Sexual Dysfnx & Special Populations

slide 54

slide 54

Pediatrics

UI and constipation are common.

Urinary incontinence often co-occurs with constipation- must treat the underlying constipation!

Surface EMG or real-time Ultrasound imaging are utilized for evaluation and retraining of pelvic floor muscle function.

There are no internal examinations until age 18yo (approximately)

Behavioral retraining is the focus of pediatric pelvic PT

Interoception = ability to perceive and interpret urge sensations

Motor planning = get to toilet, undress, sit on toilet, then void

Reducing fear or stress around the toileting experience

Pediatrics

Functional mobility = ability to get to the toilet

Dexterity = undressing and wiping abilities

Defecation mechanics:

Toileting footstool

Flexed hips, straight spine

Exhale with PF relaxation

Blow a cotton ball with a straw

Pediatrics

Adequate trunk strength and postural control are needed for

PF muscle relaxation/downtraining

Fun sustained stretches for PF muscle relaxation

Frog pose

Childs pose

Core strengthening includes PF muscle strengthening

Pregnancy and Postpartum

Mechanical stressors and hormone changes can lead to urinary incontinence, fecal incontinence, pelvic pain, sexual dysfunction, and pelvic girdle pain during pregnancy or postpartum.

screen for menstrual symptoms and dysfunction; understand pregnancy and birth experiences.

Evaluate pelvic floor muscle function during pregnancy and postpartum

Menopause

Hormone changes begin in early-40s for most women

Menopause = date 1 year after last period

Significant drop in estrogen production →

urinary incontinence, urinary tract infections, pelvic organ prolapse, pelvic pain and sexual dysfunction; glute med tendinopathy, ?frozen shoulder, osteoporosis, heart disease, mood and sleep disorders

Significant impact on long-term exercise, wellness, and QOL

MSK symptoms are “normalized” or underdiagnosed

Treatment:

Systemic or local HRT is safe and effective (for most)

Pelvic floor muscle retraining (PT) benefits most

Geriatrics

UI and constipation are VERY common, due to:

Mobility issues and activity limitations

Accelerated decline in muscular strength

Dietary and fluid changes

Medications

Acquired diseases, especially neurologic

Menopausal changes compounding over time (for females)

Consider functional limits to toileting abilities

Treatment

Functional mobility

Scheduled voiding

Pelvic floor and pelvic girdle muscle strengthening

Spine and hip mobility

Neuro conditions

Symptoms of: Urinary retention, Low urge sensation, Incomplete bladder emptying

Diagnosed with US of bladder, EMG

Results in frequent UTIs and kidney infections, overflow urinary incontinence

Treatment: intermittent catheterization, behavioral training (scheduled voiding), PF muscle training/voiding mechanics

Urinary urgency/urge UI are also common in degenerative neuro conditions related to PF muscle dysfunction

Neurogenic bladder:

impaired detrusor contraction and internal urethral sphincter relaxation

Athletes

Urinary incontinence is common.

Often due to pelvic floor muscle overactivity, not weakness

Pelvic pain can co-occur with hip and spine injuries, and may impact surgical outcomes and return to sport.

Task-specific PF muscle training must be incorporated to achieve long-term outcomes.

RED-S should be screened in every athlete

Bone stress reactions and amenorrhea (infrequent or absent menstruation) are the two leading signs of RED-S.

UI is an under-recognized indicator of RED-S.

Low energy availability HPA dysregulation low estrogen production→ UI