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Role of Physiotherapist in Obstetric and Gynecological Conditions
Purvi K Changela
CHAPTER 1:
Women's Health Care in Physical Therapy
INTRODUCTION
THE PHYSIOTHERAPISTS AS HEALTH PROMOTERS
AWARENESS ON UTILIZATION OF MATERNAL HEALTH EDUCATION AND SERVICES
BARRIERS TO UTILIZATION OF MATERNAL HEALTH SERVICES
QUALITY OF MATERNAL HEALTH SERVICES
CHANGING DEFINITION OF WOMEN's HEALTH-IMPLICATION FOR HEALTH CARE
ROLE OF PHYSIOTHERAPIST IN WOMEN's HEALTH EDUCATION
Physiotherapy in Adolescent and Puberty
Physiotherapy in Reproductive Age
Physiotherapy During and After Pregnancy
Physiotherapy During the Stages of Climacteric and Menopausal Age
ROLE OF PHYSIOTHERAPY IN HEALTH-RELATED QUALITY OF LIFE
SUMMARY
CHAPTER 2:
Anatomical Consideration
INTRODUCTION
FEMALE PELVIS ANATOMY
The Bony Pelvis
Classification of Pelves
Male v/s Female Pelvis
Bony Landmarks of the Pelvis
The Soft Tissues
The Ligaments
The Pelvic Floor and Muscles of the Pelvis
The Abdominal Muscles
The Biomechanics of Pelvis
Joints of the Pelvis Girdle are (Fig. 2.12)
Balanced Loading (Fig. 2.14)
The Force Couple (Fig. 2.15)
THE PERINEUM
THE FEMALE REPRODUCTIVE TRACT
Changes Related to Reproduction….
Function of Female Reproductive Tract
Blood Supply and Nerve Supply
Uterine Anomalies
THE BREAST
THE URINARY TRACT
The Ureter
The Bladder
The Kidney
The Urethra
The lower urinary tract
THE ANORECTAL REGION
ANATOMICAL CONSIDERATION AND PHYSIOTHERAPY
SUMMARY
CHAPTER 3:
Physiology of Pregnancy
THE FEMALE REPRODUCTIVE CYCLE
Stages of Menstruation (Fig. 3.1)
Phases of the Female Reproductive Cycle
The Ovarian Cycle (Fig. 3.3)
The Follicular Phase
Luteal Phase
The Uterine Cycle (Fig. 3.3)
Menstrual Phase (day 1–4)
Proliferative (estrogenic) Phase (day 4–14)
Secretory (progestational) Phase (day 15–28)
Clinical Implication
Hormonal Regulation (Table 3.1)
Common Symptoms During the Menstruation (Table 3.2)
PREGNANCY AND FETAL DEVELOPMENT
Estimated Date of Delivery (EDD)
Prenatal Development ~ Phase 1
Prenatal Development ~ Phase 2
Prenatal Development ~ Phase 3
PHYSIOLOGICAL CHANGES IN PREGNANCY
Changes in Blood Volume
Physiological Anemia of Pregnancy
Clinical Implications
Changes in the Cardiovascular System
Workload on the Heart
Blood Pressure
Venous Return
Stuffy Nose
Clinical Implications
Changes in the Respiratory System
Anatomy and Physiology
Lung Volume and Capacity
Pulmonary Circulation
Blood Gases
Clinical Implications
Changes in the Renal System
Renal Dilatation
Renal Function
Bladder Function
Clinical Implications
Changes in Endocrine System
Parathyroid Gland
Pituitary Gland
Placenta
Effects of Progesterone
Effects of Oestrogens
Effects of Relaxin
Clinical Implication
Changes in the Gastrointestinal System
Gastrointestinal Motility
Stomach and Esophagus
Gallbladder
Clinical Implications
Changes in the Central and Peripheral Nervous Systems
Clinical Implications
Changes in Hematological System
Clinical Implication
Changes in the Musculoskeletal System
Generalized Changes
Structural Changes (Fig. 3.9)
Clinical Implication
Changes in the Dermatological System
Linea Nigra
Mask of Pregnancy (Chloasma)
Striae Gravidarum (Stretch Marks)
