Pelvic Health: Anatomy,Physiology, Pregnancy

Pelvic Health Basics

• Gravida describes the number of times a woman has been pregnant.
• NVD stands for Normal Vaginal Delivery.
• Pelvic floor muscles (PFM) support pelvic organs, assist with urinary and faecal continence, and contribute to sexual function.
• The bulbospongiosus muscle is not part of the levator ani group.
• The round ligament’s main function is to attach the uterus to the mons pubis.

Pelvic Anatomy and Physiology

• In females, the true pelvis is shallower compared to males.
• The broad ligament covers and supports the uterus, fallopian tubes, and ovaries.
• The iliococcygeus muscle contributes to the elevation of the recto-anal junction.
• The pelvic inlet separates the true pelvis from the false pelvis.
• The urogenital triangle consists of the bulbospongiosus, ischiocavernosus, and superficial transverse perineal muscles.

Pregnancy and Postpartum Changes

• Relaxin is the hormone responsible for relaxing ligaments and joints during pregnancy.
• Pelvic girdle pain (PGP) during pregnancy is commonly caused by increased weight gain, increased joint mobility due to hormonal changes, and decreased physical activity.
• The gynaecoid pelvic shape is most favorable for vaginal delivery.
• LUSCS stands for Lower Uterine Segment Caesarean Section.
• Diastasis rectus abdominis (DRAM) is defined as a separation of the rectus abdominis along the linea alba.

Pelvic Floor Dysfunction and Prolapse

• Regular swimming is not a risk factor for pelvic organ prolapse (POP).
• Obstetric Anal Sphincter Injury (OASI) includes third- and fourth-degree perineal tears.
• The primary role of the perineal body is to provide attachment for pelvic floor muscles.
• The overload principle in pelvic floor muscle training (PFMT) focuses on progressively increasing intensity to improve muscle strength.
• Pelvic floor muscles contain a mix of slow and fast-twitch fibers.

Male Pelvic Health and Prostate Conditions

• The prostate gland is located between the bladder and the pelvic floor muscles and anterior to the rectum.
• Radical prostatectomy (RP) is a surgical treatment for prostate cancer.
• Stress urinary incontinence (SUI) is the most common type of urinary incontinence following radical prostatectomy.
• The external urethral sphincter is the most important muscle for urinary continence post-prostatectomy.
• Post-RP erectile dysfunction (ED) can be improved by pelvic floor muscle training, vacuum erection devices, and medications like Viagra.

Bladder and Bowel Health

• The normal bladder capacity for an adult is 300–600 mL.
• The pelvic nerve controls bladder contraction during micturition.
• The detrusor muscle contracts during urination.
• Acetylcholine is the main neurotransmitter responsible for bladder contraction.
• The internal anal sphincter is controlled by the parasympathetic and sympathetic nervous systems.

Pelvic Floor Assessment and Training

• Digital vaginal or rectal examination is considered the gold standard for evaluating pelvic floor muscle function.
• The Modified Oxford Scale (MOS) measures the strength of the PFM.
• A strong contraction has a MOS score of 5.
• "The Knack" refers to a quick squeeze before sneezing or coughing in pelvic floor muscle training.
• PFM training is a first-line treatment for stress urinary incontinence, urge urinary incontinence, and pelvic organ prolapse.

Pelvic Floor Assessment and Training (Continued)

• The recommended number of PFM contractions per day for optimal training is 20-30.
• PFM training should start in the lying down position for a beginner with weak pelvic floor muscles.
• Biofeedback is most useful for patients who cannot identify their pelvic floor muscles.
• Type I (slow-twitch) muscle fibres make up most of the pelvic floor.
• PFM training is not only useful for postpartum women.

Pelvic Organ Prolapse (POP)

• Pelvic organ prolapse (POP) is most commonly associated with previous vaginal delivery, obesity, and aging.
• Cystocele is the most common type of POP.
• The best non-surgical treatment for POP is vaginal pessary, pelvic floor exercises, and lifestyle modifications.
• A Stage III prolapse means the organ is slightly beyond the vaginal opening.
• The primary purpose of a vaginal pessary is to support prolapsed pelvic organs.

Pelvic Health in Men

• The most common post-prostatectomy issue is urinary incontinence.
• Nerve damage is the primary cause of erectile dysfunction (ED) after radical prostatectomy.
• The bulbospongiosus muscle in men controls ejaculation and maintains erection.
• Sildenafil (Viagra) is most commonly prescribed for post-prostatectomy erectile dysfunction.
• Penile rehabilitation post-RP is used for maintaining penile blood flow.

Urinary and Faecal Incontinence

• Stress incontinence is characterized by leakage associated with physical exertion.
• An overactive bladder is a common cause of urge urinary incontinence (UUI).
• Pelvic floor muscle training (PFMT) is the first-line treatment for stress urinary incontinence.
• Faecal incontinence is most commonly associated with chronic constipation, obstetric trauma, and anal sphincter dysfunction.
• Dietary fibre modification, pelvic floor muscle exercises and biofeedback training are effective in managing faecal incontinence.

Sexual Function and Pelvic Health

• Testosterone is primarily responsible for libido in both men and women.
• The pubococcygeus muscle plays a key role in sexual function.
• Dyspareunia, anorgasmia, and vaginismus are common sexual dysfunctions in women with pelvic floor dysfunction.
• Recommended treatments for vaginismus include cognitive behavioural therapy, pelvic floor physiotherapy, and vaginal dilator therapy.
• Regular physical activity is not a risk factor for sexual dysfunction.

Post-Surgical Pelvic Rehabilitation

• Hysterectomy is the type of surgery most likely to result in pelvic organ prolapse.
• The primary roles of physiotherapy after pelvic surgery are to promote tissue healing, improve pelvic floor function, and reduce postoperative complications.
• Pelvic floor muscle training (PFMT) is most effective in managing post-hysterectomy urinary incontinence.

Lifestyle and Pelvic Health

-After pelvic surgery, patients should wait 6-8 weeks before resuming high-impact activities.

• Urinary incontinence is a common complication following a radical prostatectomy.
• Chronic constipation is strongly associated with pelvic organ prolapse.
• Increased water intake helps prevent urinary tract infections (UTIs).
• Running, weightlifting and jumping is not recommended for individuals with pelvic floor dysfunction.
• Kegel exercises are best for strengthening the pelvic floor.
• Obesity contributes to pelvic floor dysfunction by increasing intra-abdominal pressure, weakening pelvic floor muscles, and leading to increased strain on ligaments.

Special Populations and Pelvic Health

• Postmenopausal women are most at risk for pelvic floor dysfunction.
• High-impact sports increases the risk of stress urinary incontinence in female athletes.
• Avoiding weight-bearing exercises is the best exercise modification for pregnant women with pelvic girdle pain.
• Pelvic floor muscle training can improve continence in older adults.
• Pelvic floor muscle training is most appropriate for an elderly patient with both urinary and faecal incontinence.