Musculoskeletal LQ Week 4 - Pelvic Health

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Questions and Answers

Which of the following factors is NOT associated with an increased risk of pelvic organ prolapse?

  • Increased body weight
  • Poor lifting mechanics
  • Dehydration
  • Regular exercise (correct)

In the study by Durnea et al. (2014), what percentage of women who had given birth to their first child reported experiencing a cystocele (bladder prolapse) within one year postpartum?

  • 70%
  • 90% (correct)
  • 65%
  • 89%

Which of the following statements accurately describes the prevalence of constipation in hospitalized patients?

  • Constipation affects a significant number of hospitalized patients, with a prevalence rate around 70%.
  • Constipation affects a majority of hospitalized patients, with a prevalence rate exceeding 50%. (correct)
  • Constipation affects a significant number of hospitalized patients, with a prevalence rate around 30%.
  • Constipation affects a small minority of hospitalized patients, with a prevalence rate below 10%.

According to the information provided, which of the following groups is NOT significantly less likely to seek care for constipation?

<p>Individuals with a high income (C)</p> Signup and view all the answers

Which of the following is a symptom commonly associated with pelvic organ prolapse?

<p>Feeling of heaviness in the vagina (D)</p> Signup and view all the answers

What is the estimated economic burden associated with constipation per patient?

<p>$1,900 to $12,000 (D)</p> Signup and view all the answers

Which of the following types of pelvic organ prolapse is described as the bladder leaning backwards into the vaginal canal?

<p>Cystocele (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for pelvic organ prolapse?

<p>Regular aerobic exercise (C)</p> Signup and view all the answers

What is the primary cause of pelvic organ prolapse based on the information provided?

<p>Vaginal childbirth (C)</p> Signup and view all the answers

What percentage of people assigned female at birth who have chronic pelvic pain report symptoms of PTSD?

<p>31% (C)</p> Signup and view all the answers

According to the presented information, which of the following statements about the prevalence of pelvic organ prolapse within one year postpartum is true?

<p>The majority of women experience some form of pelvic organ prolapse within one year of giving birth. (C)</p> Signup and view all the answers

What is the average increase in the width of the pubic symphysis during pregnancy?

<p>2-3 mm (D)</p> Signup and view all the answers

Which of the following is NOT a risk factor for diastasis recti?

<p>Regular exercise (B)</p> Signup and view all the answers

Which of the following is NOT a symptom of diastasis recti?

<p>Increased abdominal muscle strength (D)</p> Signup and view all the answers

What is NOT a risk factor for perineal tears during childbirth?

<p>Short second stage of labor (D)</p> Signup and view all the answers

What type of perineal tear involves a complete tear of the anal sphincter muscle?

<p>Fourth-degree tear (B)</p> Signup and view all the answers

What is the prevalence of diastasis recti at 6-8 weeks postpartum?

<p>53.4% (D)</p> Signup and view all the answers

Which of the following is NOT a common pregnancy-related pelvic girdle injury?

<p>Spinal stenosis (C)</p> Signup and view all the answers

What is the definition of pubic symphysis diastasis?

<p>An increase in the width of the pubic symphysis greater than 10 mm (D)</p> Signup and view all the answers

What is the prevalence of pubic symphysis diastasis?

<p>1/30,000 (C)</p> Signup and view all the answers

What is the primary focus of the study investigating pelvic floor muscle activity?

<p>The mechanism underlying vaginismus (C)</p> Signup and view all the answers

Which condition is characterized by involuntary contraction of the muscles of the outer third of the vagina?

<p>Vaginismus (A)</p> Signup and view all the answers

What typical symptom is associated with dyspareunia?

<p>Pain during or after sex (A)</p> Signup and view all the answers

Which factor is NOT typically associated with the etiology of vaginismus?

<p>Chronic bladder pain (B)</p> Signup and view all the answers

What is central sensitization commonly associated with in the context of pelvic pain conditions?

<p>Upregulation of spinal cord activity (D)</p> Signup and view all the answers

Which of the following is a symptom of endometriosis?

<p>Painful menstrual cramps (A)</p> Signup and view all the answers

What is the reported prevalence of dyspareunia worldwide?

<p>3-18% (D)</p> Signup and view all the answers

In the research study, which muscles were primarily measured for EMG activity?

<p>Pelvic floor and upper quarter postural muscles (B)</p> Signup and view all the answers

Which demographic is predominantly affected by Bladder Pain Syndrome?

