DOCSLIB.ORG

The Pelvic Floor in Orthopedic Physical Therapy Sarah Dominguez, PT, MSPT, CLT, WCS, CMTPT

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Pelvic Floor in Orthopedic Physical Therapy Sarah Dominguez, PT, MSPT, CLT, WCS, CMTPT 4/1/2018 The Pelvic Floor In Orthopedic Physical Therapy Sarah Dominguez, PT, MSPT, CLT, WCS, CMTPT No Disclosures Objectives 1. Understand the function of the pelvic floor in functional tasks such as walking, squatting, running, step up. 2. Understand how to consider the pelvic floor as a potential problem in spine, SIJ and hip disorders. 3. Know how to screen for pelvic floor and when to refer to a Pelvic Floor PT. 4. Learn several treatment ideas to implement in addressing the pelvic floor in orthopedic rehabilitation. 1 4/1/2018 What is the Pelvic Floor? • Group of muscles in the base of the pelvis • Works alongside the Abdominal, hip and spinal musculature • Coordinates with the Diaphragm to control intra- abdominal pressures Pelvic floor musculature • Bulbospongiosus, Ischiocavernosus, transverse perineal most superficial • Urethral sphincter, urethrovaginalis, deep transverse perineal second layer • Illiococcygeus, coccygeus, puborectalis, pubo-coccygeus (levator ani), and obturator internus make the deepest layer Pelvic Floor Superficial layers • Ischiocavernosus, bulbospongiosus, transverse perineal, deep transverse perineal, urethral sphincter, urethrovaginalis, External anal sphincter (EAS) • Share common attachments at perineal body • Provide more Sphincteric action 2 4/1/2018 Pelvic Floor Levator ani group • Deepest layer of the pelvic floor muscles • Iliococcygeus, ischiococcygeus, puborectalis, pubococcygeus, • Share tendinous attachments with obturator internus (hip ER) • Attach at coccyx, ileum, ischium and pubis Pelvic floor muscles • Type 1 and Type 2 fibers exist • Genetic factors and race influence the percentage of each type per person. Studies show that specific training can convert type 1 to type 2 and vice versa • Pelvic Floor is typically 70-80% Slow twitch (type 1) and 20-30% Fast twitch (type 2) • Fast twitch are found in higher percentage around the urethra and anus • Must maintain an active resting tone for continence • Must respond reflexively to prevent incontinence Functions of the Pelvic Floor • Supportive • Sphincteric • Sexual • Stability • Sump Pump (venous/lymphatic) 3 4/1/2018 Pelvic Floor Mechanics • Concentric Contraction: Produces a squeeze and a lift • close vaginal, urethral and anal openings • bring ischial tuberosity together • counter-nutating sacrum • bring tailbone toward pubic bone • Eccentric Contraction • Opens urethra, anal and vagina • Levator plate descends • Allows for normal function of bowel and bladder empty • Important in gait and running Pelvic floor as part of the functional system • Pelvic floor is a primary stabilizer for the pelvic girdle • Functions alongside local and global muscles for optimal motor control • Just doing Kegel exercises isn’t addressing the issue • Movement pattern compensations require us to consider the pelvic floor activity or inactivity as part of the puzzle 4 4/1/2018 Pelvic floor as part of the functional system • PFM has direct connection with Obturator internus through tendinous attachments. • It contributes to local hip control and stabilizes hip with work by the larger global muscles • Play a role in anchoring deep hip rotators and provide good hip joint mechanics and allow optimal power for the larger muscles Activity! • Palpate Posterior sling in stand with pelvic floor contraction • Palpate Obturator Internus in side lying 5 4/1/2018 Note Fascial attachments from Diaphragm to Pelvic Floor Through: Quadratus Lumborum Psoas Iliacus Obturator Internus The Amazing Diaphragm • Note how far into the thoracic cavity the diaphragm goes. The core really starts in mid-thoracic range and runs to pelvic floor. Diaphragm attachments • Xyphoid process • Internal surfaces of lower 