Sweat Glands
Vascular Nevi
Fat Deposition
Changes in Mammary Tissue
Blood Supply
Sebaceous Gland Activity
Hyperpigmentation
Clinical Implications
Changes in the ocular system
Clinical Implications
Changes in Reproductive System
Uterus
Cervix
Vagina, Perineum, and Vulva
Ovaries
Clinical Implication
Changes of Body Temperature During Pregnancy
Changes in Body Weight During Pregnancy
Clinical Implication
Changes in Posture and Balance
Clinical Implication
RISK AND COMPLICATIONS DURING PREGNANCY
Pregnancy Complications
SUMMARY
CHAPTER 4:
Pregnancy Tests and Special Investigations
INTRODUCTION
CLINICAL MANIFESTATIONS OF EARLY PREGNANCY
DIAGNOSIS OF PREGNANCY
History and Physical Examination
Laboratory Evaluation
Ultrasonography
FIRST TRIMESTER
Symptoms
Amenorrhea
Breasts Changes
Skin Changes
Morning Sickness
Vaginal Discharge
Irritability of the Bladder
Uterine Changes
Pregnancy Tests
Hormonal Test
Ultrasound
SECOND TRIMESTER
Symptoms
Physical Examination
Fetal Movements (Quickening)
Uterus
Investigations
THIRD TRIMESTER
Symptoms
Physical Examination
SCREENING TESTS DURING PREGNANCY
SUMMARY
CHAPTER 5:
Physical and Physiological Changes of Normal Labor and the Puerperium
INTRODUCTION
CAUSES OF ONSET OF LABOR
Hormonal Factors
Mechanical Factors
CLINICAL PICTURE OF LABOR
Prodromal (Pre-labor) Stage
STAGES OF NORMAL LABOR
First Stage
Second Stage
Third Stage
Fourth Stage
EVENTS IN DIFFERENT STAGES OF LABOR
First Stage (Fig. 5.3)
Causes of cervical dilatation:
Clinical Relavance
Second Stage (Fig. 5.5)
The Second Stage has two Phases
Third Stage (Fig. 5.6)
Mechanism
MECHANISM OF NORMAL LABOR (FIG. 5.7)
Engagement
Descent
Flexion
Internal Rotation
Crowning
Extension
Restitution
External Rotation
Expulsion of the Trunk
PROCESS OF NORMAL LABOR
The Powers
The Passenger
The Passages
LABOR PAIN
Perception of Pain in Pregnancy
Mechanisms and Characteristics of Labor Pain
MANAGEMENT OF NORMAL LABOR
Aims
Management of First Stage of Labor
History
Examination
Investigations
Active Procedures
Management of Second Stage of Labor
Management of Third Stage of Labor
Immediate Care of Newborn
Management of the Fourth Stage of Labor
Care of the Newborn
Complications During Labor
Failure to Progress
Fetal Distress
Breech Presentation
Malposition
Prolapsed or Presentation of the Cord
Knots of the Umbilical Cord
Incoordinate Uterine Activity
Hemorrhage
Contracted Pelvis and Cephalopelvic Disproportion
Placental Abruption
Multiple Births
Perineal Trauma
Retained Placenta and Placenta Accreta
Shoulder Dystocia
INDUCTION OF LABOR
Induction of labor can be justified when:
Prerequisites for Labor Induction
Maternal
Fetal
Indications, Contraindication and Caution
Maternal Indications
Fetal Indictions
Contraindications
Cautions
Methods of Induction
ABNORMAL PROGRESSION OF LABOR
To Initiate Labor in the First Stage
Prostaglandins
Oxytocin
Amniotomy
To Assist Delivery in the Second Stage
Non-operative Practices that Decrease the Need for Operative Birth
Operative Vaginal Birth
THE PUERPERIUM
Duration
Physiological Changes During Puerperium
Physiological Considerations
Muscle
Endometrium
Blood Vessels
Clinical Assessment of Involution
Involution of the Other Pelvic Organs
