Professional Documents
Culture Documents
G ldil k
Goldilocks
{ Specific
f grouping off muscles,
ligaments and fascia which interlace
and provide support-includes
support includes
pubococcygeus and levator ani
{ Keep pelvic organs in the pelvis
z Bladder
z Uterus
z Rectum
J t Right…
Just Ri ht
{ Heredity
z Genetic predisposition to poor tissue
integrity
{ Can be seen in need for multiple
reconstructions
z Prolapse and incontinence can often
“run in the family”
C
Causes ffor pelvic
l i fl
floor relaxation
l ti
{ Age
z GRAVITY!!
{ Anything that increases abdominal
pressure
z Runners
R
z Horseback riders
z Gymnasts
P
Prevalence
l off St
Stress Incontinence
I ti
{ 1 in
i three
th women willill have
h leaking
l ki
with stress maneuvers within 5
years of a vaginal delivery
{ 50-75% of women who have it
won’t even tell their p
physician.
y Of
those who did, 61% waited 4 years
{ In the U.S. more feminine pads are
usedd for
f iincontinence
i than
h for
f
menstruation
Prevalence of pelvic organ prolapse
{ Grade
{ Accessory muscle use
z Most common-bottom, thighs and
abdominal muscles
z Make note if patient is using
z When a Kegel is done correctly the
contraction is in pelvic floor only!!
Ed
Education
ti
{ Identify
f muscle
{ Start doing 3 long hold exercises in
a set
z Hold for 3 seconds and relax for 3
seconds in between
z 4 sets/day
z May not feel the entire 3 seconds but
should strive for them
P
Progressive
i exercise
i program
{ Standing
{ Elevator
z Sit on floor and increase the
contraction in stages
z Think about as floors until top floor and
back down
z Takes a lot of concentration and control
F
Formal
l ttraining
i i
{ Before
f childbearing
z Can see hypertonicity in this group
z A k about
Ask b pain
i with
i h intercourse
i or
during voiding
Pregnancy
{ Most helpful
f to have strong pelvic
floor going into pregnancy and
continue to do exercises throughout
z No specific guidelines regarding
trimester variations
z OK to do immediately after delivery
z Often taught
g in p prenatal y
yoga
g classes
D li
Delivery
{ Often
f when dysfunction
f begins to
appear in terms of incontinence and
prolapse
z Stress and urge related incontinence
z May be more compliant after symptoms
appear
z Must ask about these symptoms
y p to
open a dialogue!
P t
Post-menopausal
l
{ Estrogen depletion
z Consider vaginal estrogen for stress
incontinence research not definitive
incontinence-research
z May have more time for physical
therapy
z May be more interested in non-surgical
intervention due to co-morbidities
z Sometimes have hard time identifying
the muscles due to weakness
Wh t do
What d Kegels
K l NOT d
do?
?