<p>People assigned female at birth (D)</p> Signup and view all the answers

What is a common comorbidity associated with Bladder Pain Syndrome?

<p>Diabetes (A)</p> Signup and view all the answers

What is the common cause of fecal incontinence?

<p>Dehydration (A)</p> Signup and view all the answers

Which symptom is NOT associated with constipation?

<p>Frequent bowel movements (A)</p> Signup and view all the answers

Which of the following statements about fecal urgency is true?

<p>It involves a sudden need to rush to the bathroom. (B)</p> Signup and view all the answers

What feeling is commonly reported by those who experience incomplete defecation?

<p>Feeling that some stool is stuck (B)</p> Signup and view all the answers

What is the prevalence of fecal incontinence worldwide?

<p>1 in 12 adults (B)</p> Signup and view all the answers

Which of the following is NOT a common symptom of fecal incontinence?

<p>Acute abdominal pain (C)</p> Signup and view all the answers

Which factor does NOT contribute to constipation?

<p>High fruit and vegetable intake (A)</p> Signup and view all the answers

Which condition is primarily linked with pelvic floor muscle hypertonicity?

<p>Constipation (D)</p> Signup and view all the answers

Which of the following may indicate a lack of access to hygiene for a patient with fecal incontinence?

<p>Wearing multiple pant layers (B)</p> Signup and view all the answers

What is a common treatment discussion included in pelvic floor therapy?

<p>Understanding optimal food and liquid intake (D)</p> Signup and view all the answers

What is the primary purpose of the Cozean Pelvic Dysfunction Screening Protocol?

<p>To create a simple screening questionnaire for pelvic pain identification (C)</p> Signup and view all the answers

Which of the following conditions is NOT screened for in the Pelvic Floor Screening for Patients with Low Back and Hip Pain?

<p>Nausea (B)</p> Signup and view all the answers

What does the Overactive Bladder Diary track during urination?

<p>Urine volume and leakage amount (B)</p> Signup and view all the answers

In the NIH-CPSI questionnaire for people with a vagina, what major aspect is evaluated?

<p>Quality of life related to pelvic symptoms (C)</p> Signup and view all the answers

Which outcome measure asks patients to rate the impact of their symptoms on three important activities?

<p>Patient Specific Functional Scale (D)</p> Signup and view all the answers

What type of information does the Kathe Wallace Bladder and Bowel Diary track?

<p>Defecation frequency and associated urges (A)</p> Signup and view all the answers

What aspect of pelvic health does the NIH-CPSI for people with a penis primarily focus on?

<p>Pain or discomfort with specific activities (B)</p> Signup and view all the answers

Which outcome measure uses a scale from 0 to 10 to assess activity performance?

<p>Patient Specific Functional Scale (D)</p> Signup and view all the answers

Which of the following describes the primary goal of pelvic health lifestyle education?

<p>To teach breathing and stress management techniques (D)</p> Signup and view all the answers

Which pelvic health outcome measure assesses symptoms like urinary urgency and frequency?

<p>Bladder and Bowel Diary (D)</p> Signup and view all the answers

Which nerve has its segmental origin from S2, S3, and S4 and is responsible for sensory function to the genitalia?

<p>Pudendal (B)</p> Signup and view all the answers

What is the primary function of the pelvic floor regarding urinary control?

<p>Acts as a sump pump (D)</p> Signup and view all the answers

Piriformis and obturator internus are both categorized under which muscle group?

<p>Pelvic wall muscles (C)</p> Signup and view all the answers

What condition is characterized by involuntary urine leakage due to increased intra-abdominal pressure?

<p>Stress urinary incontinence (B)</p> Signup and view all the answers

Which nerve is primarily responsible for innervation to the gluteus maximus muscle?

<p>Inferior gluteal (B)</p> Signup and view all the answers

Which pelvic floor function is primarily responsible for maintaining fecal and urinary continence?

<p>Sphincteric (D)</p> Signup and view all the answers

What common urinary condition is associated with a strong urge to urinate followed by involuntary leakage?

<p>Urge urinary incontinence (B)</p> Signup and view all the answers

Which nerve originates from the S1 and S2 segments and is involved in the innervation of the piriformis muscle?

<p>Nerve to piriformis (C)</p> Signup and view all the answers

The clitoris extends alongside which other anatomical structure in females?

<p>Labia majora (C)</p> Signup and view all the answers

Which of the following nerves provides cutaneous branches to the medial part of the buttocks?

<p>Perforating cutaneous (A)</p> Signup and view all the answers

What is a potential consequence of dysfunction in the pelvic floor area?