General Physiological Changes in Puerperium
MANAGEMENT OF NORMAL PUERPERIUM
Management of Ailments
COMPLICATIONS IN THE PUERPERIUM
Postpartum Hemorrhage (PPH)
Etiology of PPH
Sign and Symptoms of PPH
Prevention of PPH
Retained Placental Fragments
Etiology and Pathophysiology
Signs and Symptoms
Treatment
Placenta Accreta
Etiology and Pathophysiology
Signs and Symptoms
Treatment
Hematoma
Etiology and Pathophysiology
Signs and Symptoms
Treatment
Puerperal Infections
Causative Factors
Signs and Symptoms
Treatment
Venous Thrombosis, Pulmonary Embolism
Predisposing Factors
Signs and Symptoms
Treatment
Mastitis
Types
Signs and Symptoms
Treatment of Mastitis
Preventative Measures
Puerpeal Cystitis
Etiology and Pathophysiology
Prevention
Signs and Symptoms
Treatment
Postpartum Depression
Predisposing Factors
Localized Infection
Signs and symptoms
Treatment
Vesicovaginal Fistula (VVF)
Late Postpartum Hemorrhage
SUMMARY
CHAPTER 6:
Antenatal Care and Role of Physiotherapy
INTRODUCTION
THE MATERNITY TEAM CARE
THE AIMS OF ANTENATAL CARE
ANTENATAL EDUCATION— “PREPARATION FOR BIRTH AND BEYOND”
Antenatal Care Options (Fig. 6.2)
Pregnancy
Labor and Birth
ROUTINE ANTENATAL CARE
Schedule of Clinical Visit
Booking Visits
Subsequent Visits
Schedule the Next Visit
Antenatal Screening Tests (AST)
Antenatal Screening Includes
PRECONCEPTUAL CARE
Preconception Planning Schedule
Key Components of Preconception Care
Role of Physiotherapy in Preconception Care
Infertility/subfertility and Role of Physical Therapy
Early Pregnancy Care
“BIRTH, BABY AND BEYOND” —PLANNING AND LEADING LABOR AND CHILDBIRTH PREPARATION CLASSES IN COMMUNITY
Programme Aims, Contents and Plans
Aims
Contents
Plans
Role of Physiotherapist
Complementing Instructions from Other Team Members
Class Arrangements
Environment
“Early Bird “ classes
Assessment of Physical Health
Pregnancy Back Care
Treatment of Neuromuscular and Musculoskeletal problems
Recognize the Sign of Fatigue
Emotional Reactions
Advice on Lifestyle
Neuromuscular Tension Control
Diet and Weight Gain in Pregnancy
Reassurance and Self-Care Advices
Multiple pregnancies
Sexual Intercourse
Environmental Hazards
Rest, Work and Travel
Exercise and Recreation
Teach Positions for Labor
Guidance for Postnatal Exercises
Newborn Care
Education for Breastfeeding
Birth Spacing
Prenatal Pilates Classes (Fig. 6.18, Fig. 6.21D)
Benefits
Yoga Class for Pregnancy (Fig. 6.19, Fig. 6.21E)
Benefits of Yoga in Pregnancy
Aquanatal Exercise Classes (Fig. 6.20, Fig. 6.21C)
Benefits of Aquanatal Classes
SUMMARY
CHAPTER 7:
Exercises and Pregnancy
INTRODUCTION
Key Points of Concern
BIOMECHANICAL AND ANATOMICAL CONSIDERATIONS FOR EXERCISE GUIDELINES IN PREGNANCY
Clinical Relevance
BENEFITS OF EXERCISES DURING PREGNANCY FOR WOMEN
SAFETY OF EXERCISE DURING PREGNANCY
PHYSIOLOGIC CONSIDERATIONS AFFECTING EXERCISE DURING PREGNANCY
PREGNANCY PRESENTS A UNIQUE MOTIVATION TO BEGIN OR CONTINUE AN EXERCISE PROGRAM: GUIDELINES FOR EXERCISE DURING PREGNANCY
Exercises Guideline
EXERCISE PROGRAMING, TESTING AND MONITORING
EXERCISE ENVIRONMENT
NUTRITION GUIDELINES
Monitoring During Exercises
EXERCISE DURING THE POSTPARTUM PERIOD
RECOMMENDED EXERCISES FOR PREGNANT WOMEN
