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Continence and Women's Health - Coggle Diagram
Continence and Women's Health
Pelvic Floor Muscles
Risk factors for weakness
Pregnancy and childbirth
Increased weight
Chronic coughing (CF, COPD)
Hormonal changes (menopause)
Heavy lifting (children, occupation, leisure)
Function
Sexual sensation
Work with abdominal muscles (namely TA) to support organs
Close the opening to bowel and bladder to prevent incontinence
Signs of weakness
Leakage of urine
Prolapse of pelvic organs
Poor control of bowel contents
Muscles
Levator Ani
Puborectalis
Pubococcygeus
Iliococcygeus
What others have I missed?
Incontinence
Types
Urgency
Functional (impaired mobility - can't get to toilet in time)
Stress urinary incontinence
Urinary and faecal
Causes
Comorbidities
Neurological injury
Dementia - Cognitive changes
Respiratory condition
Extreme stress
Heavy weight lifting
Repetitive coughing
Prolapse
Surgery
Hysterectomy
Anterior or posterior vaginal wall repair
Prostatectomy (in men)
Trauma
Especially related to pregnancy
Fistula
Long term IDC use
Poor toileting habits
Impacts
QOL
Participation in community
Social interactions (embarrassing)
Hygiene
What else could I consider?
Prevalence
F>M
Higher in elderly
Physiotherapy
Assessment
Subjective
HOPC
Urinary habits
Frequency?
Volume?
Feel empty?
Triggers for incontinence?
Bowel habits
Frequency?
Shape?
Triggers for incontinence?
Constipation?
Impact on QOL?
Goals?
Past Medical History?
Pregnancy?
Respiratory condition?
Neuromuscular condition?
Surgeries?
Hysterectomy?
Anterior/posterior vaginal wall repair?
Toileting behaviours?
Symptoms? Worsening/getting better?
Objectively
Internal Exam
Not qualified to complete - further training needed!
How is this done?
How reliable is it?
Real time US
Not qualified to complete - further training needed!
Ax deep abdominal muscles
TA activation
Demonstration of toilet position
Mobility/function (if indicated)
Significant gaps in knowledge!
What outcome measures are used?
Unsure and uncomfortable completing!
Treatment
PFMT
Starting small 3 sec holds x10 times building to 10 sec holds x10 times
Can be done almost anywhere?
Use metaphors
What metaphors are most helpful?
Pilates exercises
Everyone should do it! (unless your overactive!)
What is the evidence based way of doing this?
Education
Good bladder and bowel habits
Toileting position
Deferral strategies (if appropriate)
Constipation
Refer to dietitian?
Using supports
Immediately post pregnancy
Pessary?
What is this and how does it work? When is it used?
Will depend on type!
Address contributing factors
Weight
Lighting to bathroom
Does pt require gait aid?
Resources
Hospital handouts
Senior Continence Therapists
Are there any other resources that could be used?
REFER ONTO WOMEN'S HEALTH SERVICE!!
Clinical Experience
Minimal exposure to area
Have provided toileting advice to women post birthing
Yet to see a patient solely for urinary incontinence
Always refer to senior therapist
To consider
PD course on continence
Supervision with women/men's health PT
Covering maternity ward when on offer