<p>Swelling in lower extremities (D)</p> Signup and view all the answers

Which of the following muscles is influenced by both the nerve to quadratus femoris and the nerve to obturator internus?

<p>Quadratus femoris (D)</p> Signup and view all the answers

What is the impact of increased pelvic floor muscle dysfunction on sexual function?

<p>Pain or sensitivity in pelvic area (A)</p> Signup and view all the answers

What percentage of people with pelvic organ prolapse report urinary incontinence?

<p>40-70% (A)</p> Signup and view all the answers

What is a common symptom of pelvic organ prolapse?

<p>Pressure or bulge in the pelvic area (D)</p> Signup and view all the answers

What anatomical structure descends through the vaginal canal due to anterior compartment prolapse?

<p>Bladder (D)</p> Signup and view all the answers

Which type of prolapse results from the descent of the rectum into the vaginal canal?

<p>Rectocele (B)</p> Signup and view all the answers

Which treatment option for pelvic organ prolapse involves using a device to support the vaginal walls?

<p>Pessary (B)</p> Signup and view all the answers

At what percentage did participants report worsening pelvic pain with pelvic organ prolapse?

<p>81% (A)</p> Signup and view all the answers

Which pelvic condition is most likely characterized by involuntary closing when relaxation is needed?

<p>Overactive pelvic floor (A)</p> Signup and view all the answers

What is a common symptom of an overactive pelvic floor?

<p>Frequent urination (C)</p> Signup and view all the answers

What method may doctors use to evaluate potential stress urinary incontinence after correcting a prolapse?

<p>Urodynamic study (D)</p> Signup and view all the answers

Which of the following is often a psychological factor contributing to an overactive pelvic floor?

<p>Chronic pelvic pain (C)</p> Signup and view all the answers

Which pelvic pain condition is caused by involuntarily involuntary contractions of pelvic floor muscles?

<p>Vaginismus (A)</p> Signup and view all the answers

What percentage of individuals with pelvic organ prolapse have reported low back pain?

<p>46% (D)</p> Signup and view all the answers

What procedure is commonly performed to manage pelvic organ prolapse?

<p>Surgery (B)</p> Signup and view all the answers

In what ways can the vaginal canal be compartmentalized in context to prolapse?

<p>Three different sections (C)</p> Signup and view all the answers

Which pelvic girdle bony feature is heart-shaped and narrow in males?

<p>Pelvic inlet (A)</p> Signup and view all the answers

What is the primary role of pelvic floor muscles?

<p>Support pelvic organs (B)</p> Signup and view all the answers

What is the characteristic shape of the femal pelvic outlet compared to males?

<p>Comparatively large (D)</p> Signup and view all the answers

Which muscle plays a critical role in aiding the blood flow to the clitoris or penis during sexual arousal?

<p>Ischiocavernosus (A)</p> Signup and view all the answers

What is a primary function of the pelvic floor concerning bowel movement?

<p>Assistance in defecation (D)</p> Signup and view all the answers

Which muscle is primarily responsible for forming a hammock between the pubic bone and the sacrum?

<p>Levator ani (D)</p> Signup and view all the answers

How does the female greater pelvis differ from the male greater pelvis?

<p>It is wider and shallow (D)</p> Signup and view all the answers

Which pelvic floor muscle loops behind the rectum and helps ease stool passage?

<p>Puborectalis (A)</p> Signup and view all the answers

What anatomical structure primarily allows for urinary exit from the body in males?

<p>Urethra (B)</p> Signup and view all the answers

What is the effect of tightness in the ischiocavernosus muscle?

<p>Can lead to dyspareunia (A)</p> Signup and view all the answers

Which male pelvic feature is characterized as round?

<p>Obturator foramen (A)</p> Signup and view all the answers

Which function is NOT associated with the pelvic floor muscles?

<p>Supports the spine directly (A)</p> Signup and view all the answers

Which anatomical term refers to the space containing the terminal parts of the urinary and reproductive systems?

<p>Pelvic cavity (C)</p> Signup and view all the answers

What is the typical characteristic of the female inferior pelvis compared to the male?

<p>Wide and shallow (A)</p> Signup and view all the answers

What procedure is performed to create more space for a baby to exit during vaginal birth?

<p>Episiotomy (C)</p> Signup and view all the answers

What percentage of primapara experienced an episiotomy in vaginal births according to the data?

<p>93% (A)</p> Signup and view all the answers

At what gestational week should perineal massage begin to reduce the risk of severe tears?