6 ribs • Lumbar spine • Arcuate ligament arch over psoas and quadratus lumborum 6 4/1/2018 Diaphragmatic assistance with trunk control • Contributes to trunk control • Resting tone increased prior to peripheral movements • Tonically active with sustained activity • Modulates activity with respiration during peripheral activities Coordination of diaphragm and TrA • TrA and diaphragm activity linked with opposing patterns • TrA activity increases with expiration while diaphragm activity decreases • TrA activity decreases with inspiration while diaphragm activity increases Coordination of Pelvic Floor and diaphragm • Inhale: • Diaphragm actively contracts, and pulls down, expanding rib cage and belly • Pelvic Floor relaxes and descends • Exhale: • Diaphragm relaxes up, rib cage contracts, abdominals contract • Pelvic floor contracts and lifts 7 4/1/2018 Transversus Abdominus • Deepest abdominal muscle • Arises from inguinal ligament, iliac crest, thoracolumbar fascia, and inner surfaces of lower 6 ribs • Attaches into fascial plane of rectus abdominus and linea alba • Fibers of upper, middle, and lower sections of TrA lay at different orientations • Superior fibers lay superiomedially • Middle and inferior fibers lay inferiomedially at slightly different angles Internal oblique • Lies between TrA and EO • Arises from iliac crest, inguinal ligament, and thoracolumbar fascia inferior to L3 • Attach to 7-10th ribs at costochondral joints and tips of 11-12th ribs • Blend into to rectus fascia and into linea alba to pubic crest • Fibers are generally oriented in superiomedial plane • Over activity of IO presents with increased inferior rib angle or rib flaring External oblique • Largest abdominal muscle • Arises from lower 8 ribs • Interdigitates with serratus anterior and latissimus dorsi, possible attachments onto thoracolumbar fascia • Attach onto anterior iliac crest • Blend to rectus fascia and into linea alba • Fibers run generally inferomedially • Over activity presents with rigidity of rib cage or acute inferior rib angle 8 4/1/2018 Rectus abdominus • Arises from pubic crest and ligaments of pubic symphysis • Inserts into 5-7 costal cartilage and xyphoid process • Enclosed in fascial sheath formed by aponeurosis of TrA, EO and IO • Medial borders of RA connect via the linea alba, a strong fascial sheath Activity • Palpate rib angle: Acute? Obtuse? Just right? • Palpate Diaphragm with breathing Multifidus • Superficial fibers • Insert 3 vertebral levels below origin • Deep fibers • In pelvis, attaches to deep levels of thoracolumbar fascia of raphe of glut max • Connect into capsule of SIJ • Blends with Sacrotuberous ligament • More Type I fibers than Type II 9 4/1/2018 Thoracolumbar fascia • Critical structure for load transfer between trunk and lower extremities • Contains alpha-smooth muscle actin called myoblasts with contractile capability • Tension is transmitted to ligamentum flavum and assists with lumbar alignment Bony and fibrous attachments of thoracolumbar fascia Bony attachments Fibrous attachments • Iliac crest • Ligamentum flavum • PSIS • Iliolumbar ligament • Posterior sacrum • Supraspinal ligament • Sacrotuberous ligament Muscle attachments of thoracolumbar fascia • Transverse abdominus • Biceps femorus • Internal oblique • Quadratus lumborum • External oblique • Lower trap • Glut max • Multifidus • Latissimus dorsi • Erector spinae 10 4/1/2018 Palpate Multifidus • Palpate just lateral to sp’s and deep • Feel muscle swell into thumbs • Ask For Pelvic Floor contraction • Have them raise their arm Pelvic Floor Role in trunk and pelvic stability • Plays a role in feedforward and feedback mechanism of Lumbopelvic stability • Contributes to force closure of the SIJ and controls motion of the sacrum relative to the ilia • SIJ stiffness • Sacral counternutation • Contributes to control of Intra-abdominal Pressures (IAP) and tension in the thoracolumbar fascia PFM coordination with trunk musculature • Studies show PFM to be coordinated with Abdominal wall • PFM fire first, prior to abdominal wall and spinal mm. • Must contract to control IAP, but must have coordinated effort of TRA, Lumbar multifidus to provide stability with mobility of the trunk. • Dysfunction in the PFM leads to poor anchor at sacrum, tailbone and ilia for the rest of the system. 