Stretching Exercises for Pregnant Women
Strengthening Exercises for Pregnant Women
Corrective Exercises for Diastasis Recti
Abdominal Exercises for Pregnant Women
Modified Cycle Exercises
Pelvic Floor Strengthening Exercises
Pelvic Clock Exercises
Heel Slide Exercises
Pelvic Bridging Exercises
Unsafe Posture During Exercises
SUMMARY
CHAPTER 8:
Pregnancy Discomforts and Role of Physiotherapy
INTRODUCTION
Pregnancy Related Problems: Role of Physiotherapy
BACK AND PELVIC GIRDLE PAIN
Mechanisms of LBP occurrence during Pregnancy
Biomechanical/Musculoskeletal
Hormonal
Vascular
Treatment Options
Prevention of Back Pain
Proper Posture
Ergonomic Enhancement
Exercise Programs
Sacroiliac Joint Dysfunction
Symptoms
Treatment Options
Sciatica
Treatment Options
Symphysis Pubis Dysfunction (SPD)
Treatment Options
Coccydynia
Treatment Options
Postural Backache
Symptoms
Treatment Options
Thoracic Spine Pain
Treatment Options
Pregnancy Associated Osteoporosis
NERVE COMPRESSION SYNDROMES
Carpal Tunnel Syndrome
Clinical Symptoms
Treatment Options
Brachial Plexus Pain
Treatment Options
Meralgia Paraesthetica
Treatment Option
Posterior Tibial Nerve Compression
Treatment Options
CIRCULATORY DISORDERS
Varicose Veins
Treatment Options
Vulval Varicose Veins
Treatment Options
Hemorrhoids (Fig. 8.12)
Treatment Options
Cramps
Treatment Options
Thrombosis and thromboembolism
Treatment Options
OTHER PROBLEMS
Body Image
Consequences
Treatment Options
Breast Changes
Treatment Options
Constipation
Treatment Options
Chondromalacia Patellae
Treatment Options
Dizziness
Treatment Options
Depression
Treatment Options
Fatigue
Treatment Options
Fibroids (Fig. 8.14)
Treatment Options
Heartburn
Treatment Options
Hip Pain
Treatment Options
Insomnia and Nightmares
Treatment Options
Joint Laxity
Treatment Options
Morning Sickness
Treatment Options
Pain from Abdominal Adhesions
Pelvic Pressure and Pain During Pregnancy
Symptoms
Treatment Options
Rib Cage Pressure
Treatment Options
Restless Leg Syndrome
Treatment Option
Swelling
Causes
Symptoms
Treatment
Uterine Ligament Pain
Treatment Options
Urinary Frequency
Urge and Stress Incontinence
Treatment Options
SUMMARY
CHAPTER 9:
Preparation for Labor and Physiotherapy
INTRODUCTION
GOALS OF PREPARATION FOR LABOR AND BIRTH
PREPARATION FOR LABOR
Aims
Education
RELAXATION TECHNIQUES
During Labor and Delivery, Fit Women Experience
BREATHING AWARENESS
Benefits/Purpose of Breathing Techniques
Lamaze Breathing Technique
Breathing Techniques for First Stage Labor
Slow Breathing (Relaxed Chest Breathing, Abdominal Breathing)
Light Breathing (Hee Hee Breathing)
Patterned Breathing (Hee-Blow Breathing, Lamaze Breathing)
Variable Breathing (Transitional Breathing, Take Charge Routine)
Breathing Techniques for Second Stage Labor
Pant-Blow
Spontaneous Bearing Down (Expulsion Breathing)
Directed Pushing
POSITIONS IN LABOR
MASSAGE IN LABOR
Technique
Back Massage (Fig. 9.6)
Leg/Foot Massage
Perineal Massage
Abdominal Massage (Fig. 9.10)
Hand Massage (Fig. 9.11)
PAIN RELIEF STRATEGIES
Placement of Electrodes
Mode of Stimulation
Safety Limits
Practical considerations in the use of TENS
Benefits of Labor TENS
Ideal time to Start Labor TENS