<p>35 weeks (A)</p> Signup and view all the answers

What was the improvement percentage reported by patients with interstitial cystitis after physical therapy?

<p>75%-99% (C)</p> Signup and view all the answers

What is the 'knack' technique primarily aimed at?

<p>Reducing stress urinary incontinence (C)</p> Signup and view all the answers

Which of the following exercises was NOT assessed for its effectiveness on primary dysmenorrhea?

<p>Warrior (C)</p> Signup and view all the answers

What type of therapy was conducted in the study on urinary incontinence among people assigned female at birth?

<p>Group-based yoga therapy (A)</p> Signup and view all the answers

Which pelvic organ prolapse stage was included in the Hagen et al., 2014 study?

<p>Stage 1 (D)</p> Signup and view all the answers

What percentage of the intervention group showed an improvement in pelvic organ prolapse symptoms according to Braeken et al., 2010?

<p>19% (A)</p> Signup and view all the answers

What was the average decrease in urinary frequency for the yoga therapy group in Huang et al., 2014?

<p>70% (C)</p> Signup and view all the answers

What common fear is associated with medical professionals, particularly in pelvic health?

<p>Iatrophobia (A)</p> Signup and view all the answers

In the study by Miller et al., 2008, which group had a greater reduction of incontinence during the knack maneuver?

<p>Pregnant individuals (C)</p> Signup and view all the answers

What duration of perineal massage is recommended?

<p>2-3 minutes (A)</p> Signup and view all the answers

What was the improvement reported by the pelvic floor muscle training group in relation to bladder symptoms?

<p>Reduced frequency (A)</p> Signup and view all the answers

What is a common environmental trigger for urinary incontinence?

<p>Running water (C)</p> Signup and view all the answers

What defines mixed urinary incontinence?

<p>Combination of stress and urge urinary incontinence (B)</p> Signup and view all the answers

Which of the following is NOT a common cause of functional urinary incontinence?

<p>Strong urge to urinate (B)</p> Signup and view all the answers

How many times is urinating defined as overactive bladder in a 24-hour period?

<p>5-8 times (D)</p> Signup and view all the answers

What can lead to the prevalence of nocturia?

<p>Liquid consumption before bed (A)</p> Signup and view all the answers

What is a common psychological consequence of urinary incontinence?

<p>Anxiety and depression (A)</p> Signup and view all the answers

What percentage of people assigned female at birth over age 70 experience urinary incontinence?

<blockquote> <p>40% (B)</p> </blockquote> Signup and view all the answers

What defines nocturia?

<p>Urinating more than once a night (A)</p> Signup and view all the answers

What is often associated with an increased prevalence of overactive bladder?

<p>Non-Hispanic white ethnicity (D)</p> Signup and view all the answers

Which of the following is NOT a consequence of urinary incontinence?

<p>Enhanced social reputation (C)</p> Signup and view all the answers

What aspect often contributes to the economic burden of urinary incontinence?

<p>Purchasing bladder pads and related items (A)</p> Signup and view all the answers

What demographic shows a higher prevalence of bladder irritants consumption?

<p>Pregnant individuals (B)</p> Signup and view all the answers

What is a common contributing factor for urinary incontinence during pregnancy?

<p>Increased weeks of gestation (A)</p> Signup and view all the answers

What is a possible reason for nocturia in older adults?

<p>Poor bladder storage (B)</p> Signup and view all the answers

Flashcards

Pelvic Floor Anatomy

The structure formed by muscles and ligaments at the bottom of the pelvis.

Pelvic Girdle Differences

Variations in pelvic anatomy between males and females.

Pelvic Inlet Shape

The shape of the opening at the top of the pelvic cavity.

Functions of the Pelvic Floor

Includes support for organs, stability, and urinary control.

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Urethra Function

Tube through which urine exits the body.

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Puborectalis Muscle

Muscle that loops behind the rectum and aids stool passage.

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Ischiocavernosus Muscle

Muscle that contributes to sexual arousal and orgasm.

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Superficial Pelvic Floor Muscles

First layer of muscles supporting pelvic organs.

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Coccygeus Muscle

Muscle that supports pelvic organs and resists pressure.

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Deep Transverse Perineal Muscle

Muscle that provides support behind the superficial layer.

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Pelvic Floor as Boundary

Acts as the caudal boundary of the abdominal cavity.

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Greater Pelvis Characteristics

Top part of the pelvis, shallow in females, deep in males.

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Pelvic Outlet Size

The size of the opening at the bottom of the pelvis.

