Physiotherapy in Women's Health and Geriatric

Bony Pelvis

• The bony pelvis provides a strong, stable connection between the trunk and lower extremities.
• Its main functions are:
  • Transmitting the weight of the body from the vertebral column to the femurs.
  • Containing, supporting, and protecting the pelvic viscera.
  • Providing attachment to trunk and lower limb muscles.
• The pelvic girdle is composed of four bones:
  • Two hip bones (coxal bones).
  • Sacrum.
  • Coccyx.
• The hip bone is a large, irregular bone formed by the fusion of three bones:
  • Ilium.
  • Ischium.
  • Pubis.

Hip Bone

• The ilium is the upper, flattened part of the hip bone.
• It possesses:
  • Iliac crest.
  • Iliac fossa.
  • Auricular surface.
  • Iliopectinial line.
• The pubis forms the anterior and inferior part of the hip bone.
• It has:
  • Body.
  • Pubic crest.
  • Pubic tubercle.
  • Two pubic rami.
  • Obturator foramen.
• The ischium forms the inferior and posterior part of the hip bone.
• It has:
  • Ischial tuberosity.
  • Ischial spine.
  • Greater sciatic notch.
  • Lesser sciatic notch.

Articulations of Hip Bone

• Symphysis pubis:
  • A cartilaginous joint between the two pubic bones.
• Sacroiliac joints:
  • Strong synovial joints between the auricular surfaces of the ilium and sacrum.
• Hip joint:
  • The outer surface articulates at the acetabulum with the head of the femur.

Sacrum

• The sacrum is a single, wedge-shaped bone formed by the fusion of five rudimentary vertebrae.
• It has:
  • Sacral promontory.
  • Sacral canal.
  • Sacral foramina.
  • Sacral hiatus.

Coccyx

• The coccyx is formed by the fusion of four vertebrae.
• It articulates with the sacrum.

Male vs Female Pelvis

• The female pelvis is wider and shorter than the male pelvis.
• The pelvic outlet is oval-shaped in females and heart-shaped in males.
• The angle of the pubic arch is wider in females.
• The promontory and ischial spines are less projecting in females.

Types of Female Bony Pelvis

• Gynecoid/genuine pelvis:
  • Round brim.
  • Wider pelvic cavity.
  • Less prominent ischial spines.
• Android pelvis:
  • Heart-shaped brim.
  • Narrower pelvic cavity.
  • Prominent ischial spines.
• Anthropoid pelvis:
  • Oval brim.
  • Slightly narrower pelvic cavity.
  • Larger outlet diameter.
• Platypelloid pelvis:
  • Shallow pelvic cavity.
  • Decreased anteroposterior diameter.
  • Broad outlet.

Pelvic Floor Muscle

• The pelvic floor is a dome-shaped muscular sheet separating the pelvic cavity from the perineal region.
• It encloses the pelvic viscera (bladder, intestines, and uterus in females).
• Functions:
  • Supports the abdominal and pelvic viscera.
  • Maintains continence of urine and faeces.
  • Allows voiding, defecation, sexual activity, and childbirth.

Pelvic Floor Muscles

• The pelvic floor is a funnel-shaped structure.
• It consists of three main components:
  • Levator ani muscles.
  • Coccygeus muscle.
  • Fascia coverings of the muscles.

Levator Ani Muscles

• The levator ani is a broad sheet of muscle.
• It consists of three paired muscles:
  • Pubococcygeus.
  • Puborectalis.
  • Iliococcygeus.

Abdominal Muscles

• The abdominal muscles are the muscles forming the abdominal walls.
• Functions:
  • Support the trunk.
  • Allow movement.
  • Hold organs in place.
  • Are distensible.

Muscles of the Abdominal Wall

• Rectus abdominis.
• External oblique.
• Internal oblique.
• Transversus abdominis.

Rectus Abdominis

• Origin: Crest of pubis and symphysis pubis.
• Insertion: Xiphoid process of sternum and costal cartilages of 5th to 7th ribs.
• Action: Tenses abdominal wall, compresses abdominal contents, and flexes vertebral column.

External Oblique

• Origin: Outer surfaces of lower 8 ribs.
• Insertion: Iliac crest and linea alba.
• Action: Tenses abdominal wall and compresses abdominal contents.

Internal Oblique

• Origin: Crest of ilium and inguinal ligament.
• Insertion: Cartilages of lower ribs, linea alba, and crest of pubis.
• Action: Tenses abdominal wall and compresses abdominal contents.

Transversus Abdominis

• Origin: Costal cartilages of lower ribs, processes of lumbar vertebrae, and lip of iliac crest.
• Insertion: Linea alba and crest of pubis.
• Action: Tenses abdominal wall and compresses abdominal contents.### Abdominal Wall
• Consists of skin, external oblique, internal oblique, transversus abdominis, and peritoneum
• Rectus abdominis muscle located in the anterior abdominal wall

Female Reproductive System

• Consists of ovaries, uterine tubes, uterus, vagina, and external organs (vulva or pudendum)
• Mammary glands also part of the female reproductive system

Ovaries

• Paired organs that produce secondary oocytes and hormones
• Located in the pelvic cavity on each side
• Ovarian follicles consist of an oocyte and surrounding cells that nourish the oocyte and produce hormones
• Follicles develop into mature (graafian) follicles, which rupture to release a secondary oocyte (ovulation)
• Remnants of an ovulated follicle develop into corpus luteum, which produces progesterone, estrogen, relaxin, and inhibin

Uterine Tubes (Fallopian Tubes)

• Two tubes that extend laterally from the uterus
• Infundibulum is the open and funnel-shaped end of the tube
• Fimbriae sweep the secondary oocyte into the tube
• Site of fertilization (occurs within 24 hours after ovulation)
• Unfertilized ova disintegrate, while the zygote reaches the uterus in approximately 7 days

Uterus

• Pathway for sperm and site of implantation
• Structure consists of:
  • Fundus: dome-shaped area above the uterine tubes
  • Body: tapering central portion
  • Cervix: narrow opening into the vagina
• Uterine cavity: interior of the body
• Middle muscular layer: myometrium
• Innermost layer: endometrium, which sheds each month during menstruation if fertilization doesn't occur

Vagina

• Extends from the cervix to the exterior
• Functions include:
  • Receptacle for the penis during sexual intercourse
  • Outlet for menstrual flow
  • Passageway for childbirth
• Acid environment prevents bacterial growth
• Smooth muscular layer adjusts for intercourse or birth
• Hymen: a thin membrane fold that can cover the vaginal orifice

Menstrual Cycle

• Consists of menstrual phase, preovulatory phase, ovulation, and postovulatory phase
• Menstrual phase: 5-7 days, characterized by menstruation and repair of the endometrium
• Preovulatory phase: increase in estrogen stimulates the thickening of the endometrium
• Ovulation: rupture of the mature follicle and release of the secondary oocyte into the fallopian tube
• Postovulatory phase: corpus luteum produces progesterone and estrogen, which promote thickening of the endometrium