2) Symptoms of Pain: Nature, Location, Duration, Severity, Irritability, Aggravating & Relieving Factors

Total Page:16

File Type:pdf, Size:1020Kb

2) Symptoms of Pain: Nature, Location, Duration, Severity, Irritability, Aggravating & Relieving Factors Assessment and treatment of anorectal & bowel dysfunction Bowel & anorectal dysfunctions include: Constipation Fluteal incontinence Fecal incontinence Incomplete empty feeling Post evacuation leakage Subjective (taking history): 1) Specific symptoms that bring patient to therapy: determine the priorities: constipation, IBS, flatus and feces incontinence, fecal urgency, post evacuation leakage. 2) symptoms of pain: nature, location, duration, severity, irritability, aggravating & relieving factors. 3) Review medical & surgical history: *respiratory illness * GI & bowel dysfunctions * neurological issues * Urological issues: UTI & IC * psychological issues 4) Fluid & food charts to note the relationship of eating/ drinking to bowel movements. 5) Allergies & sensitivity related to food, gluten & wheat. 6) Quality & quantity of stool, Bristol stool scale. 7) )ADLs & lifestyle: * do you exercises routinely? If not, what is the obstacles? * Habits related to toileting & impact on lifestyle. * Muscloskeletal problems that may impact patient's ability to take off clothes or reach bathroom on time. Objective (physical examination): 1) orthopedic screening: *posture/ body, pelvis, sacral, illium & pubic symphsis alignment * joint mobility & muscle performance around hip & pelvis (adductors, psoas, hamstring, quadrates lumborum, gluts, piriformis, coccygeus & obturator internus) * observe breathing pattern, coordination between pelvic & thoracic diaphragm 2) Abdomen/ viscera: *Rebound tenderness by compress slowly & release abruptly if it cause stabbing sudden pain, it’s peritoneal pain. * Carnett’s test: ask the patient to raise her head while you press to tender areas. If it’s painful, +ve abdominal muscles tenderness and if it’s less pain it means intra-peritoneal *soft tissue, fascia & scars mobility * mobility & motility of viscera 3) PFM examination: * pain & spasm PFM * PFM strength & endurance. * external anal sphincter, sensation, tone, tension and relaxation. * Coordination TrAs & PFM Treatment plan: 1) Education: *Process of defecation: peristalsis, letting go, importance of not ignoring the urge to defecate, sensory retraining PFM after bowel movement. *Defecation mechanics: semi-squatting, bear down with exhaling out & bulge your lower abdomen so that's relaxed * Fluid & fiber intake: For constipated patients: eat breakfast with warm liquids, gradually add the fiber rich foods to your diet 27-40 grams per day & maintain diary. For IBS patients: Avoid insoluble fibers in ( whole grain, cabbage, broccoli, onion, tomato, carrots, dark leafy vegetables, raisins & grapes) and add soluble fibers food in (oatmeal, apple, orange, pears, strawberries, blueberries, beans & cucumber) For fecal incontinence patients: fiber increase is essential to restore normal size & texture of stool. * Explain different types of laxatives: bulk forming (oat meal, Metamucil & konsyl), stimulants (caffeine, aloe, castor oil & correctol), stool softeners to hydrate the intestine ( surfak & colace), osmotic (milk magnesium, ,sorbitol in saline & gum), lubricants (mineral oil, fleet & zymenol). 2) general exercises program & orthopedic intervention to use both inner core stabilizers & outer core mobilizers: *posture & pelvis re-alignment. * core training to improve abdominal tone which contributes to appropriate intra- abdominal pressure. *cardio: walking, swimming, jogging & gentle aerobics *swiss ball ex's to pelvic mobility, lumbo-pelvic diassociation & core stabilization. *supervised yoga & general mobility ex's: downward dog, cobra, inversion. Also bridging, bridge & twist, and hooklying spinal twist. 3) pelvic floor treatment: *rectal and/ or vaginal massage in case of overactive EAS and/ or PFM *restore contract/ relax efficiency of EAS & PFM * use manual biofeedback to coordinate EAS, PFM & TrA *Mobilize sacrococcygeal joint 4) Visceral intervention: *mobilize liver, ileocecal valve, sigmoid, cecum, mesenteric root, & rectum. Women's health physical therapist Alanoud Alduwish .