Duration of Treatment with Labor TENS
SUMMARY
CHAPTER 10:
Physical Therapy and Postpartum Care
INTRODUCTION
PLANNING POSTNATAL CARE
The Initial Care Planning Should Include
POSTPARTUM PHYSICAL/ MENTAL CHANGES
Ligaments
Abdominal Muscles
Uterus
Endometrium
Pelvic Floor Muscle (PFM)
The Perineum
Edema
Back Discomforts
Breasts Discomforts
Psychological State
POSTNATAL CARE
Routine Care
Assessment During Postnatal Period
History
Physical Assessment
Postpartum Care Immediately After Birth and During Early Postpartum (Table 10.1)
The Postnatal Check
POSTNATAL PHYSIOTHERAPY
The Role of the Physiotherapist
Assessment
Potential Impairments and Functional Limitations
PLAN OF CARE
To Teach Awareness and Control of Posture after Pregnancy
Posture Exercises
Learn Safe Body Mechanics
The Essentials of Good Body Mechanics Include
Prepare the Lower Extremities for the Demands if Increased Weight Bearing and Circulatory Compromise
Develop Awareness and Control of the Pelvic Floor Musculature
Kegel's Exercises
Techniques
Maintain Abdominal Function and Prevent or Correct Diastasis Recti
Strengthening Exercise for Abdominals
Stabilization Exercises
Promote Increased Body Awareness and a Positive Body Image
Develop Strength for the Demands of Infant Care
Learn Relaxation Skills
Selective Tension
Breathing Technique
Promote or Maintain Safe Cardiovascular Fitness
Learn About the Changes of Pregnancy and Birth
Prepare Physically for Labor, Delivery, and Postpartum Activities
Baby Massage (Fig. 10.5)
Here's What to Keep in Mind Before Mother Lay Her Hands on Newborn
Here are Some Infant Massage Moves to Get Started
Establishing Breastfeeding
Key Points for Correct Positioning and Attachment
Positioning
Attachment
Resuming Normal Activities
Sexual Intercourse
Postnatal ‘Home’ Exercises
POSTNATAL FITNESS CLASSES IN THE COMMUNITY
The Early Postnatal Class
Setting up a Class
Suggested Plans
Individual vs Group Discussion
Teaching Points
Points to remember
The Postnatal Fitness Class
Postnatal Pilates Classes
Benefits
Group vs Private Classes
Venue
Teaching Points
POSTNATAL PROBLEMS
Immediate Postnatal Problems
Perineal Dysfunction/Pain
Genitourinary Dysfunction/pain
Incontinence
Musculoskeletal Problems
Diastasis Recti Abdominis (DRA)
Back Pain
Circulatory Dysfunction/pain
Edema
Varicose Veins
Thromboembolism
Hemorrhoids
Breast Problems (Table 10.7)
Fatigue
Psychological Problems
Postnatal Depression
Sexual Problem
The ‘Maternity’, ‘Baby’ or ‘Third Day’ Blues
Puerperal Psychosis
AFTER-EFFECTS OF INSTRUMENTAL INTERVENTION
Cesarean Section
Indications
Risks
Risks for the Mother
Risks for the Child
Other Risks Include
Anesthesia
Vaginal Birth after Cesarean
Recovery Period
Post C-section Assessment and Observations
Potential Impairments and Functional Limitations
Plan of Care for Physiotherapist
Improve Pulmonary Function and Decrease the Risk of Pneumonia
Decrease Incisional Pain with Coughing, Movement, or Breast Feeding
Prevent Postsurgical Vascular Complications
Enhance Incisional Circulation and Healing; Prevent Adhesion Formation
Decrease Postsurgical Discomfort from Flatulence, Itching, or Catheter
Correct Posture
Prevent Injury and Reduce Low Back Pain
