided by the phasic fast twitch fibers.
- Closure during rest (i.e. static resting tone) is provided by the slow twitch muscle fibers.
- Continence is preserved when the pressure in the urethra is higher than the pressure in the bladder.
- Loss of sphincter function may lead to incontinence.
- The medical literature commonly points out that incontinence is a symptom and not a disease.
- Based on the terminology used in this book, incontinence results from impairments, not a pathologic condition.
- Interventions should be aimed at the impairments that contributes to the syndrome of incontinence.
Pelvic floor function- Sexual function
- Increases sexual appreciation and maintains erection)- the vagina has very few sensory nerve fiber.
- The PFMs provides proprioceptive sensation that contributes to sexual appreciation.
- Hypertrophied PFMs provide a smaller vagina and more friction against the penis during intercourse. Results in the stimulation of more nerve endings and provides pleasurable sensation during intercourse.
- Strong PFM contractions occur during orgasm.
- Patients with weak PFMs often cannot achieve orgasms.
- In men, the PFMs assists in achieving and mintaining an erection
From Mincer’s class
- Proprioceptive feedback
- If muscles are toned, they provide more sensory feedback
- Orgasm and erection
Treatment of patients with PFM disfunction 3s
- Will usually be treating them for sphincteric issues
- Related to support but usually main problem is incontinence
- Teach pts exercises and then promote the sexual side to make them want to make muscles better
- Strengthening muscles will help all three s’s
What is pelvic Prolapse?
- Second largest category of medical diagnosis associated with underactive PFMs.
- The cause of prolapse may be complex and is often associated with underactive PFM and prolonged increase in intra-abdominal pressure.
- The most common types of organ prolapses are Cystocele (protrusion of the bladder into the anterior vaginal vault). Uterine Prolapse (displacement of the uterus into the vaginal canal) and Rectocele (protrusion of rectum into the posterior vaginal vault)
The second largest category of medical diagnosis associated with underactive PFMs.
Pelvic Prolapse
The cause of Pelvic Organ Prolapse
May be complex and is often associated with underactive PFM and prolonged increase in intra-abdominal pressure.
Pelvic organ prolapse- organs start descending past or out of the outlet
The most common types of Pelvic organ prolapses- CURe
- Cystocele -protrusion of the bladder into the anterior vaginal vault.
- Uterine Prolapse - displacement of the uterus into the vaginal canal) and
- Rectocele -protrusion of rectum into the posterior vaginal vault)
Cystocele
Protrusion of the bladder into the anterior vaginal vault.
Uterine Prolapse
Displacement of the uterus into the vaginal canal) and
Rectocele
Protrusion of rectum into the posterior vaginal vault)
Common symptoms of Pelvic Prolapse: P2- FeD2S2
- Painful intercourse (uterine prolapse)
- Pain or pressure in the perineum that may limit functional activities in standing
- Feeling that there is something bulging in the vagina
- Difficulty defecating (i.e. rectocele)
- Difficulty urinating (i.e. cystocele)
- Sensation of sitting on a ball
- Sensation of organs :falling out”
PT treatment for Pelvic Prolapse
Pt. education on dec. intra-abdominal pressure
Vulvodynia (everything)
- A broad diagnosis of pain in the external genitalia, perineum and vestibule.
- Can be a severe, often idiopathic condition that may or may not be assoc with PFM dysfunctions.
- Characterized as localized or generalized. It is also described as provoked (occurring with palpation or penetration) or unprovoked (pain present at all times even without contact).
- Pt reports stabbing pain in the vagina and less commonly the rectum.
- Many pts are completely unable to have vaginal penetration of any kind (e.g. intercourse, speculum eval, tampon insertion)
- Symptoms inc. with sitting and wearing tight pants.
- Cause of Vulvodynia: complex and can include overactive PFMs. Environmental irritants and reactions. Alteration in the vaginal mucosal properties and nerve inputs in the area, or a complication of pelvic surgery. Infection by bacterial or viral organisms (yeast infection are common) commonly precede the onset of vulvodynia but their relationship to the condition is not understood.
Vulvodynia is a difficult condition to treat. A multidisciplinary approach is the best. All impairments should be considered, esp mobility impairments of the pelvic and lumbar joints, mobility impairments of scars, and altered tone of the PFMs and assoc muscles. These pts need special instructions in avoiding perineal irritants and may benefit from pain reducing modalities such as TENS at the sacral nerve roots.
Cause of Vulvodynia: BASE-O
Complex and can include:
- Bacterial or viral infection (yeast infection are common) commonly precede the onset of vulvodynia but relationship to condition not understood.
- Alteration in the vaginal mucosal properties and nerve inputs in the area
- Surgical complication- to pelvic
- Environmental irritants and reactions.
- Overactive PFMs.
Vulvodynia (specific)
- A broad diagnosis of pain in the external genitalia, perineum and vestibule.
- Can be a severe, often idiopathic condition that may or may not be assoc with PFM dysfunctions.
- It is characterized as localized or generalized.
- It is also described as provoked (occurring with palpation or penetration) or unprovoked (pain present at all times even without contact).
- Pt reports stabbing pain in the vagina and less commonly the rectum.
- Many pts are completely unable to have vaginal penetration of any kind (e.g. intercourse, speculum eval, tampon insertion) Symptoms inc. with sitting and wearing tight pants.
Vaginasmus
- A spasm of muscle around the vagina, the superficial muscle layer or pelvic diaphragm layer.
- Pts reports symptoms similar to Vulvodynia, although to a lesser degree.
- Dyspareunia (painful intercourse)is a common symptom.
- Muscle spasms may be a secondary impairment in response to a medical condition, such as atrophic vaginasms or fistula (a small opening in the skin similar to a small cut at the corner of the mouth.)
- Primary dyspareunia may occur with vaginismus as a result of fear of penetration.
Dyspareunia
Painful intercourse
Common symptom of Vaginasmus
Dyspareunia
Anismus
- Spasm of the anal sphincters.
- Similar to vaginismus in that it may be a secondary impairment caused by trauma, fissure, fistula or hemorrhoid at the anal opening.
- Pts report severe pain with defecation, which often leads to constipation because pts delay defecation. Other PFMs may or may not spasm
Anismus aka
Nonrelaxing puborectalis syndrome
Symptoms of Anismus
- Pts report severe pain with defecation, which often leads to constipation because pts delay defecation.
- Other PFMs may or may not spasm
