PA and PM dx in Pelvic Health

More than _____ voids per 24 hours is considered mixed urinary continence

7

A width of _____cm or wider is labeled significant separation and considered DRA

> 2 cm

A International Continence Impact Questionnaire for UI score of ____ warrants further investigation

A International Continence Impact Questionnaire for UI score of > 4 warrants further investigation

A patient with pelvic floor muscle weakness may present with ___________ over __________ or POP symptoms

A patient with pelvic floor muscle weakness may present with STRESS over URGE or POP symptoms

For someone undergoing PFM training, they must perform at LEAST _____ contractions for _____ weeks minimum

For someone undergoing PFM training, they must perform at LEAST 24 contractions for 8 weeks minimum

What is the Q-tip test?

For vulvodynia a cotton swab with gentle pressure is applied to sites around the introitus; the patient rates their pain

Functional incontinence

Loss of urine due to decreased functional mobility and an inability to reach the toilet in a timely manner

How to palpate EO > IO > TA at 3 locations?

Lower region: palpate abdomen 2.5in medial and slightly inferior to the ASIS with both thumbs Middle region: palpate abdomen at the level of the umbilicus just lateral to the lateral margin of RA Upper region: palpate abdomen medial to the 9th or 10th ribs

Common musculoskeletal dysfunctions in pregnancy?

PGP (SIJ dysfunction or pubic symphysis separation) CTS TOS thoracic/lumbar pain

POP is worse in the _________ and in ________ positions

POP is worse in the evenings and in upright positions

What does a normal vs abnormal contraction of the PFM and TrA look like?

cue "anus to pubic bone" normal: no change in rib cage, naval draws in and up abnormal: upper abs draw in, increased pressure in belly

Anterior examples of pelvic organ prolapse

cystocle: anterior vaginal wall pushed down by the bladder cystourethrocele: anterior vaginal wall pushed down by bladder and urethra

Doming during the active bent leg test indicates ______,

diaphragm is pressed down

Sagging during the active bent leg test indicates ______,

diaphragm staying lifted

What makes up the female athlete triad?

disordered eating menstrual dysfunction osteoporosis

What cue activates lower TrA?

draw anus towards pubic bone draw ASIS together close book cover

UTI symptoms

dysuria pain/burning with urination hamturia

T/F: Any rotation, ant/post tilt of the pelvis relative to the spine or change in the infrasternal angles normal during the active bent leg test

false!!

What is vulvodynia?

general diagnosis for pain at the external genitalia

During an automatic curl up, what's the difference between invagination and doming

invagination creates negative IAP doming creates increased IAP

What is urge urinary incontinence?

involuntary loss of urine accompanied by or immediately preceded by urgency caused by uninhibited bladder contractions or a hypertonic pelvic floor

Mixed urinary incontinence?

involuntary loss of urine associated with urgency AND with exertion, effort, coughing, or sneezing due to weak PFM or uninhibited bladder contractions

What is stress urinary incontinence?

involuntary loss of urine on effort/exertion due to weak PFM or supportive dysfunction

Yeast infection (candidiasis) symptoms

itching cottage cheese/curdy discharge yeasty odor dysuria dyspareunia

Upper urinary tract symptoms

kidneys of ureteral unilateral costovertebral tenderness flank pain ipsilateral shoulder pain fever/chills skin hypersensitivity nocturne

If a patient's symptoms improve with compression at the PSIS, you're thinking ________

lumbosacral multifidus

Pelvic support is PRIMARILY...

muscular with ligamentous stabilization above

Bulging during the active bent leg test indicates ______

no TrA activation

What is dyspareunia?

painful sex

A vaginal pH > _____ indicates increased risk of infection

4.5

Cues for PFM relaxation

"sit bones spread apart" "release as if you're passing gas" "imagine you're letting a lime pass through your vagina"

Cues for PFM contraction

"squeeze and lift" "sit bones come together" "squeeze as if you're stopping urine" "squeeze as if you're holding back gas"

Levator Ani MMT

0 = no contraction 1 = flicker 2 = weak squeeze, no lift 3 = fair squeeze, definite lift (grades 3-5 are generally discernible on visual perineal inspection) 4 = good squeeze, good lift, able to hold against resistance 5 = strong squeeze, against strong resistance

The first sensation to pee occurs when your bladder is about half full, around ______ ml

200 ml

What does a positive active SLR look like?