Recommended publications
  • About Emotions There Are 8 Primary Emotions. You Are Born with These
    About Emotions There are 8 primary emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. Here is a list of primary emotions: Eight Primary Emotions Anger: fury, outrage, wrath, irritability, hostility, resentment and violence. Sadness: grief, sorrow, gloom, melancholy, despair, loneliness, and depression. Fear: anxiety, apprehension, nervousness, dread, fright, and panic. Joy: enjoyment, happiness, relief, bliss, delight, pride, thrill, and ecstasy. Interest: acceptance, friendliness, trust, kindness, affection, love, and devotion. Surprise: shock, astonishment, amazement, astound, and wonder. Disgust: contempt, disdain, scorn, aversion, distaste, and revulsion. Shame: guilt, embarrassment, chagrin, remorse, regret, and contrition. All other emotions are made up by combining these basic 8 emotions. Sometimes we have secondary emotions, an emotional reaction to an emotion. We learn these. Some examples of these are: o Feeling shame when you get angry. o Feeling angry when you have a shame response (e.g., hurt feelings). o Feeling fear when you get angry (maybe you’ve been punished for anger). There are many more. These are NOT wired into our bodies and brains, but are learned from our families, our culture, and others. When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. .
    [Show full text]
  • In This Issue
    July 2020 NEWS Post-Traumatic Stress Disorder (PTSD) Assessment and Treatment In this Issue: Guidelines for Pediatric Primary Upcoming Clinical Care Conversations 5 Clinical Conversation: May 26, 2020 Presented by Sylvia Krinsky, MD, Tufts Medical Center For some children, childhood is far from a carefree time; they Leadership: experience trauma which can disrupt development and lead John Straus, MD to post-traumatic stress disorder (PTSD). At the May Clinical Founding Director Conversation, Sylvia Krinsky, MD, MCPAP site director at Tufts Barry Sarvet, MD Medical Center, discussed how to address PTSD in the primary Medical Director care setting. Beth McGinn Types of trauma Program Manager There are three major types of trauma: Elaine Gottlieb • Discrete Trauma – examples include a car accident, injury, Contributing Writer medical procedure, or a single episode of physical or sexual assault, when life is filled with otherwise helpful and supportive people • Complex Trauma – series of repeated traumas usually in close interpersonal contexts, such as childhood abuse or neglect, witnessing domestic or community violence, or racism and chronic social adversities • Adverse Childhood Event – a term from the Adverse Childhood Experiences (ACE) study, referring to potentially traumatic events that can have an impact on physical and psychological health Discrete trauma is most recognized in the DSM-5, while ACE is more familiar to the medical community, says Dr. Krinsky. 1000 Washington St., Suite 310 One study reported in the Journal of the American Medical Boston, MA 02118 Association (JAMA) found that more than 90 percent of pediatric Email: [email protected] patients seen in a primary care pediatric clinic had experienced a traumatic exposure, and 25 percent met full or partial criteria for www.mcpap.org PTSD.
    [Show full text]
  • Understanding Children's Mental Health Disorders and the Impact On
    Understanding Children’s Mental Health Disorders and the Impact on Learning and Functioning 1 2 Introduction to Children’s Mental Health An Overview of Depression 3 Depression is Common Estimates of Incidence 1 % Preschoolers 2 % School age 5 % Adolescents 20 % Lifetime prevalence during adolescence (parallels adult life time prevalence) Birmaher et al., 2002 4 Risk and Reoccurrence Childhood Adolescent Later Onset Depression Adolescent Depression Depression Adult Depression 5 Depression is… a mood disorder a sleep and energy disorder a thinking disorder 6 Depression: Signs and Symptoms Mood Changes Behaviors MEANING Interpersonal Relationships Physical Changes Cognitive Changes School Performance 7 Mood Symptoms Sad Sadness Irritable “mood swings” Anhedonia loss of interest social withdrawal or Anhedonia Irritability isolation boredom 8 Physical Symptoms Sleep Difficulty either with too much or too little sleep Fatigue Appetite Change loss of appetite increased carbohydrate craving 9 Cognitive Symptoms Difficulty concentrating Increased distractibility and “spaciness” Decreased attention and focus 10 Cognitive Symptoms Worried, ruminating thoughts Worthlessness, low self-esteem, guilt Distortions, misperceptions, misinterpretations 11 Symptoms in Infants and Toddlers Mood – Excessive whining – Too little or too much crying – Withdrawn from cuddling, being held – Lack of interest in surroundings 12 Symptoms in Infants and Toddlers Physical – Sleep disturbance – Sad or flat facial expression – Little motor activity – Failure to grow and
