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Course Notes - Pelvic Floor Dysfunction

If patient can’t maintain re-positioning…

Breathing

  • Are they diaphragmatically breathing?
  • Quality of respiration?
  • Symmetry of respiration?
  • Decreased diaphragmatic motion, increased descent of pelvic floor, altered breathing patterns associated with pelvic pain.
  • Diaphragmatic and TA muscle activity reduced with hypercapnea.
  • Pelvic floor depression associated with breath holding/Valsalva maneuver.

Abdominals

  • Can they isolate IO / TA?
  • Symmetrical or Asymmetical?

Abdominals

  • Palpate approximately 2 cm medial and inferior to ASIS.
  • Slowly & gently draw in your abdominals away from your fingers.
  • Sub maximal contraction.
  • Change positions (supine, side lying).
  • Monitor for substitutions.
  • Is IO / TA activity sustained with breathing?

Abdominals

  • Can they maintain IO / TA contraction with upright static & dynamic control?

Walking Seated Ball Pregnancy Squat

Pelvic Floor

  • Can they isolate their pelvic floor muscles?
  • Can they actively contract and relax the pelvic floor?
  • Do they feel an up & in contraction?
  • Are they substituting (glute squeeze, breath holding, adductor squeeze, bearing down)?
  • Is there symmetry?
  • Is there appropriate motor planning?
  • Voluntary contraction of the abdominal muscles stimulates pelvic floor contraction.
  • TA and IO recruited during all pelvic floor muscle contractions.
  • Relaxed abdominals resulted in only 25% of maximum pelvic floor contraction.
  • Women with stress incontinence have increased OE activity (increased OE increases IAP).
  • Back pain more common in women with incontinence , increased probability of LBP if have symptoms of incontinence.
  • Pelvic floor muscles are part of preprogrammed response to postural adjustment.
  • Decreased pelvic floor strength, endurance and thickness noted in women with incontinence.
  • Increased pelvic floor activity with postural perturbations noted with women with incontinence.
  • Pelvic floor tonic activity at rest, with cough automatic phasic response, in women incontinence unsustained tonic pattern with asymmetrical recruitment.
  • Timing deficit of muscle recruitment lost with women with incontinence.
  • Higher resting tone of pelvic floor with dysfunction, need to teach down training.
  • High resting tone does not always mean a strong pelvic floor.
  • The pelvic floor needs to relearn how to function within a neutral pelvis.
  • Feel the pelvic floor contract and relax.
  • Reported cure rate of pelvic for urinary incontinence ranges between 44-69%.
  • 30% of contractions are performed incorrectly; 50% of contraction are strong enough to increase urethral pressure.
  • Pelvic floor muscle activity alone does not predict UI, activity related to UI needs to be considered.
  • Isolated contraction of pelvic floor produces greatest displacement of pelvic floor.

Hypermobility - But Still Have Symptoms

  • Is there global hypermobility?
  • There is a high correlation of pelvic dysfunction with a reduction in tissue collegan concentration.

Abdominal Binder

Referral

  • Has there been trauma?  Consider referral early on if patient not progressing appropriately.
  • Patient can reposition but they still have symptoms- are they able to relax their pelvic floor?
  • Is there psyco-social issues?

Referral To

  • If symptoms have not subsided consider referral to OB GYN/Urologists/Primary MD
  • PT with pelvic floor specific training (biofeedback, internal evaluation, condition specific integration)
  • Podiatry (correlation of foot flexibility and SUI)
  • Dentist
  • Neuro - Optometrist
Posted April 6, 2009 at 7:16PM
Categories: Courses

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