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Perineal Body

Area where several muscles attach between anus and vagina.

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Fecal Continence Function

The ability to control bowel movements.

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Fecal Incontinence

Inability to control bowel movements resulting in fecal leakage.

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Symptoms of Fecal Incontinence

Includes fecal smell, frequent gas, and multiple layers of clothing.

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Causes of Fecal Incontinence

Bowel irritants, dehydration, medication, stress, and anal sphincter dysfunction.

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Constipation

Infrequent bowel movements; fewer than 3 times a week.

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Symptoms of Constipation

Hard feces, painful passage, abdominal pain, and incomplete feeling.

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Common Causes of Constipation

Insufficient fiber, dehydration, sedentary lifestyle, and pelvic issues.

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Fecal Urgency

Sudden need to rush to the bathroom to empty bowels.

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Symptoms of Fecal Urgency

Intense urge to defecate, often triggered by diet or stress.

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Incomplete Defecation

Inability to fully empty bowels, feeling of obstruction.

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Common Causes of Incomplete Defecation

Constipation, pelvic prolapse, pelvic floor muscle issues, and stress.

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Pelvic Floor Functions

Seven main functions include stability, support, sphincteric control, and more.

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Stress Urinary Incontinence

Involuntary urine leakage due to increased abdominal pressure.

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Urge Urinary Incontinence

Involuntary leakage accompanied by a strong urge to urinate.

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Pelvic Floor Muscles

Muscles supporting pelvic organs and regulating functions.

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Piriformis Muscle

A pelvic wall muscle that can affect the sciatic nerve.

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Obturator Internus

Muscle in the pelvic wall contributing to pelvic function.

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Pudendal Nerve

Nerve involved in perineal structures and genital sensation.

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Nerves of the Sacral Plexus

Nerves originating from L4 to S4 affecting lower body functions.

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Pelvic Splanchnic Nerves

Nerves providing innervation to pelvic viscera.

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Genital Anatomy

Anatomy influencing sexual function and pelvic floor dynamics.

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Clinical Significance of Pelvis

Pelvis acts as a pumping mechanism for blood and nutrients.

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Nocturia

Excessive urination during the night.

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Mixed Urinary Incontinence

Combination of stress and urge incontinence symptoms.

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Overactive Bladder

Condition with frequent need to urinate and potential leakage.

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Posterior Femoral Cutaneous Nerve

Nerve affecting sensation in the posterior thigh.

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Pelvic Organ Prolapse

Condition where pelvic organs fall into or through the vaginal canal due to lost support.

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Symptoms of Prolapse

Pressure/bulge sensation and feeling of incomplete emptying are common in prolapse.

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Associated Conditions

40-70% of those with pelvic organ prolapse experience urinary incontinence.

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Surgery Statistics

3,000,000 surgeries for pelvic organ prolapse occur annually in the U.S.

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Pelvic Pain Reporting

42% of individuals with prolapse report pelvic pain as a symptom.

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Low Back Pain Connection

46% of people with prolapse report low back pain alongside their symptoms.

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Pelvic Support Compartments

Vagina has three compartments: anterior, posterior, and central or top, each supporting different organs.

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Cystocele

A type of prolapse where the bladder descends into the vaginal canal (anterior compartment).

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Rectocele

Posterior compartment prolapse where the rectum displaces into the vaginal canal.

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Uterovaginal Prolapse

Central compartment prolapse leading to cervix and uterus displacement downward.

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Post-Hysterectomy Prolapse

Loss of top vaginal support after hysterectomy, known as vaginal vault prolapse.

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Urodynamic Study

Bladder test recommended before prolapse surgery to assess for potential urinary incontinence.

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Overactive Pelvic Floor

Condition where pelvic floor muscles do not relax properly, leading to various dysfunctions.

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Symptoms of Overactive Pelvic Floor

Includes chronic pelvic pain, urinary urgency, and sexual dysfunction; affects both genders.

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Etiological Factors

Chronic pain, psychological distress, and trauma can contribute to an overactive pelvic floor.

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PCOS Prevalence

Polycystic Ovary Syndrome affects 5-10% of females aged 15-44.

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Involuntary Detrusor Contraction

A sudden, involuntary contraction of the bladder muscle leading to urine leakage.

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Symptoms of PCOS

Common symptoms include irregular periods, ovarian pain, and possible back pain.

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Depression in Pelvic Pain

Nearly 50% of individuals with pelvic pain report depression or sadness.

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Environmental Triggers

Situations or stimuli that provoke a need to urinate, such as running water.

