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The Female Pelvic Floor and Goldilocks-Handout | Urinary Incontinence | Urology

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Slides from recent talk by Meagan Matteson, a Nurse Practitioner with a specialty in urogynecology.
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  5/23/20091 The Female Pelvic Floor andGoldilocks Too weak, too tight and just right!(or just right, too weak and too tight)Meagan Matteson, RN, MS, CNP meagan.matteson@osumc.eduFeel free to contactme with ?swww.augs.org(great resource!)   Just Right…  Specific grouping of muscles,ligaments and fascia which interlaceand provide support-includes  Keep pelvic organs in the pelvis  Bladder  Uterus  Rectum Just Right…  Muscles create circles (sphincters)around outlets of those organs tokeep us clean and dry    or exampe-urnaon  Bladder muscle is relaxed until need tovoid-pelvic floor muscles are contracted  When voiding bladder muscle contractsand pelvic floor relaxes Just right…  Roll in sexual function  Orgasm is essentially a rhythmicmuscular contraction-stronger= Too Weak…  Increased risk of stress urinaryincontinence due to weakness of both the urethral sphincter and  Leaking with coughing, laughing, etc.  Increased risk of pelvic organprolapse or relaxation   “My bladder is falling out…”   5/23/20092 Types of Pelvic Organ ProlapseCauses for pelvic floor relaxation  Childbearing (not just vaginaldelivery!)  Increased pressure intra-abdominally  Vaginal delivery disrupts integrity of the musculature if everything goes well(intact)  Increased risk with perineal traumasuch as tearing or episiotomy Causes for pelvic floor relaxation  Heredity  Genetic predisposition to poor tissueintegrity  reconstructions  Prolapse and incontinence can often “run in the family”  Causes for pelvic floor relaxation  Age  GRAVITY!!  Anything that increases abdominalpressure  Runners  Horseback riders  Gymnasts Prevalence of Stress Incontinence  1 in three women will have leakingwith stress maneuvers within 5years of a vaginal delivery-7   won’t even tell their physician. Of those who did, 61% waited 4 years  In the U.S. more feminine pads areused for incontinence than formenstruation Prevalence of pelvic organ prolapse  40% of women over the age of 40have some pelvic organ prolapse  50% of women who delivervagnay ave some egree oprolapse  5/23/20093 Too Tight (Hypertonic)…  Detrusor sphincter dyssynergia(DSD)-inability to appropriatelyrelax the pelvic floor with acontraction of the bladder-leads topoor emptying or painful voiding  Pelvic pain syndromes such asvestibulodynia or vulvar vestibulitis  May contribute to Irritable BowelSyndrome and Interstitial Cystitis Causes for pelvic floor hypertonicity  Spinal cord injury  Dysfunctional habits in response tochronic pain  Severe vaginal atrophy  Pelvic trauma  Repeated infections  Pain-fear cycle=pain causes fear causestension causes more pain What can we do?  Talk about the pelvic floor with yourpatients or your clinician  Initiate honest discussion about pelvic  Start young-easier for patients toidentify and strengthen when theyare young and muscles are strong  Elicit pelvic floor history to aid inintervention! Physical exam-What to expect  Done at time of bimanual exam  Ask patient to squeeze around yourfingers, aka…  Squeeze like you are trying to hold ingas in a crowded room Stop your urine on the toilet…  Not a great idea long term-confusesthe voiding messages  Patient should feel a liftingsensaon-e a srng pung ervagina up  Do on a hard chair for mostfeedback-hardest to do standing(gravity) Physical exam  Give patient a grade 0-5/5  0-no movement to the pelvic floor  1-flicker  -wea  3-moderate (lift)  4-good (lift)  5-strong (lift)  5/23/20094 Physical exam  Grade  Accessory muscle use  Most common-bottom, thighs andaomna musces  Make note if patient is using  When a Kegel is done correctly thecontraction is in pelvic floor only!! Education  Not just for older women or peoplewho are incontinent!  Start early and help the musclessay one.  Re-visit this every year at annualexam starting at initialappointment. Education  2 types of exercises-long holds andquick flicks  Long holds work slow-twitch musclecontinent-unconscious (70%)  Quick flicks work fast-twitch fibers usedduring stress maneuvers (30%) Progressive exercise program  No special devices are needed  Patient compliance is key!  Only works while patients do them-use it or lose it!  Informal or formal training (athome versus physical therapy) Progressive exercise program  Identify muscle  Start doing 3 long hold exercises ina set  Hold for 3 seconds and relax for 3seconds in between  4 sets/day  May not feel the entire 3 seconds butshould strive for them Progressive exercise program  When you feel the hold for 3seconds increase the hold/relaxtime and number of reps by 2    reps, o secons, reax secons4x/day
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