OB-Pelvic floor

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choward04
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220296
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OB-Pelvic floor
Updated:
2013-05-19 20:43:31
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OB
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  1. 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
  2. Name 4 common diagnoses treated with pelvic PT?
    • 1. Urinary incontinence
    • 2. Pelvic organ prolapse
    • 3. Bowel dysfunction
    • 4. Pelvic pain
  3. 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)
  4. 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
  5. 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)
  6. 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
  7. 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)
  8. 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
  9. Define fecal incontinence.
    Involuntary passage of fecal material
  10. 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
  11. 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
  12. What's the name of the pelvic floor dysfunction for constipation?
    Paradoxical puborectalis
  13. What is pelvic girdle pain (PGP)?
    • Pelvic pain that is articular in origin (not GYN/URO)
    • **often r/t to pregnancy or trauma
  14. 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)
  15. 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
  16. 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
  17. Discuss vaginismus.
    Involuntary spasm of PFM preventing entrance of penis or finger often associated with pain
  18. What are some possible causes of vulvodynia?
    • -genetics
    • -hormonal (OCP, menopause)
    • -inflammation, persistent infection
    • -neuropathic changes
    • -PFM DYSFUNCTION
  19. What are some etiologies for pudendal neuralgia?
    • -cycling
    • -surgery/radiation
    • -trauma
    • -prolonged sitting with job/travel
    • -PFM overactivity
  20. What spinal nerves make up the pudendal?
    S2,3 & 4 keeps the pee, poo off the floor
  21. What are some secondary causes of PFM overactivity?
    • 1. Chronic pelvic painĀ 
    • 2. painful bladder syndrome
    • 3. endometrosis
    • 4. abdominal adhesions
    • 5. fibromyalgia
  22. 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
  23. What is included in the internal pelvic evaluation?
    • -Pelvic floor integrity (tone, trigger points)
    • -Prolapse assessment (supine & standing)
  24. 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
  25. 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)
  26. 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
  27. What is a kegel?
    -A "squeeze" around the opening of the pelvis with an inward "lift"
  28. What muscle is a key synergistic muscle with PFM?
    tranversus abdominus
  29. Discuss behavioral training for PFM?
    • 1. Education about normal bladder fxn
    • 2. Nutritional guidance (avoid irritants)
    • 3. Bladder re-training (diaries, timed voids)
  30. What the normal daytime/nightime voiding?
    • Daytime-> 5-8x q 2-4hrs
    • Nightime--> 0-1 (1-2x for >65yo)
  31. 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

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