VCU DPT - Clinical Medicine (Pelvic Floor Dysfunction: Overactivity)

w/ pelvic floor, we can break it into ____Activity and ____ activity

hyper

hypo

non functioning pelvic floor implies it is ?

non moving

spasm, so weak it cant

pelvic pain umbrella INCLUDES

chronic pain and acute pain

in outpaitnet, do we see chronic or acute pelvic pain

give more cateogries we can break it into

chornic

urologic pelvic pain

vulvodynia

pudnedal neuralgia

pelvic floor myalgia

pelvic neuropathy

urologic pelvic pain

vuvlodynia

pudnedal neuralgia

pelvic floor myalgia

pelvic neuropathy

ALL EXAMPLES OF ?????

chronic pelvic pain

interstitial cysitits and bladder pain syndrome are AKA as ??

urologic pelvic pain

dyspareunia is a symptom of what

vulvodynia

pudendal pain distribution is what

pain naywhere in pelvic floor it what

pudendeal neuralgia

pelvic floor mylagia

urgency, frequency, urge UI, incomplete emptying, nocturnal enursis are symptoms of what

dysuria

name some bowel disorders

constipation

incmplete emptying

pelvic pain, dysuria, and bowel disorders are diagnosis of what

overactive/nonfunctioonal PFM

risk factors for overactive/nonfn PFM

joint malignment of SI/ lumbar

posture dysfn (sitting with one leg on bottom, or a job that has the same repeated tasks)

childbirth trauma

surgery trauma

sexual abuse

pelvic inflam. dz

hemorrhoids, fistula, fissures (p! in anal area)

bowel/bladder disorders (chronically contracting for fear)

joint malignment of SI/ lumbar

posture dysfn (sitting with one leg on bottom, or a job that has the same repeated tasks)

childbirth trauma

surgery trauma

sexual abuse

pelvic inflam. dz

hemorrhoids, fistula, fissures (p! in anal area)

bowel/bladder disorders (chronically contracting for fear)

RISK FACTORS FOR WHAT

overactive and nonfn pfm

what are some interventions for overactive/nonfn PFM

joint alignment, mob/manip, muscle energy technique

- just gets symtpoms, but likely need to address cause

muscle re-ed, relaxation, STRENGTH

biofeedback

- with emg, ultrasound

functional training

posture and body mechanics (including breath pattern)

modalities

soft tissue mob, visceral mob, trigger point release, connective tissue mob

joint alignment, mob/manip, muscle energy technique

- just gets symtpoms, but likely need to address cause

muscle re-ed, relaxation, STRENGTH

biofeedback

- with emg, ultrasound

functional training

posture and body mechanics (including breath pattern)

modalities

soft tissue mob, visceral mob, trigger point release, connective tissue mob

THESE ARE ALL ____________ FOR OVERACTING/NONFN PFM

interventions

__________________ is:

non-malignant pain perceived in strucutres of pelvis for men/women that is continous or recurrent for at least 6 months

OR

non-acute mechanism are documented, pain can be regarded as chronic REGARDLESS of time period

chronic pelvic pain

pelvic pain area is

abdomen below umbilicus and back from T10 TO perineum

(LBP-ish area)

genitourinary symptoms of menopause (?) is what

pain regarding menopause

vulvodynia

PGAD is what

what umbrella it fall under

pelvic genital arousal disorder

pelvic ???????????

who can corrently diagnose in chronic pelvic pain better

PT

MD

PT

patients get misdiaognised (miss diagnosed) or not diagnosed at all

what are 2 ways patient can be considered to have chronic pelvic pain

non-malignant pain perceived in strucutres of pelvis for men/women that is continous or recurrent for at least 6 months

OR

non-acute mechanism are documented, pain can be regarded as chronic REGARDLESS of time period

which is how you dianogse chronic pelvic pain:

non-malignant pain perceived in strucutres of pelvis for men/women that is continous or recurrent for at least 6 months

OR

non-acute mechanism are documented, pain can be regarded as chronic REGARDLESS of time period