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Bladder Irritants

Substances like coffee or alcohol that can cause increased urgency or frequency of urination.

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Impact of Sexual Pain

Approximately 90% of individuals with pelvic pain experience pain during sex.

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PTSD and Pelvic Pain

31% of individuals with chronic pelvic pain report PTSD symptoms.

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Functional Urinary Incontinence

Recognizing the urge to urinate but not being able to reach the toilet in time.

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Diastasis Recti

Increased distance between rectus abdominis muscles; common post-pregnancy.

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Perineal Tears

Tears can occur during vaginal birth; classified into four degrees.

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Episiotomy Definition

Surgical incision made in the perineum during childbirth to prevent tearing.

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Prevalence of Urinary Incontinence

The common occurrence of urinary incontinence among different demographic groups.

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Pubic Symphysis Diastasis

Excessive widening (>10 mm) of the pubic symphysis; postpartum risk.

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Prevalence in Pregnancy

Higher occurrence of urinary incontinence in pregnant individuals, especially in later trimesters.

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Risk Factors for Pelvic Injuries

Factors include age, number of pregnancies, and larger body size.

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Nocturia Prevalence

The frequency of nocturia often increases with age.

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Psychological Consequences

Emotional effects like anxiety and social isolation linked to urinary incontinence.

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Physical Consequences

Issues like decreased sleep quality and increased daytime fatigue stemming from incontinence.

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Economic Burden

The financial impact of incontinence management items on individuals, especially those in lower socioeconomic status.

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Common Causes of Incontinence

Factors like bladder irritants, dehydration, or environmentally induced urgency that can lead to urinary incontinence.

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Age and Incontinence

Increased prevalence of urinary issues as age advances.

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Vaginismus

Involuntary contraction of the muscles at the outer vagina, making penetration difficult.

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Dyspareunia

Pain experienced during sexual intercourse, often linked to various physical causes.

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Pelvic Floor Muscle Hypertonicity

Increased tension in pelvic floor muscles, often triggered by psychological stress.

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Central Sensitization

Increased sensitivity of the nervous system, leading to persistent pain.

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Chronic Pelvic Pain

Persistent pelvic pain lasting more than six months with no clear cause.

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Endometriosis

Condition where tissue similar to the uterine lining grows outside the uterus, causing pain.

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Bladder Pain Syndrome

Chronic pain condition of the bladder characterized by urgency and pain.

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Polycystic Ovarian Syndrome (PCOS)

Hormonal disorder causing missed periods, cysts, and infertility.

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Neuropathophysiology

Study of nerve function and pain mechanisms related to pelvic pain conditions.

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Pelvic Organ Cross Talk

Communication between pelvic organs that can lead to pain sensations.

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Prevalence of Constipation

Constipation affects 55.6% of hospitalized patients.

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Constipation Risk Factors

Older adults, frailty scores, and certain medications increase constipation risk.

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Pelvic Organ Prolapse Definition

When pelvic organs drop from their normal position into the vaginal canal or rectum.

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Types of Pelvic Organ Prolapse

Includes cystocele, uterine prolapse, and rectocele.

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Symptoms of Pelvic Organ Prolapse

Includes pressure in the vagina, pain, and unexpected bleeding.

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Risk Factors for Pelvic Organ Prolapse

Poor lifting mechanics, sedentary lifestyle, and vaginal childbirth increase risk.

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Leading Causes of Symptoms

Vaginal childbirth and nerve damage are major causes of prolapse symptoms.

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Impact of Constipation

Constipation can cause social isolation, increased anxiety, and decreased productivity.

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Economic Burden of Constipation

Cost ranges from $1,900 to $12,000 per patient due to productivity loss.

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Pelvic Health Lifestyle Education

Education focusing on breathing, bladder and bowel irritants, and stress management for pelvic health.

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Bladder and Bowel Diary

A tool for tracking bladder and bowel habits including frequency, volume, and discomfort.

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The Knack Technique

A method taught for managing stress incontinence during activities such as cough or sneeze.

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Pelvic Floor Muscle Exercises

Exercises aimed at strengthening the pelvic floor muscles to improve bladder control.

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Patient Specific Functional Scale

A questionnaire to assess the impact of symptoms on three important patient activities.

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NIH-CPSI

A questionnaire assessing pain, urination effects, and quality of life for individuals with pelvic symptoms.

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Overactive Bladder Diary

A diary for tracking bladder activity including urges, frequency, and leakage.