11 4/1/2018 Pelvic Floor response to varying postures • Capson et al, 2011 • N = 16 nulliparous, 22-41 yo • EMG recorded in stand, cough, valsalva, MVC and load-catching task with hyperlordosis, neutral and hypolordosis • Higher tone in PFM in stand and hypolordotic postures • Increased peak strength in hypolordotic postures for all tasks • Posture influences both contractility and power for static and dynamic tasks • Posture did not influence PFM timing for the tasks Pelvic Floor Activity with Curl UP Study by Barton, et al (2015) • 90 women in exercise class • Transabdominal US scan of PFM and Bladder • 25% (n=23 women) could not produce an appropriate lift of the Pelvic Floor • ALL 90 displayed descent of the bladder • 60% had Stress Urinary Incontinence What should we see with Curl Up? • Rib angle remains the same • Abdominal wall flattens (no doming) • Pelvis remains neutral (no posterior tilt) 12 4/1/2018 PFM Activity with Active Straight Leg Raise • Sjodahl, et al. • 16 women with PGP and 11 pain free women • sEMG recordings of PFM and Abdominal wall during ASLR • Pre-activation of PFM occurred in 91% of pain free women and only 36% of women with PGP • Women with PGP have a delated onset in both PFM and Abdominal wall recruitment • PFM should have feed forward mechanism for pelvic girdle stability What should we see with ASLR? • Observe symmetry, abdominal wall, rib angle, pelvis • Ask patient if there is a difference • Apply pressure to determine where the issue maybe PFM Activity in limb movements
Load more

Recommended publications
  • Pelvic Anatomyanatomy
    PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx)
    [Show full text]
  • Advanced Retroperitoneal Anatomy Andneuro-Anatomy of Thepelvis
    APRIL 21-23 • 2016 • ST. LOUIS, MISSOURI, USA Advanced Retroperitoneal Anatomy and Neuro-Anatomy of the Pelvis Hands-on Cadaver Workshop with Focus on Complication Prevention in Minimally Invasive Surgery in Endometriosis, Urogynecology and Oncology WITH ICAPS FACULTY Nucelio Lemos, MD, PhD (Course Chair) Adrian Balica, MD (Course Co-Chair) Eugen Campian, MD, PhD Vadim Morozov, MD Jonathon Solnik, MD, FACOG, FACS An offering through: Practical Anatomy & Surgical Education Department of Surgery, Saint Louis University School of Medicine http://pa.slu.edu COURSE DESCRIPTION • Demonstrate the topographic anatomy of the pelvic sidewall, CREDIT DESIGNATION: This theoretical and cadaveric course is designed for both including vasculature and their relation to the ureter, autonomic Saint Louis University designates this live activity for a maximum intermediate and advanced laparoscopic gynecologic surgeons and somatic nerves and intraperitoneal structures; of 20.5 AMA PRA Category 1 Credit(s) ™. and urogynecologists who want to practice and improve their • Discuss steps of safe laparoscopic dissection of the pelvic ureter; laparoscopic skills and knowledge of retroperitoneal anatomy. • Distinguish and apply steps of safe and effective pelvic nerve Physicians should only claim credit commensurate with the The course will be composed of 3 full days of combined dissection and learn the landmarks for nerve-sparing surgery. extent of their participation in the activity. theoretical lectures on Surgical Anatomy and Pelvic Neuroanatomy with hands on practice of laparoscopic and ACCREDITATION: REGISTRATION / TUITION FEES transvaginal dissection. Saint Louis University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) Early Bird (up to Dec. 31st) ...........US ....$2,295 COURSE OBJECTIVES to provide continuing medical education for physicians.
