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Summary physioth.theory: urinary problems (pelvic rehab) $5.43   Add to cart

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Summary physioth.theory: urinary problems (pelvic rehab)

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Summary of the urinary problems lesson in the pelvic rehab section given by prof. I. Geraerts of the physiotherapeutic theory course. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as pos...

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  • December 17, 2023
  • 41
  • 2023/2024
  • Summary
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Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
minder
CONTENT
 Aim: to gain insight in
- anatomy, physiology and pathophysiology of the urogenital/colo-proctological system
- the intact innervation of bladder, bowel and sexual function
- the pathologic innervation of bladder, bowel and sexual function in different neurological diseases
- the principles of pelvic floor muscle reeducation
- different types of incontinence and other problems in the urogenital and colo-proctological region
- Specific urinary, sexual and bowel problems in different neurological diseases (CVA, Parkinson’s
- Disease, Multiple Sclerosis, Spinal Cord Injury)

 Specialisation after master: Interuniversity course in pelvic reeducation and perinatal physiotherapy

INTRODUCTION
INDICATIONS FOR PELVIC REEDUCATION
 In children
- Enuresis (nocturna) bedplassen
- Dysfunctional voiding
- Enuresis diurna
- Obstipation
- Pain tijdens plassen of stoelgang
- Recurrent urinary tract infections

 In women
- Stress urinary incontinence
- Urgency urinary incontinence, overactive bladder
- Prolaps
- Urgency
- Pain
- Sexual problems: vaginismus, dyspareunia
- After surgery: neo-bladder (na blaaskanker), prolaps-surgery

 In men
- Post-prostatectomy, post-micturitional dribbling
- Neo-bladder
- Elderly
- Pain, prostatodynia, dysuria teveel spanning dat pijn geeft
- Sexual problems: erectile dysfunction, premature ejaculation

 In neurological patients
- Cerebrovascular accident
- Multiple Sclerosis
- Parkinson’s Disease
- Spinal Cord Injury
- Spina Bifida,…

ANATOMY OF THE PELVIC FLOOR
1. FUNCTION
 closure function
- test: micturition-stoptest
 dit is een test, geen oefening! We willen niet dat de blaas leert om in stukken te legen maar we willen dat
dit in 1x gebeurd
 Als je dit zou oefenen dan zal de blaas zich niet volledig kunnen legen en blijft er steeds een klein beetje
urine in de blaas zitten
- Micturition-starttest:
 als je heel dringend naar toilet moet dan moet je kunnen ophouden totdat je op toilet zit

Nala Melis Pagina 1

, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems

 support function
- stabiliteit: man (2 openingen) > vrouw (3 openingnen)
- organen

 sexual function
- orgasme
- ejaculatie


2. VESSELS
 slow twitch vessels (type I, red or tonic vessels)
- ophouden van urine voor lange tijd
 fast twitch vessels (type II, white or phasic vessels)
- bij hoesten of niezen (P op pelvic floor) urine ophouden
 beide zijn nodig in pelvic floor

3. MUSCLES
3.1. THE SUPERFICIAL LAYER
 M. Sphincter ani externus (subcutaneous and superficial part)
- Aim: voluntary contraction of the anus
- Als kring rond anus  kringspier
 M. Bulbospongiosus (M. bulbocavernosus)
- Woman: compression of the deep dorsal vein
- Men: during ejaculation through rithmic contractions evacuate the sperm via the urethra
 M. Ischiocavernosus ( erection)
- Aim: prohibit venous reflux
- belangrijk voor man
 M. Transversus perinei superficialis
- Aim: stabilise the perineal central tendon




3.1.i. ARTERIAL AND VENOUS SYSTEM IN A NORMAL ERECTION
 Tijdens erectie zal arterieel bloed in de penis vloeien en deze moet hier ook blijven
- Vasthouden bloed
 Bij erectieproblemen gaat het bloed erin en direct terug eruit
- bij ouderen mannen= vaak te snelle outflow
 viagra etc. voorkomt veneuze outflow
 arteriën zich vullen & venen zich sluiten = bloed niet kan terugvloeien
 Ischiocavernosus kan hierbij helpen, dit ligt aan de basis van de penis
- Het kan op de venen drukken en dus een terugvloei voorkomen

Nala Melis Pagina 2

, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
- Bij problemen leren we deze spier aan te spannen om te compenseren
 Corpus cavernosum & spongiosum

3.2.




THE MIDDLE LAYER
 M. Transversus perinei profundus
- Aim: support function, fixation of the perineum, sexual function
 M. Sphincter urethrae externus (horseshoe-shaped)
- Aim: support urinary
- niet cirkelvormig  hoefijzer
 M. Sphincter ani (deep part)
- Aim: voluntary contraction of the anus




Nala Melis Pagina 3

, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
 Laatste fig (rechts onderaan)
- Subcutanious & superficial sfincter ani
- M.puborectalis
 Constipatie door niet kunnen ontspannen van de spier




3.3. THE DEEP LAYER
 M. Levator ani
 M. puborectalis
- van os pubis cirkelvormig rond ureter & anaal kanaal
 M. pubococcygeus
 M. iliococcygeus
 M. Coccygeus
 = important support function
 = diaphragma pelvis
 Spanning in m.puborectalis te hoog
- scherper worden anorectale hoek
 Te hoge spanning in BB= problemen
geven

3.4. DIAPHRAGMA UROGENITALE/PELVIS
 Diaphragma urogenitale
- Superficial part
 M. ischiocavernosus
 M. bulbospongiosus
 M. transversus perinei superficialis
- Deeper part
 M. transversus perinei profundus
 M. sphincter urethrae

 Diaphragma pelvis
- M. coccygeus
- M. levator ani
- (M. sphincter ani externus (deep part))

 Other important pelvic muscles
- m.obturator internus
 exorot heup
- m.piriformis
 exorot geextendeerd been
 abd geflexteerd been

Nala Melis Pagina 4

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