Prevent Pelvic Floor Dysfunction
Development of Abdominal Strength
LONG-TERM POSTNATAL PROBLEMS
Perineal/vaginal Pain or Discomfort
Dyspareunia
Physical Therapy Treatment
Manual Therapy Techniques
Modalities
Incontinence
Fecal Incontinence
Back Pain
Diastasis Recti Abdominis Muscle
Diastasis Symphysis Pubis
Carpal Tunnel Syndrome
Mastitis and Breast Abscesses
Postnatal Depression
SUMMARY
CHAPTER 11:
The Climacteric
INTRODUCTION
PHYSIOLOGY OF MENOPAUSE (FIG. 11.2)
PHYSICAL SYMPTOMS
Menopause Markers
PHYSICAL CHANGES DURING MENOPAUSE
POSTMENOPAUSAL PROBLEMS
Cardiovascular Disease
Skeletal System
Osteoporosis
Pathophysiology
Risk Factors
Osteoporosis Screening
Treatment Options
Special Considerations for Post-menopausal Women
Central Nervous System
Cognition
Dementia and Alzheimer's Disease
Libido
Breast Changes (Fig. 11.7)
Thyroid Gland
Lower Reproductive Tract
Adrenal Gland
Depression and Sleep Disturbances
Obesity
Treatment Options
Dietary Interventions
Exercise/Physical Activity
Health Benefits of Exercise/Weight Reduction
Special Consideration
Surgery
Criteria for Obesity Surgery
SUMMARY
CHAPTER 12:
Role of Physiotherapy in Gynecological Conditions
INTRODUCTION
THE ROLE OF PHYSICAL THERAPY IN GYNECOLOGICAL DISORDERS
GYNECOLOGICAL HEALTH
Being Breast Awareness
Physical Check-ups
Cervical Cytology
GYNECOLOGICAL DISORDERS
Risk Factors of Gynecological Disease
Disorders of Pelvic Pain
Chronic Pelvic Pain (CPP)
Physiotherapy Treatment Options
Dyspareunia/vestibulitis/vulvodynia
Causes
DISORDERS OF PELVIC FUNCTION
Pelvic Organ Prolapse
Causes
Physical Therapy and Treatment Options
Stress Urinary Incontinence(Tables 12.5)
Causes
Urge Incontinence (Table 12.5)
Overactive Bladder
Physiotherapy Treatment Option
Fecal incontinence
Physiotherapy Treatment Options
FURTHER GYNECOLOGICAL CONDITIONS OF RELEVANCE TO THE PHYSIOTHERAPIST
Disorders Associated with Menstruation
Menarche
Amenorrhea
Oligomenorrhea
Dysmenorrhea
Premenstrual Syndrome
Abnormal Uterine Bleeding
Gynecological Conditions and Back/Abdominal Pain
Polycystic Ovarian Syndrome (PCOS)
Infertility
Premature Ovarian Failure (POF), Also Known as Premature Menopause
Psychosexual Problems
SEXUALITY
In Pregnancy
In the Puerperium
PREMENOPAUSAL WOMEN
IN THE CLIMACTERIC
IN OLDER AGE
SUMMARY
CHAPTER 13:
Role of Physiotherapy in Gynecological Surgery
INTRODUCTION
GYNECOLOGICAL EXCISION SURGERIES
Hysterectomy
Reasons for the Procedure
Risks of the Procedure
Hysterectomy Preoperative Procedures
Postoperative Care after Hysterectomy
OVARIAN SURGERIES
Salpingectomy
Myomectomy
Cone Biopsy
Vulvectomy
PELVIC RADIOTHERAPY
GYNECOLOGICAL REPAIR SURGERY
Colporrhaphy
Manchester Repair
Gilliam's Ventrosuspension
Sacral Colpopexy
Salpingostomy
SURGICAL TREATMENT OF STRESS INCONTINENCE
COMPLICATIONS OF GYNECOLOGICAL SURGERY
PHYSIOTHERAPY CARE OF PATIENTS UNDERGOING GYNECOLOGICAL SURGERY
Preoperative Physiotherapy
Assessment
Instruction and Preparation
Respiratory System
Circulatory System
Bed Mobility
Pelvic Floor Muscle Exercises
Abdominal Muscle Exercises
Posture and Back Care
Wind Pain
Patient Discussion
Discharge Precautions
Treatment
POSTOPERATIVE PHYSIOTHERAPY
Checklist for First Postoperative Assessment
Treatment
