Pelvic Hypotonic/Hypertonic Dysfunction

Question 1

hypotonic disorders

Answer 1

urinary incontinence
urinary frequency
urinary urgency
fecal incontinence/urgency
fecal frequency
pregnancy
prolapse
post surgical
ED
anorgasmia
core instability
diastasis recti

Question 2

typical presentation for hypotonic disorders

Answer 2

predominantly weakness

Question 3

what must happen first in order to cause opening of external sphincter?

Answer 3

pelvic floor must relax

Question 4

micturition/voiding

Answer 4

bladder emptying

Question 5

upper urinary tract

Answer 5

includes kidneys

Question 6

lower urinary tract

Answer 6

includes ureters, bladder, urethra

Question 7

layers of bladder

Answer 7

peritoneal, epithelial, detrusor

Question 8

detrusor

Answer 8

smooth muscle layer allowing bladder to stretch/fill
-results in involuntary contraction to initiate bladder empyting

Question 9

why do men have more continence control than women?

Answer 9

urethra is 4-5x longer

Question 10

urinary incontinence

Answer 10

any involuntary loss of urine that is a social or hygenic problem

Question 11

what is required for bladder control?

Answer 11

intact nervous system and urinary system, cognitive ability to recognize need to void, and physical capacity to make it to bathroom

Question 12

stress incontinence

Answer 12

loss of urine during physical exertion or when intravesical pressure > maximum urethral pressure
- d/t inc in intraabdominal pressure in absence of detrusor contraction
-cough, laugh, sneeze, jump
-small volume loss

Question 13

underlying causes of stress incontinence

Answer 13

urethral hypermobilty
pelvic floor muscle laxity/weakness
intrinsic/internal sphincter deficits
chronic respiratory disorder
high level athletes

Question 14

stress incontinence process

Answer 14

change in intra-abdominal pressure -> pelvic floor cant keep up -> pushes on bladder -> urine forced downward -> pelvic floor not strong enough -> leak

Question 15

urge incontinence

Answer 15

involuntary loss of urine that occurs with a strong desire to urinate with little warning time
-bladder contracts
-usually occurs w/ trigger
-mod to large loss of volume

Question 16

mixed incontinence

Answer 16

patient displays s/s of both stress and urge incontinence
-leakage w/ cough, laugh, sneeze
-leakage on way to bathroom

Question 17

functional incontinence

Answer 17

patient is aware of need to urinate but is unable to make it to the restroom in time d/t physical or cognitive limitations
-small to large volume loss

Question 18

normal age related bladder changes

Answer 18

-dec bladder capacity
-dec ability to postpone voiding
-inc post void residual
-dec estrogen -> dec urethral mucosa
-dec estrogen -> dec vascularity
-loss of smooth muscle fibers

Question 19

how much water should you drink a day?

Answer 19

1/2 BW in ounces

Question 20

what can dark brown urine color indicate?

Answer 20

liver dysfunction

Question 21

how much volume does bladder hold?

Answer 21

400-600 mL

Question 22

normal frequency to void

Answer 22

4-8x/day

Question 23

1st sensation of voiding

Answer 23

100-200 mL or 40% capacity

Question 24

1st desire to void

Answer 24

60% capacity

Question 25

normal night voiding frequency

Answer 25

0-1x (<65 y/o) 1-2x (>65 y/o)

Question 26

timed voiding

Answer 26

voiding at a consistent rate -helps get normal neurological signal going to bladder to fill then tell brain time to void

Question 27

fecal incontinence

Answer 27

inability to hold bowel movement until reaching bathroom

Question 28

why squatty potty is optimal posture for bowel emptying

Answer 28

relaxes pelvic floor muscles (puborectalis) -> inc anorectal angle

Question 29

pelvic organ prolapse

Answer 29

decent of 1 or more ant. vaginal wall, pos. vaginal wall, or uterus

Question 30

cystocele

Answer 30

bladder prolapse

Question 31

cystourethrocele

Answer 31

bladder and urethra prolapse

Question 32

rectocele

Answer 32

rectal prolapse

Question 33

enterocele

Answer 33

intestinal prolapse

Question 34

uterine prolapse

Answer 34

prolapse of uterus

Question 35

risk factors for pelvic organ prolapse

Answer 35

-female -vaginal burst -pelvic floor avulsion -tears -inc. intra-abdominal pressure -inc. BMI -CT disorder -prolonged pushing during labor (>90min) -inc thoracic kyphosis or lumbar lordosis -> tilts pelvis -> pressure on organs

Question 36

hypertonic disorders

Answer 36

-generalized pelvic pain -hypertonic pelvic floor -myofascial pain syndrome -interstitial cystitis -endometriosis -PCOS/dysmenorrhea -constipation -UTI/infections -prostatitis -coccydynia

Question 37

5 APTA categories of pelvic pain

Answer 37

-supportive -hypertonus -incoordination -visceral -chronic pelvic pain

Question 38

supportive pelvic pain

Answer 38

hypermobility issue -ELS, CT disorder -> inc tissue mobility -pelvic floor becomes overactive w/ lack of structural support to lumbar/pelvis/hip

Question 39

hypertonus pelvic pain

Answer 39

pelvic tensioning -myalgia/spasms/vaginisimus -dyspareunia -vulvodynia -coccydynia -constipation

Question 40

incoordination related pelvic pain

Answer 40

muscles create dissynergy (doing opp. of what they're supposed to)

Question 41

endometriosis

Answer 41

endometrial cells (found in uterus) that produce menstrual cycle are found outside uterus -produce same effect (sloughing, scar tissue, plaques) -cells grow that should not be there -chronic/systemic pain

Question 42

interstitial cystitis

Answer 42

body is attacking cells w/in lining of bladder leading to ulcers -begins w/ urinary frequency, urethral burning, pain in lower abdomen -mimics UTI -urinate up to 40-60x/day; worse at night

Question 43

pudendal neuralgia

Answer 43

irritation injury; impacts pudendal nerve (runs thru pudendal canal) -S2-4; innervates genitals, sphincters, pelvic floor muscles -common in cyclists -nerve pain symptoms

Question 44

lichen sclerosis

Answer 44

painful white patches of skin occur throughout genital areas -leads to scarring; short/tight pelvic floor

Question 45

prostatitis

Answer 45

inflammation of prostate -leads to swelling, pressure on pelvic floor, compress nerves/bladder/bowel -present w/ UTI