BOTH ARE

treatment for overactive/nonfn Pelvic floor muscle

correct the muscle imbalance*******

manual therapies, neruomuscular Re-ed, exercise

also like trigger point, botox, dry needling

obturator internus muscle:

is it in pelvic floor?

can it contirbute to pelvic floor pain?

not really, but in the pelvic region

yes it can

what is main treatment for overactive/nonfn PFM

correct the muscle imbalance

WHAT ARE THESE:

correct the muscle imbalance

manual therapies, neruomuscular Re-ed, exercise

also like trigger point, botox, dry needling

treatments for nonfn/overactive pelvic floor mm

ex: we rely on obturator internus to take over because glute med is offline. your patient now has pelvic pain. what would you do

correct muscle imbalance

uptrain glute med, downtrain obt. int.

DRG stimulus for chronic pelvic pain is

L1-S2

somatic and sympathetic fibers

is pudnendal nerve issue an easy one to put at risk

yes

sitting issues can cause it

obturator nn distrivbution

upper medial thigh

it makes a small circle

how many branches does the pudendal nerve have

3

WHAT CONDITION IS THIS

sx: pain, persistnet arousal

aggs: sitting, walking

treatments: mechanicsl, myofascial, connective tissue, ergonomic correction

pudendal nerualgia

pudenddal nerualgia symptoms

pain in vulva/penis

persistnt arousal that does not go away

___________________:

sxs to do not away with orgasm, sx occur outside of subjective sexual excitement, arousal is unbidden/intrusive/unwanted

minimimum 3 months in duration

persistant genital arousal disorder:

treament for pudendal neuralgia

manual therapies

cryotherapy

neuromuscular red-ed

nerve glides

(NON PT: meds, nerve block, ablation, dorsal root ganglion stim, peripheral nn stim, spinal nerve block)

t/f: DRG stimulus for Chronic pelvic pain is L1-S2, and involves BOTH somatic and sympatheitc fibers

t

vulva pain syndromes is known as

vulvodynia

t/f: vulvodynia can be put into categories of:

generlaized

localized

unprovoked

provoked

primary

secondary

true

so like... there are categories for literally anything

abscene of comfort in absecne of relavent findings or a specific, clinically identifiable neruologic disorder

IS WHAT

vulvodynia

vulvar pain syndrome

vestibulodynia is a symptom of ___________ category of vuvlar pain

localized

dyspareunia is a symptom of _____ category of vulvar pain

provoked

primary vs secondary category of vulvar pain

primary: happens ALWAYS

secondary: pain used to not be there but IT IS NOW

vulvar pain syndrome treatment

treat pelvic floor based on clinical findings

- overactive PFM

- low tone/weak/hypotonic PFM

education

correct misalignments or dysfunctional movement patterns

core stabilization and therex

treat pelvic floor based on clinical findings

- overactive PFM

- low tone/weak/hypotonic PFM

education

correct misalignments or dysfunctional movement patterns

core stabilization and therex

IS ______________ FOR VULVAR PAIN

treatment

_______ is genital, sexual, urinary changes in the lower genital tract associated with low-estrogen state

genitourinary syndrome of menopause

estradiol, androgen precursor DHEA, testosterone are all vital to maintain normal structure and function

issues with this hormones can result in ________

genitourinary syndrome of menopause

what are some symptoms of genitourinary syndrome of menopause (6)

perineal pain, itchy, dry

urinary frequency

vaginal discharge

pain/burn w/ urination

pain w/ & bleeding after intercourse

chronic/recurrent UTI

is genitourinary syndrome of menopause common

AFFECTS 50% of postmenopausal women!!!

perineal pain, itchy, dry

urinary frequency

vaginal discharge

pain/burn w/ urination

pain w/ & bleeding after intercourse

chronic/recurrent UTI

SYMTPOMS OF WHAT

genitourinary syndrome of menopause

genitourinary syndrome of menopause:

a) chronic or acute?

b) will it resolve on own?