    [Show full text]
  • Clinical Anatomy of the Anterior Abdominal Wall in Its Relation To
    ClinicalClinical AnatomyAnatomy ofof thethe AnteriorAnterior AbdominalAbdominal WallWall inin itsits RelationRelation toto HerniaHernia Handout download: http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm 24 April 2007 LawrenceLawrence M.M. Witmer,Witmer, PhDPhD Professor of Anatomy Department of Biomedical Sciences College of Osteopathic Medicine Ohio University Athens, Ohio 45701 [email protected] AnatomicalAnatomical OverviewOverview External Internal Transversus Rectus oblique oblique abdominis abdominis fleshyfleshy rectusrectus portionportion sheathsheath aponeuroticaponeurotic inguinalinguinal tendinoustendinous portionportion ligamentligament intersectionsintersections • Three flat abdominals: attach to trunk skeleton, inguinal lig., linea alba, etc.; fleshy laterally and aponeurotic medially, forming rectus sheath medially • Two vertical abdominals: rectus abdominis and pyramidalis (not shown) Moore & Dalley 2006 AnatomicalAnatomical OverviewOverview intramuscular exchange of intermuscular exchange of contralateral external oblique fibers contralateral external & internal oblique right external oblique left internal oblique • continuity of external oblique • continuity of fibers across midline fibers across midline • “digastric” muscle with central • blending of superficial & deep tendon fibers on opposite side • torsion of trunk Moore & Dalley 2006 AnatomicalAnatomical OverviewOverview transv. abd. linea alba rectus sheath rectus abdominis int. obl. ext. obl. semilunar line peritoneum transversalis fascia aponeuroses of abdominal
    [Show full text]
  • 6Th Advanced Retroperitoneal Anatomy and Neuro-Anatomy of the Pelvis
    Session I Theoretical Lectures will be given in Portuguese and Session II Lectures in English. Session I, June 9-10 will be presented in Portugese. Optional English and Portuguese speaking Faculty are available for the practical part of both sessions. Course Description SESSION I SESSION II SESSION III This theoretical and cadaveric course is designed for both intermediate and JUNE 9 - JUNE 13 advanced laparoscopic gynecologic surgeons and urogynecologists who want to ST. LOUIS, MISSOURI, USA Tuesday, June 9 7:30 am - 5:00 pm Wednesday, June 10 7:30 am - 5:00 pm Thursday, June 11 7:30 am - 5:00 pm Friday, June 12 7:30 am - 5:00 pm Saturday, June 13 7:30 am - 4:00 pm practice and improve their laparoscopic skills and knowledge of retroperitoneal 2020 From Books to Practice Simulcast: Parallel Theoretical From Books to Practice Simulcast: Parallel Theoretical anatomy. ➢ Pelvic Neuroanatomy and the Nerve Sparing Surgical ➢ Pelvic Neuroanatomy and the Nerve Sparing Surgical ➢ Hands-on Cadaver Lab: Presentations and Live Dissection Presentations and Live Dissection The course will be composed of 2 full days of combined theoretical lectures on Concept Concept Dissection of Lateral Pelvic Sidewall, Ureter, Vessels; ➢ The Avascular Spaces of the Pelvis Surgical Anatomy and Pelvic Neuroanatomy with hands on practice of laparoscopic From Books to Practice Simulcast: Parallel Theoretical ➢ The Avascular Spaces of the Pelvis From Books to Practice Simulcast: Parallel Theoretical Development of the Obturator Space and Identification and transvaginal dissection and a third optional dissection-only day, with a new 6th Advanced Retroperitoneal Anatomy Presentations and Live Dissection ➢ Diaphragmatic Anatomy and Strategies for Diaphragmatic Presentations and Live Dissection ➢ Diaphragmatic Anatomy and Strategies for Diaphragmatic of Obturator, Sciatic, and Pudendal Nerves; Identification specimen.
