CM - 4 - Pelvic Floor Muscle Dysfunction

tears

fecal incontinence after birth is usually a result of _______

pelvis / pelvic girdle

the ________ supports the abdomen and lower organs, as well as providing a dynamic link between the spine and LEs

osteoarticular

the pelvis is a closed ________ ring involving 6-7 bones and 6-7 joints

TRUE

T/F: you can’t have an issue in one pelvic area without it affecting another

superficial genital muscles, levator ani

the two layers of PF muscles are the ________________ and ___________ muscles

bulbocavernosus/bulbospongiosus, ischiocavernosus, superficial transverse perineal

the superficial genital muscles are ______________, ___________, and ____________

pubococcygeus, puborectalis, iliococcygeus

the levator ani muscles are ___________, ____________, and ____________

coccygeus

the _________ is a muscle that should be looked at if a pt is having tailbone pain

internal

the (internal/external) anal sphincter muscles are made of smooth muscle

external

the (internal/external) anal sphincter muscles are made of skeletal muscle

external

the (internal/external) anal sphincters are controlled voluntarily (like to hold farts)

external

the (internal/external) anal sphincters are more likely to tear with vaginal delivery

internal

the (internal/external) anal sphincter muscles aid the resting pressure

• urinary incontinence

• pelvic organ prolapse

• fecal incontinence

three key things that pelvic floor underactivity can cause are: (3)

continence

contraction of the pelvic floor muscles elevates the bladder neck, causing urethral compression and _______________

IS NOT

if only superficial ab muscles are contracted, there (is/is not) sufficient PFM activity to elevate the bladder neck

micturition

__________ is the act of urinating

elastic

bladder muscle is ______ and stays relaxed to allow filling

FALSE - constant rate

T/F: the bladder usually fills at a variable rate

TRUE

T/F: as the bladder fills, the PF muscles should contract a bit

5-8x, 2-5hrs

it is normal to void ___-___x per day; or once every ___-___ hours

0-1

nocturia for those under 65 yo is urinating ___-___x at night

1-2

nocturia for those over 65 yo is urinating ___-___x at night

“just in case”

you should never use the toilet “___________”

• alcohol

• artificial sweeteners

• coffee/caffeine

• citrus juices

• cranberry juice

• hot peppers/spicy foods

• soda

• smoking/nicotine

BLADDER IRRITANTS: (8)

stress UI

________ is involuntary urinary leakage on effort or exertion, or with sneezing or coughing

urge UI

_________ is involuntary leakage accompanied or immediately preceded by urgency

mixed UI

___________ is involuntary leakage associated with both urgency and also with exertion, effort, sneezing, or coughing

stress, urge, mixed

the three types of urinary incontinence UI are _______, _______, and ______

nocturnal enuresis

____________ is the complaint of loss of urine occurring during sleep

• age

• higher BMI

• more than 2 children birthed

• oral birth control use

• cigarette smoking

risk factors for a higher prevalence of UI are: (5)

females

in 65yo+ community dwellers, UI is more common in ________

intra abdominal pressure

there is an increased risk of UI with increased ________________; from obesity, chronic cough, lifting, chronic constipation, or high impact exercise

TRUE

T/F: in pelvic health histories, you need to get into the nitty gritty questions with everyone

**nothing in here on the medications and bladder control

**nothing in here on the medications and bladder control

radical prostatectomy

the most common cause of UI in males is ________________

PFM thickness

increased pre-op ____________ in males receiving a radical prostatectomy is associated with better post-op continence

pre-op education

___________ can make a huge different in males getting a radical prostatectomy

sphincter function, detrusor contractility

medications for UI focus on modulating ____________ or ____________ through effect on nerve supply of the lower urinary tract

parasympathetic

the (parasympathetic/sympathetic) supplies the detrusor S2-S4

sympathetic

the (parasympathetic/sympathetic) supplies the urethra and bladder neck T10-L2

stress

meds don’t help _______ UI

antimuscarinics

_____________ medications are used to treat urge UI and overactive bladder

pelvic organ prolapse POP

____________ is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina

hymen

the ________ is used as a reference for pelvic organ prolapse

0-4

POP is staged ___-___

cystocele

anterior vaginal wall prolapse causes a ________

rectocele

posterior vaginal wall prolapse causes a __________

pelvic floor muscles

the ______________ are the support of the pelvic organs, especially when pelvic ligaments are lax

50%

___% of women lose pelvic organ support during adult life

correctional surgery - need PT!!

prolapse reoccurs in up to 58% of women after ____________ - they _______!!

PFM dysfunction

there is a direct correlation between _____________ and severity of POP

FALSE - INCREASES

T/F: kyphosis decreases intra-abdominal pressures

• tissue changes related to estrogen loss

• childbirth

• chronic constipation

• weight lifting

• overweight/obesity

• kyphotic posture

risk factors for pelvic organ prolapse: (6)

intra abdominal pressure!!!!

the overarching theme of risk factors for prolapse is increased ____________

TILTS bruh

pelvis ______ actually inhibit TA and don’t strengthen the core!!!!!!!!!

NEUTRAL SPINE

pelvic floor exercises should be done in ___________ to work on TA or glutes

crunches, exertion

if your patient has a history or risk of POP, avoid ________ and emphasize exhaling with _________ to control IAP

FALSE - ALL EXERCISES

T/F: cueing for core recruitment is only used for pelvic floor exercises

neutral, extended

_______ or _______ postures of the lumbar spine should be used to perform PFM exercises to increase activation of TA

“stop your pee”

an anterior PF verbal cue would be ____________

“hold back gas”

a posterior PF verbal cue would be ____________

30%

over ___% of women are unable to correctly voluntarily contract their PFM with verbal instruction

gravity lessened

start re-education PFM contraction in a __________ position

posterior, combined

the most effective PFM contraction cues are ________ or _______ verbal cues

TRUE HELLO

T/F: PFM training is very effective for stress incontinence and POP

4

grade ___ POP can’t be reversed with PT

stress

PFM training alone is effective to treat ______ UI, with cure rates of 44-70%

EMG

_____ can be used for biofeedback to get confirmation of PFM contractions, or as a treatment

pessaries

_________ are essentially a sports bra for pelvic contents and can improve voiding symptoms, bowel symptoms, and POP symptoms

fecal incontinence

__________ is the involuntary or inappropriate passage of feces

passive

________ FI is the involuntary discharge of stool or gas without awareness, due to decr resting anal tone; complaints of repeated anal wiping

urge

______ FI is the discharge of fecal matter in spite of active attempts to retain bowel contents, but unable to generate enough sustained pressure to inhibit

fecal seepage

__________ is the leakage of small amount of stool without awareness or staining of undergarments following an otherwise normal evacuation

40

___% of those with fecal incontinence also have urinary incontinence

anal incontinence

_________ is the unwanted release of gas, liquid, or solid stool; broader term

internal

the (internal/external) anal sphincter has a visceral component

external

the (internal/external) anal sphincter has a somatic component

internal

the (internal/external) anal sphincter is a continuation of circular smooth muscle from the rectum

external

the (internal/external) anal sphincter is composed of the levator ani muscles

4 & 5

the most ideal types of stool according to the bristol stool chart are types _____ and _____