c) treatment is focused on WHAT

a) chronic

b) no, needs tx

c) symptom management, individualized

symptoms and signs of genitourinary syndrome of menopause are similar to what

UTI

what are some ways to maange genitourinaryu syndrome of menopause

lifestyle changes

nonhormonal treatments

hormonal treatment

lifestyle change examples with GSM management

smoking cessation

pelvic floor exercise

vaginal hygiene (NO PADS)

avoid the use of chemicals/fragrances

nonhormonal treatment examples with GSM management

lubricant and moisturizers

laser therapy

hormonal treatment examples with GSM management

vaginal estrogen, DHEA, testosterone, osphena(ospemifen)

difference in lubricant and moisturizer

lubricant is SHORT TERM

moisturize is something you use all the time and LONG term

impact of osmoloairty between lubricant and moisturizer

if the osmolarity is high, then it will actually dry out tissues

impact of pH with lubricant and moisturizer

want something that is similar to the natural pH

Hormone therapy is acceptable for treating moderate to severee symptomsof mennopause in healthy women __________ or within _____ years of menopause

less than 60 years old

10 years

during menopause, women with a uterus should take ________

progesterone

what is the preferred method of treatment for women with vaginal symptoms only

low dose vaginal estrogen

what is role of physical therapy in menopause treatment: (~7)

increase blood flow

address muscle/tissue dysfn

education

strength training

dilators

self perineal stretch

maybe some prevention

increase blood flow

address muscle/tissue dysfn

education

strength training

dilators

self perineal stretch

maybe some prevention

IS THE ________________ IN TREATMENT OF MENOPAUSE

role of physical therapy

t/f: PT helps menopause by helping things move and getting blood flow, while addressing muscle and tissue dysfunction

- provide education too!

t

urologic chronic pelvic pain is what

unpleasant sensation/pressure/discomfort percieved to be related to urinary bladder

more than 6 weeks

in abscene of infection/other causes

symptoms of urologic chronic pelvic pain

pain

urinary hesitancy

slow stream

post void residual

urgency

frequency

what is the preferred treatment of urologic chrnic pelvic pain

conservative, non-insavie, approach first

AKA PHYSICAL THERAPY!!!

treatment strategies for urologic chronic pelvic pain

education

manual therapy

neuro re-ed

education aspects with urologic chronic pelvic pain

evaluating diet

fluid intake/management

stress management

bowel managemtn

mm to receive manual therapies with urologic chronic pelvic pain

PF

diaphragm

abdomen

posterior pelvis

mechanical correction

neuro re-ed treatment strategies for urologic chronic pelvic painm

stability/motor control

breath

do PTs treat endometriosis

no, but can treat the symptoms

what are symptoms of endometrosis

chronic, steadily worsening pelvic pain, worse with menses, worse with ovulation

PT treatment strategies for endometriosis

treat symptoms

postural re-ed

bowel and bladder

manual therapies

medical management for endometrosis

menstrual cycle regulation

excision surgery

hormone suppressants

diagnosed based on symptoms or laparoscopy

t/f: conservative mnagement is often successful for patients with coccygodynia

true

causes of coccygodynia

traumatic (fall, labor/delivry)

idiopathic

PFM involvement

joint hyper/hypo mobility

treatment for coccygodynia

ergonic adaption

soft tissue work or manips

injection

coccygectomy

CONSERVATIVE MANAGEMENT THE BEST

what is gold standard treatment for endometrosisi

excision surgery

name some symptoms for pelvic pain in males

urological pain

discomfort in pelvic region

urinary symptoms

sexual dysfunction

fibromyalgia:

a) common comorbidities

b) best treatment

a) IBS, PFMD

b) exercise

how to evaluate and treat chronic pelvic pain in males

evaluate musculoskeletally, treat on findings

post op hernia repair, prostatectomy are some reasons contirbuting to _____________

chronic pelvic pain in males

is chronic pelvic pain in males simialr to females

yes

can men have chronic pelvic pain

YES