    [Show full text]
  • Detailed and Applied Anatomy for Improved Rectal Cancer Treatment
    REVIEW ARTICLE Annals of Gastroenterology (2019) 32, 1-10 Detailed and applied anatomy for improved rectal cancer treatment Τaxiarchis Κonstantinos Νikolouzakisa, Theodoros Mariolis-Sapsakosb, Chariklia Triantopoulouc, Eelco De Breed, Evaghelos Xynose, Emmanuel Chrysosf, John Tsiaoussisa Medical School of Heraklion, University of Crete; National and Kapodistrian University of Athens, Agioi Anargyroi General and Oncologic Hospital of Kifisia, Athens; Konstantopouleio General Hospital, Athens; Medical School of Crete University Hospital, Heraklion, Crete; Creta Interclinic, Heraklion, Crete; University Hospital of Heraklion, Crete, Greece Abstract Rectal anatomy is one of the most challenging concepts of visceral anatomy, even though currently there are more than 23,000 papers indexed in PubMed regarding this topic. Nonetheless, even though there is a plethora of information meant to assist clinicians to achieve a better practice, there is no universal understanding of its complexity. This in turn increases the morbidity rates due to iatrogenic causes, as mistakes that could be avoided are repeated. For this reason, this review attempts to gather current knowledge regarding the detailed anatomy of the rectum and to organize and present it in a manner that focuses on its clinical implications, not only for the colorectal surgeon, but most importantly for all colorectal cancer-related specialties. Keywords Anatomy, rectum, cancer, surgery Ann Gastroenterol 2019; 32 (5): 1-10 Introduction the anal verge [AV]) to a given landmark (e.g., the part from the sacral promontory) [1]. This study can be considered as Even though rectal anatomy is considered by most indicative of the current overall knowledge on rectal anatomy clinicians to be a well-known subject, it is still treated as a hot across CRC-related specialties.
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • Review Article Ovariohysterectomy in the Bitch
    Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2010, Article ID 542693, 7 pages doi:10.1155/2010/542693 Review Article Ovariohysterectomy in the Bitch Djemil Bencharif, Lamia Amirat, Annabelle Garand, and Daniel Tainturier Department of Reproductive Pathology, ONIRIS: Nantes-Atlantic National College of Veterinary Medicine, Food Science and Engineering, Site de la Chantrerie, B.P:40706, 44307 Nantes Cedex, France Correspondence should be addressed to Djemil Bencharif, [email protected] Received 31 October 2009; Accepted 7 January 2010 Academic Editor: Liselotte Mettler Copyright © 2010 Djemil Bencharif et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovariohysterectomy is a surgical procedure widely employed in practice by vets. It is indicated in cases of pyometra, uterine tumours, or other pathologies. This procedure should only be undertaken if the bitch is in a fit state to withstand general anaesthesia. However, the procedure is contradicated if the bitch presents a generalised condition with hypothermia, dehydration, and mydriasis. Ovariohysterectomy is generally performed via the linea alba. Per-vaginal hysterectomy can also be performed in the event of uterine prolapse, if the latter cannot be reduced or if has been traumatised to such an extent that it cannot be replaced safely. Specific and nonspecific complictions can occur as hemorrhage, adherences, urinary incontinence, return to oestrus including repeat surgery. After an ovariectomy, bitches tend to put on weight, it is therefore important to inform the owner and to reduce the daily ration by 10%.