Difficulty or pain with leg lift, followed by a reduction in pain or improved ease of leg raise with pelvic compression

During the Q-tip test for patients with vulvodynia, pain is typically most severe in the ________ vestibule between the __ and __ o'clock positions

During the Q-tip test for patients with vulvodynia, pain is typically most severe in the POSTERIOR vestibule between the 5 and 7 o'clock positions

During the active bent leg test, if the patients belly draws in or narrows, it's over activation of __________; if it widens it's overactivation of ___________

During the active bent leg test, if the patients belly draws in or narrows, it's over activation of EO; if it widens it's overactivation of IO

PERFECT scale

Power (PFM MMT) Endurance (hold time) Repetitions (up to 10 of MVC) Fast twitch (quick contraction) Elevation (lifting posterior vaginal wall toward pubic) Co-contraction (of deep abdominal muscles) Timing (ability of PFM to contract w/ cough)

What is the sling procedure?

Surgery for stress urinary incontinence using either a pubovaginal swing or tension free vaginal tape

The 3 Incontinence Questions can be used to distinguish _________ from _______

The 3 Incontinence Questions can be used to distinguish UUI from SUI

If a patient's symptoms improve with compression at the ASIS, you're thinking ________ and _________

TrA and IO

Pelvic floor hypertonicity is associated with what diagnoses?

Urge incontinence Stress incontinence Dyspareunia Pelvic pain syndromes Bowel disorder

Urge urinary incontinence, otherwise known as ___________, can be associated with ___________

Urge urinary incontinence, otherwise known as DETRUSOR SYNDROME, can be associated with OVERACTIVE BLADDER (OAB)

The Pelvic Organ Prolapse Simple Symptom Index is compromised of what four items?

Urinary incontinence with laughing, sneezing, coughing Urinary urgency Pain during pooping Seeing/feeling bulge in vagina

Apical examples of pelvic organ prolapse

Uterine/cervix prolapse: uterus prolapses through the vagina Vaginal vaults prolapse: vault prolapses through the vagina Enterocele: intestines herniated between the vagina and rectum

__________ remains the single most effective treatment option for LPV

Vestibulectomy

When we're referring to the upper urinary tract, think ____________ or ____________. When we're referring tot he lower urinary tract, think ____________ or ____________

When we're referring to the upper urinary tract, think KIDNEY or URETERAL. When we're referring tot he lower urinary tract, think CYSTITIS or URETHRITIS

What does TrA contraction feel like?

a deep, light tension will be felt in the TrA at the middle/lower regions and a gentle bulge in the upper region the abdomen should hollow slightly and the thumb should be drawn inward and lateral

What is a Pessary?

a device that functions as an orthotic to hold up the POP to delay surgery or for temporary support

Cystocele and cystourethrocele are examples of

anterior POP

uterine/cervix prolapse, vaginal vault prolapse, and enterocoele are examples of

apical POP

How do we traditionally evaluate for DRA?

patient supine with knees bent palpate the linea alba instruct the patient to performa. lift of the head and shoulders measure the distance between the RA muscle bellies in fingers test 4.5 cm above

What are the normal patterns of the bladder?

pee 5-8x per day 8-12 oz in the morning; 6-10 oz common daily void 2-5 hours in between each 400-600 ml capacity

What cue activates middle TrA?

pelvic floor cues

____________ can be a significant finding in pelvic pain syndromes including coccygodynia, pudendal nerve neuralgia, vulvodynia

pelvic floor muscle imbalance L/R

perineal descent syndrome

perineum "balloons" downward during cough/strain; should not descend beyond the level of the ischial tuberosities

Rectocele is an example of

posterior POP

What is a Retropubic urethropexy (Colposuspension)?

primarily an anti-urge incontinence procedure that can be used to repair a low grade cystocele

rectal prolapse

rectal tissue prolapses through the rectum

Posterior examples of pelvic organ prolapse

rectocele: posterior vaginal wall pushed down by the rectum

Surgery for POP?

sacrocolpopexy sacrospinous ligament suspension anterior or posterior colporrhaphy

What is diastasis recti?

separation of the rectus abdominis at the linea alba

What is the active SLR test for?

to assess load transfer between the trunk and LE in patients with pelvic pain

What is the purpose of Sahrmann's lower abdominal muscle progression?

to test and grade combined local and global abdominal muscle strength

In healthy individuals, a 10-15% contraction of the PFM should result in activation of...

transverse abdominis

POP symptoms

urge incontinence, urgency/frequency, dribbling, incomplete emptying straining at stool, incomplete or discomfort with evacuation, heaviness, sensation that something is falling out of the vagina

Lower urinary tract symptoms

urinary frequency/urgency LBP pelvic/lower abdominal pain dysuria dyspareunia