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