    [Show full text]
  • Review Article Ovariohysterectomy in the Bitch
    Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2010, Article ID 542693, 7 pages doi:10.1155/2010/542693 Review Article Ovariohysterectomy in the Bitch Djemil Bencharif, Lamia Amirat, Annabelle Garand, and Daniel Tainturier Department of Reproductive Pathology, ONIRIS: Nantes-Atlantic National College of Veterinary Medicine, Food Science and Engineering, Site de la Chantrerie, B.P:40706, 44307 Nantes Cedex, France Correspondence should be addressed to Djemil Bencharif, [email protected] Received 31 October 2009; Accepted 7 January 2010 Academic Editor: Liselotte Mettler Copyright © 2010 Djemil Bencharif et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovariohysterectomy is a surgical procedure widely employed in practice by vets. It is indicated in cases of pyometra, uterine tumours, or other pathologies. This procedure should only be undertaken if the bitch is in a fit state to withstand general anaesthesia. However, the procedure is contradicated if the bitch presents a generalised condition with hypothermia, dehydration, and mydriasis. Ovariohysterectomy is generally performed via the linea alba. Per-vaginal hysterectomy can also be performed in the event of uterine prolapse, if the latter cannot be reduced or if has been traumatised to such an extent that it cannot be replaced safely. Specific and nonspecific complictions can occur as hemorrhage, adherences, urinary incontinence, return to oestrus including repeat surgery. After an ovariectomy, bitches tend to put on weight, it is therefore important to inform the owner and to reduce the daily ration by 10%.
    [Show full text]
  • Review of Enhanced Revision Programme Part 2
    This presentation will discuss the anatomy of the anterior abdominal wall as it pertains to gynaecological and obstetric surgery. 1 The border of the anterior abdominal wall is defined superiorly by the xiphoid process of the manubrium sterni and the inferior aspects of the lower ribs that make up the subcostal margins. Caudally, the border is defined by the upper edge of the pubic symphysis, inguinal ligaments and the iliac crests. 2 In addition to the structures that define the upper and lower borders of the anterior abdominal wall, important surface markings need to be noted. These include the umbilicus and the linea alba in the midline, the linea semilunaris – which defines the lateral edges of the recti muscles – the anterior superior iliac spine, and the superficial vessels, which may be visible in some thin women. 3 A cross section of the anterior abdominal wall will reveal, from outwards–inwards: the skin, the subcutaneous layer, which is made up of fatty tissue called the Camper's fascia and membranous tissue called the Scarpa’s fascia, the pyramidalis muscle, which may be absent in up to 20% of humans, and the rectus muscle encased within the rectus sheath along with the pyramidalis if this is present. 4 Beneath the rectus muscle is the external oblique muscle and its aponeurosis, the internal oblique muscle and its aponeurosis, the transversus abdominis muscle and its aponeurosis, the transversalis fascia, extraperitoneal fat and, finally, the parietal peritoneum. It should be noted that the skin is loosely attached to the underlying structures with the exception of the umbilicus where it is firmly tethered to underlying tissue.
    [Show full text]
  • Changes You Can Make to Improve Bladder Problems
    CHANGES YOU CAN MAKE TO IMPROVE BLADDER PROBLEMS The SUFU Foundation OAB Clinical Care Path Way For more information on better bladder control visit: http://sufuorg.com/oab GUIDE TO PELVIC FLOOR MUSCLE TRAINING Your Pelvic Floor Muscles Your pelvic floor muscles are a group of muscles that support your bladder and help control the bladder opening. They attach to your pelvic bone and go around the rectum. These muscles form a sling or hammock that supports your pelvic organs (bladder, rectum, in women the uterus, in men the prostate). If the muscles weaken, the organs they support may change position. When this happens, you may have problems with urine leakage and other signs of overactive bladder (OAB) like urgency and frequency. That’s why it’s important to keep these muscles strong so they can properly support your pelvic organs. You can do this by exercising them regularly. Finding Your Pelvic Floor Muscles To begin these exercises, you first have to make sure that you know which muscles to contract. To do this, think of the muscles you would use to control the passing of gas or to hold back a bowel movement. Now, without using the muscles of your legs, buttocks, or stomach, tighten or squeeze the ring of muscles around your rectum as you would in those situations. These are your pelvic floor muscles. When you squeeze these muscles, you should feel a tightening or pulling in of your anus. Men may also see or feel their penis move and women may feel their vagina tightening or pulling up.