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Cozean Pelvic Dysfunction Screening

Screening protocol identifying musculoskeletal causes of pelvic pain through a sensitivity questionnaire.

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Pelvic Floor Screening

A tool that screens for pelvic floor dysfunction based on yes/no questions about symptoms.

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Yoga Poses for Pelvic Pain

Yoga techniques taught for alleviating pelvic pain and menstrual discomfort.

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Episiotomy

A surgical cut in the perineum to aid childbirth.

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Perineal Massage

A technique to reduce the risk of tearing during childbirth.

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Iatrophobia

An intense fear of doctors often due to past medical injustices.

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Knack Maneuver

A technique to prevent urine leakage during sneezing or coughing.

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Bladder Pain Therapy

Manual therapy aimed at reducing interstitial cystitis pain.

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Pelvic Floor Muscle Training

Exercises to strengthen pelvic muscles and alleviate prolapse symptoms.

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Yoga for Incontinence

Group yoga therapy to reduce urinary frequency and incontinence effects.

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Dysmenorrhea

Painful menstruation impacting quality of life.

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Trigger Point Release

Manual therapy technique for relieving pelvic floor muscle tension.

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Prolapse Stage Improvement

Results from pelvic floor exercises affecting severity of prolapse.

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Urinary Incontinence Improvement

Decreased symptoms of incontinence through pelvic floor training.

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Yoga Poses for Dysmenorrhea

Specific poses aimed at reducing menstrual pain intensity and duration.

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Interstitial Cystitis Results

Manual therapy significantly reducing symptoms of bladder pain.

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Lifestyle Advice for Prolapse

Information provided to patients managing prolapse through habits.

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Study Notes

Pelvic Girdle Bony Anatomy

  • Bony Pelvis: General structure differs between males (thick and heavy) and females (thin and light).
  • Greater Pelvis (False Pelvis): Shape is deeper in males and shallower in females.
  • Lesser Pelvis (True Pelvis): Males have a narrow, deep, tapering pelvis; females have a wide, shallow, cylindrical pelvis.
  • Pelvic Inlet (Superior Pelvic Aperture): Males have a narrow heart-shaped inlet; females, a wide, rounded oval inlet.
  • Pelvic Outlet (Inferior Pelvic Aperture): The pelvic outlet is smaller in males and larger in females.
  • Pubic Arch and Subpubic Angle: The pubic arch is narrower (80 degrees) in males and wider in females.
  • Obturator Foramen: Rounded in males, oval in females.
  • Acetabulum: Larger in males; smaller in females.
  • Greater Sciatic Notch: Narrower (~70 degrees, inverted V shape) in males; nearly 90 degrees in females.

Pelvic Organ Anatomy (Male)

  • Pelvic floor muscles form a hammock between pubic bone and sacrum.
  • Urethra: Urine exits.
  • Bladder: Located front.
  • Scrotum and Testicle: Below penis.
  • Rectum: Behind bladder, feces exit through anus.
  • Muscles relax to allow passage.

Pelvic Organ Anatomy (Female)

  • Uterus: Location for fetal development, within hammock region.
  • Three distinct openings: urethra (urine), vagina, and anus.

Pelvic Floor Muscles

  • Superficial Layer: Superficial transverse perineal, bulbospongiosus, ischiocavernosus, external anal sphincter. Functions include urinary and fecal continence, vaginal/penile support, and sexual function (arousal, erection, orgasm, ejaculation).
  • Intermediate Layer: Deep transverse perineal, external urethral sphincter, sphincter urethrovaginalis, compressor urethra. Functions include urinary and fecal continence, vaginal/penile support, and sexual function.
  • Deep Layer (Diaphragm): Coccygeus, ischiococcygeus, levator ani muscle group (pubococcygeus, puborectalis, iliococcygeus). Functions include fecal continence, pelvic organ support, resistance to intra-abdominal pressure.

Innervations of the Pelvic Floor

  • Various nerves, including sciatic, superior & inferior gluteal, pudendal, and nerves to levator ani and coccygeus, supply the pelvic floor muscles and associated structures, with specific segments of the sacral and coccygeal plexuses.

Pelvic Wall Muscles (Obturator Internus and Piriformis)

  • Crucial for pelvic floor function, proximity to sciatic nerve can cause pain referral.
  • Palpable and assessable externally and internally (via vaginal or anal canal).

Clinical Significance of Genital Anatomy

  • Pelvic floor function heavily influences sexual function in both sexes.
  • For females, clitoris extends along vulva, impacting sensation and function.
  • For males, saddle area tissues influence sexual function.

