Card Set Information
What are the 3 functions of the pelvic floor and explain?
1. Supportive--> acts as a hammock o hold pelvic organs against the forces of gravity
2. Sphincteric--> help with control of opening urethra/rectum for continence and voiding
3. Sexual--> allow laxity for penetration and superficial muscles facilitate arousal/erection
Name 4 common diagnoses treated with pelvic PT?
1. Urinary incontinence
2. Pelvic organ prolapse
3. Bowel dysfunction
4. Pelvic pain
What are the 4 types of urinary incontinence?
3. Mixed (stress & urge)
3. Functional--> limitation to get somewhere to void (mental, environmental barriers)
What is the definition, symptoms, causes of Stress Urinary Incontinence (SUI)?
: involuntary loss of urine on effort or exertion, or coughing/sneezing
: loss of small amt of urine w/ cough, laugh, sneeze, lifting
: PFM weakness (surgery, aging, childbirth, intra-abdominal pressure
What is the definition, s/s, and causes of Urge Incontinence Urine (UIU)?
UIU--> involuntary loss of urine accompanied by strong urge to void with inability to get to bathroom in time. (PSNS OVERDRIVE)
: loss of med-large amount of urine triggered by running H20, cold weather, way to toilet
: uninhibited bladder control (aging, UTI, bladder irritants, DM, MS, PK, SCI, CVA)
What are some POP symptoms?
-Heaviness, pressure in pelvis, low back pain
-worse as day progresses
-urinary urgency, frequency, UI
-Post-void dribble, incomplete emptying
-straining at stool
What is a some major cause of POP?
1 Collagen deficiencies
3. Chronic increase in intra-abd pressure
5. Aging (decreased E2)
What is the role of the levator Ani in POP?
Provide continuous dynamic postural support
-horizontal shelf for organs, precontracts before movement to provide support
Define fecal incontinence.
Involuntary passage of fecal material
What are some risk factors for fecal incontinence?
-anal trauma, surgery radiation
-parity and degree of tearing
**leading cause of nursing home placements
What is the ROME criteria for constipation?
2 of the following in 12 weeks in last 12 months
-Straining >25% of BMs
-Fewer than 3 BMs per week
-Sensation of incomplete evacuation
-Hard stools >25% of BMs
-Need digi removal
What's the name of the pelvic floor dysfunction for constipation?
What is pelvic girdle pain (PGP)?
Pelvic pain that is articular in origin (not GYN/URO)
**often r/t to pregnancy or trauma
What are 4 subtypes of PGP?
1. Sacro-iliac joint dysfunction
2. pubic symphasitis
3. diastis recti (separation of abd muscles)
4. postural dysfunction (weak core/hip)
What are some examples of pelvic pain associated with primary PFM overactivity?
1. Levator ani syndrome
2. dyspareunia (painful intercourse)
3. vagiismus (vaginal spasms w/ physical contact)
4. Vulvodynia (chronic vulvar pain)
7. pudendal neuralgia
What are some common findings in Hypertonic PFM?
-tenderness to palpation
-trigger points in various PFM muscles
-High PFM resting tone (digi)
-small vaginal opening
-scar tissue restrictions
Involuntary spasm of PFM preventing entrance of penis or finger often associated with pain
What are some possible causes of vulvodynia?
-hormonal (OCP, menopause)
-inflammation, persistent infection
What are some etiologies for pudendal neuralgia?
-prolonged sitting with job/travel
What spinal nerves make up the pudendal?
S2,3 & 4 keeps the pee, poo off the floor
What are some secondary causes of PFM overactivity?
1. Chronic pelvic pain
2. painful bladder syndrome
4. abdominal adhesions
What are 6 parts to the MSK exam?
1. Lumbar spine/girdle alignment
2. hip/core strength assessment, ROM
3. scroiliac joing special testing
4. neural tension (straight leg raise (sciatic n.)
5. dermatone, myotone, proprioception, reflexes
6. scar tissue assessment
What is included in the internal pelvic evaluation?
-Pelvic floor integrity (tone, trigger points)
-Prolapse assessment (supine & standing)
What is the Lycock scale for PFM strength?
0- No contraction
2- weak squeeze, no lift
3- fair squeeze, definity lift (against gravity)
4- Good squeeze, good lift, hold w/ resistance
5. Strong squeeze, against strong resistance
What are the 7 parts to the Laycock PERFECT scale?
F- fast twitch, quick contractions
C- Co-contraction (w/ tranversus abd)
T- Timing (of involuntary contraction-cough)
What are some treatment options for PFM?
1. Pelvic floor muscle training
2. Body mechanics, postural training
3. Stretches/strengthening exercises
4. behavioral training
5. manual treatment
6. dilator therapy
7. Modalities (tens, cold/heat)
What is a kegel?
-A "squeeze" around the opening of the pelvis with an inward "lift"
What muscle is a key synergistic muscle with PFM?
Discuss behavioral training for PFM?
1. Education about normal bladder fxn
2. Nutritional guidance (avoid irritants)
3. Bladder re-training (diaries, timed voids)
What the normal daytime/nightime voiding?
Daytime-> 5-8x q 2-4hrs
Nightime--> 0-1 (1-2x for >65yo)
What are some examples of manual treatment for PFM?
1. myofascial release
2. scar massage
3. joint mobilizations
4. muscle energy techniques
5. nerve glides