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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?
- 1. Stress
- 2. Urge
- 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)?
- SUI: involuntary loss of urine on effort or exertion, or coughing/sneezing
- -symp: loss of small amt of urine w/ cough, laugh, sneeze, lifting
- -Causes: 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)
- -S/S: loss of med-large amount of urine triggered by running H20, cold weather, way to toilet
- -causes: 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
- 2. Childbirth
- 3. Chronic increase in intra-abd pressure
- 4. Surgery
- 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
- -cognitive impairment
- **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)
- 5. Prostadynia/prostatitis
- 6. coccydynia
- 7. pudendal neuralgia
- ***HYPERTONIC FLOOR
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
- -neuropathic changes
- -PFM DYSFUNCTION
What are some etiologies for pudendal neuralgia?
- -prolonged sitting with job/travel
- -PFM overactivity
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
- 3. endometrosis
- 4. abdominal adhesions
- 5. fibromyalgia
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
- 1- flicker
- 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?
- P- Power
- E- Endurance
- R- repetitions
- F- fast twitch, quick contractions
- E- Elevation
- 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)
- 8. E-stim
- 8. Orthotics
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