Genital and reproductive systems (week 10)

Female pelvis

Bones: pubis, ischium, ilium, and sacrum

Joints: sacroiliac and symphysis pubis

Contents: reproductive organs, uterus, cervix, vagina, ovaries, and fallopian tubes

Support: abdominal viscera and broad and round ligaments

Blood vessels: uterine and ovarian arteries and veins

Nerves: derived from hypogastric and ovarian plexuses and sacral nerve roots 3 and 4

Muscles of the floor of the perineum: two main layers

• Inner layer known as the diaphragm

• Coccygeus and levator ani muscles

Superficial layer known as the urogenital diaphragm: two triangles

• Urogenital triangle

• Anal triangle

Pelvic floor incompetence and weakness etiology

­genetically weak pelvic floor muscles

­Pregnancy

­Multiple births

­Obesity

­Chronic coughing

­Constant heavy lifting

­Straining during BMs

­Nerve injuries 

Pelvic floor incompetence and weakness S/S

­Urinary or fecal incontinence

­Weak pelvic floor muscles, decrease bladder capacity, increase detrusor contractility (smooth muscle layer of the bladder), overactive bladder, nerve damage, pregnancies, obesity, abdominal/pelvic surgery, chronic cough, constipation,  poor pelvic alignment/mobility

­Stress incontinence

­Urge incontinence

­Rectal and uterine prolapse

Pelvic floor incompetence and weakness prognosis

­Permanent problem if caused by nerve damage like Multiple Sclerosis or Parkinson’s

­Most can improve with exercise and other treatment

Pelvic floor incompetence and weakness medical intervention

­Medications: 

­urgency – anticholinergics (oxybutynin, tolterodine) – they inhibit involuntary contractures of bladder

­Pessary – device that holds the pelvic floor up

­Surgery – bladder neck suspension and sling procedures

Pelvic floor incompetence and weakness PT intervention

­Estim and biofeedback

­Muscle reeducation

­Kegel exercises

­Patient education

Pregnancy medical

Monitoring of the fetus during pregnancy

Ultrasound, blood tests, physical exam, girth measurements, vital signs, urine analysis

pregnancy Physiological Changes:

­Cervix softens, Glands around cervix excrete mucous that plugs the opening to protect the fetus, Vagina is more elastic, Frequent micturition, Increased blood volume, Increased cardiac output, Increased heart rate, Increase ventilation, Weight gain, Fluid retention, Ca+ and iron deficiencies

Precautions and contraindications for PT intervention during pregnancy

Any change in status should be reported to PT

Modalities-caution use or not at all

No joint mobilization or cranio-sacral technique

No diathermy (must stay at least 10” away)

Massage and ice are ok

Moderate supervised exercise

If exercise before pregnancy, can safely continue unless physician says no

If no exercise before pregnancy, need to start slow like with walking or swimming a few minutes per day and increase to 30 min

Avoid overstretching and sudden movement

Monitor vitals

Avoid supine position for more than a few minutes in later stages due to increased pressure on vena cava from fetus

lactation

Milk production in mammary glands after delivery

Before milk, colostrum (clear fluid that contains high levels of antibodies, minerals, and vitamins)

Milk comes in during the first 2 weeks after delivery

Factors that affect milk production – estrogen and progesterone, stimulation of the nipple and areolar by sucking stimulate the pituitary gland to produce prolactin and oxytocin which stimulates milk “let down” reflex

­Low back pain in pregnancy etiology

ligament laxity due to hormone changes, altered center of gravity, muscle imbalances, weak abdominal muscle, increased weight may cause overstress of muscle, possible ischemia due to pressure on aorta and vena cava, referred pain from vena cava compression, lumbosacral plexus, kidney infection, and SI joint dysfunction

­Low back pain in pregnancy S/S

­Low back or SI joint pain, pain in lumbar area, pelvic floor, or radiating pain to buttocks and legs

­Prognosis: Low back pain associated with pregnancy goes away after delivery, Lumbar and SI joint problems may continue, Radiculopathy may require testing

­Medical intervention: Limited testing, Moderate exercise and rest in left side-lying, May or may not suggest acetaminophen

­Low back pain in pregnancy PT intervention

­SI belts, abdominal binders, postural education and exercise, avoid strenuous abdominal exercise

­Postpartum treatment for low back pain, abdominal and pelvic floor strengthening exercise, aerobic exercise, aquatic therapy, posture re-education

Complications of labor

Caesarean section delivery – PT for progressive abdominal exercise, pelvic floor exercise, gait training, TENS

Postpartum issues and problems

Muscle tone, ligamentous laxity, and injuries

Pelvic joint injuries

Postpartum depression and psychosis

gestational diabetes

Diabetes during pregnancy that was not there before; mother can’t produce enough insulin and glucose builds up in blood

No S&S

Most will return to normal after delivery

Have to control diabetes during pregnancy or fetal problems can occur like larger baby, hypoglycemia, jaundice, respiratory distress

Usually diet and exercise will control levels but some may need insulin

PT for exercise instruction

menopause

Begins around mid 40s-50s

Officially in menopause when there is no menses for 1 whole year

Uterine prolapse and stress incontinence due to thinning of uterus and decreased tone of ligament and muscle

Sleep disturbances, mood swings, hot flashes, headache, decreased concentration, thinning of hair

Physiological changes associated with menopause may cause neurological changes

• Confusion

• Memory loss

• Balance problems

• Osteoporosis

Male reproductive system

Penis

Scrotum

Testes

Testosterone

Prostate gland

Seminal vesicle

Ejaculatory duct

Prostate diseases

Benign prostatic hyperplasia (BPH) – noncancerous, enlargement of prostate tissue that causes constriction and prevents emptying of the bladder

inability or difficulty with urination and this could lead to chronic bladder and kidney infections 

transurethral resection of the prostate (TURP) is the removal of part of the prostate, alpha blockers like Flomax relax muscle of prostate to decrease obstruction