    [Show full text]
  • Case Report for a Refractory Levator Ani Syndrome Treated With
    J Korean Med. 2017;38(2):73-77 http://dx.doi.org/10.13048/jkm.17019 pISSN 1010-0695 • eISSN 2288-3339 Case Report Case Report for a Refractory Levator Ani Syndrome Treated with Traditional Korean Medication Chang-Gue Son Liver and Immunology Research Center, Oriental Medical College in Daejeon University Objectives: To inform a clinical case of a refractory levator ani syndrome, that was improved by treatments of traditional Korean medicine (TKM). Methods: A 55-years old female had complained severe anorectal pain which didn’t respond to Western medicine therapeutics during 5 months including 45-day hospitalization. Whereas the symptom was rapidly resolved by the treatment in a Korean medicine hospital, and the clinical outcome was monitored. Result: There was no abnormality explaining the anorectal pain from blood tests, gastrointestinal endoscopy, sonogram and computed tomography for abdomen and pelvis. The patient was diagnosed with a levator ani syndrome. Based on the typical feature of tenderness of lower abdomen as well as beating sign around belly, an herbal drug, Shihogayonggolmoryo-tang (柴胡加龍骨牡蠣湯) was prescribed. In addition, the warm acupuncture at BL 31 to BL 33 and moxibustion on lower abdomen were given to the patient. The anorectal pain was radically reduced from treatment 7-day, and it almost disappeared within treatment 25-day. Conclusion: This case report would provide information for the potential of TKM therapies focused on the refractory levator ani syndrome which no satisfactory therapy exist. Key Words : Levator ani syndrome, Functional rectal pain, Traditional Korean medicine Introduction The etiology of LAS is unknown, but spasm of the levator ani muscles without detectable organic Levator ani syndrome (LAS) and proctalgia fugax pathology is proposed4).
    [Show full text]
  • Anatomy of Abdominal Incisions
    ANATOMY FOR THE MRCS but is time-consuming. A lower midline incision is needed for an Anatomy of abdominal emergency Caesarean section (where minutes may be crucial for baby and mother). The surgeon must also be sure of the pathol- incisions ogy before performing this approach. Close the Pfannenstiel and start again with a lower midline if the ‘pelvic mass’ proves to be Harold Ellis a carcinoma of the sigmoid colon! There are more than one dozen abdominal incisions quoted in surgical textbooks, but the ones in common use today (and which the candidate must know in detail) are discussed below. The midline incision (Figures 1–4) Opening the abdomen is the essential preliminary to the per- formance of a laparotomy. A correctly performed abdominal The midline abdominal incision has many advantages because it: exposure is based on sound anatomical knowledge, hence it is a • is very quick to perform common question in the Operative Surgery section of the MRCS • is relatively easy to close examination. • is virtually bloodless (no muscles are cut or nerves divided). • affords excellent access to the abdominal cavity and retroperi- toneal structures Incisions • can be extended from the xiphoid to the pubic symphysis. Essential features If closure is performed using the mass closure technique, pros- The surgeon needs ready and direct access to the organ requir- pective randomized clinical trials have shown no difference in ing investigation and treatment, so the incision must provide the incidence of wound dehiscence or incisional hernia com- sufficient room for the procedure to be performed. The incision pared with transverse or paramedian incisions.1 should (if possible): The upper midline incision is placed exactly in the midline • be capable of easy extension (to allow for any enlargement of and extends from the tip of the xiphoid to about 1 cm above the scope of the operation) the umbilicus.
    [Show full text]