Day 1 onwards
Prevention of Chest Complications
Huffing/Coughing (Figs 13.4A and B)
Prevention of Thrombosis
Mobility
Getting in and Out of Bed Through Side-Lying (Fig. 13.6)
Early Ambulation
Abdominal Exercise
Pelvic Tilting (Fig. 13.7)
Knee Rolling (Fig. 13.8)
Posture and Back Care
Prevention of Muscle Wasting and Joint Immobility
Pelvic Floor Strengthening Exercises (PFME) (Fig. 13.9)
Day 2 After Surgery
Day 3–4 After Surgery
Day 5/Day of Discharge After Surgery
Advice on Discharge
Progression of Exercises
Rest
Walking
Sexual Activity
Driving
Work and Sports
Gardening
Household Activities
SUMMARY
CHAPTER 14:
Continence and Incontinence
INTRODUCTION
URINARY CONTINENCE AND MICTURITION
Anatomy of the Lower Urinary Tract
The Bladder
The Urethra
The Pelvic Floor
Innervations of Bladder and Urethra (Table 14.2)
Physiology of Normal Micturition Cycle
Storage of Urine
Voiding of Urine
The Neurological Control of Continence (Figs 14.1 and 14.2)
Storage Phase of the Bladder
Emptying Phase of the Bladder
Neural Reflex Arcs to Control the Bladder Function (Fig. 14.5)
SUMMARY OF FACTORS WHICH FAVOR NORMAL URINARY FUNCTIONING
LOWER URINARY TRACT DYSFUNCTION
INCONTINENCE OF URINE
Types of Urinary Incontinence
Extraurethral Incontinence
Urge Incontinence
Stress Incontinence and Genuine Stress Incontinence
Overflow Incontinence
Reflex Incontinence
Nocturnal Enuresis
Giggle Incontinence
Orgasmic Incontinence
PHYSIOTHERAPY ASSESSMENT
History of the Patient
History Taking Can be Divided into Four Components
Physical Examination
Basic Investigations
Urodynamic Study
Evaluation of the Function of the Bladder and the Urethra Using
Electrophysiological Tests
Electromyography
Single Fiber Density
Motor Nerve Conduction Tests
Further Imaging
Objective Test Used By Physiotherapist
Frequency Volume Chart (The Bladder Diary) (Tables 14.5A and B)
Pad Test
The Pelvic Floor Muscle Strength Assessment
Measurement Tools to Evaluate PFM Function and Strength
Ability to Contract
Quantification of Muscle Strength
Subjective Assessment by Physiotherapist
Quality of Life and Symptoms Questionnaires
Visual Analog Scale (VAS)
PHYSIOTHERAPY TREATMENT
Lifestyle Changes
Behavioral Modification
Medical Management
Neurologic Stimulation Therapy
Surgical Treatments
Lifestyle Changes
Behavioral Therapy
Timed Voiding, Prompted Voiding, or Bladder Training
A Voiding Log
PFES or Kegel Exercises (See Figs 13.9A, 13.9B and 13.9 C)
Biofeedback
Vaginal Cones
Intermittent Catheterization
Medical Management
Pharmacological Approach
Electrical Stimulation (Fig. 14.19)
Surgical Treatment
SUMMARY
APPENDIX 1:
Changes During Different Phases of Life of a Woman
APPENDIX 2:
Obstetrics and GynecologyPT Assessment
SUBJECTIVE EXAMINATION
General Details
Chief Complains(Present Problems of the woman)
Obstetric History
History for Genitourinary System
History of Incontinence
History for Gastrointestinal System
Pain History
Past History
Personal History
Drug History
Family History
Socio-economic History
Medical and Surgical History
Psychological History
OBJECTIVE EXAMINATION
On Observation
On Palpation
On Examination
Glossary
INDEX
TOC
Index
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