The Pelvis as a Sump Pump

  • The pelvis houses vascular and lymphatic structures.
  • Dysfunction can lead to congestion, affecting lower extremities, blood flow, urination, bowel movements, and reproductive health.

7 Main Pelvic Floor Functions

  • Stability: Spine and pelvis.
  • Posture: Support of pelvic organs.
  • Sphincteric: Control of urethra and anus.
  • Sexual: Sexual function / sump pump.
  • Breathing: Breathing mechanics.

Urinary Conditions

  • Stress Incontinence: Involuntary leakage with intra-abdominal pressure increase (e.g., coughing, sneezing). Possible causes include pelvic floor muscle weakness.
  • Urge Incontinence: Involuntary leakage with urge to urinate. Causes include involuntary bladder contractions, environmental triggers and bladder irritants.
  • Mixed Incontinence: Combination of stress and urge incontinence.
  • Functional Incontinence: Inability to reach the bathroom in time. Causes include impaired mobility, environmental barriers.
  • Overactive Bladder: Frequent urination (>5-8 times/day, ~every 2 hours). Causes include behavioral factors, stress, and liquid consumption.
  • Nocturia: Frequent nighttime urination (>0-1x/night). Causes include fluid intake close to bedtime, bladder irritants, or pelvic floor muscle weakness.

Bowel Conditions

  • Fecal Incontinence: Inability to control bowel movements. Causes include anal sphincter dysfunction, bowel irritants, or dehydration.
  • Constipation: Infrequent bowel movements ( < 3x/week). Causes include low fiber intake, dehydration, sedentary lifestyle, etc.
  • Fecal Urgency: Sudden need to defecate. Causes include bowel irritants, stress, dehydration or constipation.
  • Incomplete Defecation: Inability to fully empty bowels. Causes include constipation, pelvic floor dysfunction, or stress.

Pelvic Organ Prolapse

  • Definition: One or more pelvic organs descend into the vaginal canal or rectum.
  • Types: Cystocele (bladder prolapse), uterine prolapse, rectocele (rectum prolapse).
  • Symptoms: Pressure/heaviness, pain, bleeding, and low back pain.
    • Risk factors include vaginal childbirth, straining, and increased age.
    • Prevalence is high.

Pelvic Pain Conditions

  • Overactive Pelvic Floor: Persistent contraction of pelvic floor muscles. Associated with chronic pelvic pain, sexual dysfunction, and voiding problems.
  • Vaginismus: Involuntary contraction of the vagina. Causes include fear, trauma, or anxiety.
  • Dyspareunia: Painful intercourse. Causes include overactive pelvic floor, trauma, or hormonal changes.
  • Endometriosis: Tissue similar to uterine lining growing outside the uterus. Symptoms include pain, heavy bleeding, and infertility.
  • Interstitial Cystitis: Chronic bladder pain, relieved by emptying. Pain often occurs with bladder filling and urgency with or without leakage.
  • Polycystic Ovarian Syndrome (PCOS): Hormonal imbalance, causing irregular periods, cysts, hirsutism, acne and weight gain.
  • Psychological Implications: Common mental health conditions associated with pelvic pain.

Pelvic Health Physical Therapy Peripartum Considerations

  • Pubic Symphysis Diastasis: Excessive widening of the pubic symphysis.
  • Diastasis Recti: Separation of the rectus abdominis muscles.
  • Perineal Tears: Injuries to the perineum during childbirth (varying degrees).
  • Episiotomy: Surgical incision of the perineum to aid childbirth.

Evidence-Based Practice for Pelvic Health

  • Iatrophobia: Intense fear of doctors.
  • Physical Therapy Impact: Physical therapy can effectively address various pelvic health conditions such as incontinence, pelvic pain, and prolapse via techniques such as trigger point release and pelvic floor exercises.

Pelvic Health Outcome Measures and Questionnaires

  • Cozean Pelvic Dysfunction Screening Protocol: Simple questionnaire to identify musculoskeletal causes of pelvic pain.
  • Pelvic Floor Screening for Low Back and Hip Pain: Screens for pelvic floor dysfunction symptoms.
  • Overactive/Bladder Diary/Bladder and Bowel Diary: Track urination/defecation patterns, volumes, and related activities.
  • Patient-Specific Functional Scale: Rate the impact of the symptoms on important daily activities.
  • NIH-CPSI: Common questionnaire for evaluating various pelvic health issues, providing a comprehensive overview specific to different anatomical genders.

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