    [Show full text]
  • Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder
    Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder Denis G. Sukhodolsky, Ph.D. Yale Child Study Center Disclosures • Research support: – NIMH R01 MH101514 – NIMH K01 MH079130 – NICHD R01 HD083881 • Book royalty: – The Guilford Press Autism Spectrum Disorder (ASD) • Core symptoms – Impairment in social interaction and communication – Restricted interests and repetitive behavior • Associated features – Cognitive impairment – Deficits in adaptive functioning – Anxiety – Disruptive behavior problems Anxiety in ASD • Excessive fearfulness • Changes in routines and social situations • Can be related to core ASD symptoms • Co-occurring anxiety disorders may be present • Social anxiety may be difficult to diagnose • Contributes to impairment in functioning Cognitive-Behavior Therapy for Anxiety CBT is a well-established intervention for anxiety in children without autism. Key components: education, emotion regulation, and exposure and response prevention. Short-term duration, 8 to 16 weekly sessions. Treatment is conducted with the child and includes parent involvement. Is CBT helpful for anxiety in ASD? Main Findings: • 8 randomized controlled studies of CBT for anxiety were located. • CBT was superior to waitlist on parent and clinician-rated anxiety. • Effect sizes were 1.19 for parent ratings, 1.21 for clinician ratings and 0.68 for child self-report. Sukhodolsky, Bloch, Panza, Reichow Pediatrics, 2013 Neural Mechanisms of CBT for anxiety in ASD Subjects: • 10 children with ASD and
    [Show full text]
  • Dysphoria As a Complex Emotional State and Its Role in Psychopathology
    Dysphoria as a complex emotional state and its role in psychopathology Vladan Starcevic A/Professor, University of Sydney Faculty of Medicine and Health Sydney, Australia Objectives • Review conceptualisations of dysphoria • Present dysphoria as a transdiagnostic complex emotional state and assessment of dysphoria based on this conceptualisation What is dysphoria? • The term is derived from Greek (δύσφορος) and denotes distress that is hard to bear Dysphoria: associated with externalisation? • “Mixed affect” leading to an “affect of suspicion”1,2 1 Sandberg: Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtl Medizin 1896; 52:619-654 2 Specht G: Über den pathologischen Affekt in der chronischen Paranoia. Festschrift der Erlanger Universität, 1901 • A syndrome that always includes irritability and at least two of the following: internal tension, suspiciousness, hostility and aggressive or destructive behaviour3 3 Dayer et al: Bipolar Disord 2000; 2: 316-324 Dysphoria: associated with internalisation? • Six “dysphoric symptoms”: depressed mood, anhedonia, guilt, suicide, fatigue and anxiety1 1 Cassidy et al: Psychol Med 2000; 30:403-411 Dysphoria: a nonspecific state? • Dysphoria is a “nonspecific syndrome” and has “no particular place in a categorical diagnostic system”1; it is neglected and treated like an “orphan”1 1 Musalek et al: Psychopathol 2000; 33:209-214 • Dysphoria “can refer to many ways of feeling bad”2 2 Swann: Bipolar Disord 2000; 2:325-327 Textbook definitions: dysphoria nonspecific, mainly internalising? • “Feeling
    [Show full text]
  • The Neuroscience of Animal Welfare: Theory 80-20
    Review Article The neuroscience of animal welfare: theory 80-20 La neurociencia del bienestar animal: teoría 80-20 Genaro A. Coria-Avila, DVM, PhD1*, Deissy Herrera-Covarrubias, BSc, MSc2 1Centro de Investigaciones Cerebrales, Universidad Veracruzana, Xalapa, Ver., México 2Doctorado en Neuroetología, Universidad Veracruzana, Xalapa, Ver., México. Recibido: 28 de agosto de 2012 Aceptado: 16 de octubre de 2012 Puedes encontrar este artículo en: http://www.uv.mx/eneurobiologia/vols/2012/6/6.html Abstract Animal welfare is commonly regarded as the physical and psychological well-being of animals, fulfilled if animals are free: 1) from hunger, thirst and malnutrition, 2) from discomfort, 3) from pain, 4) to express normal behavior, and 5) from fear and distress. This paper is meant to provoke the reader to re-think the concept of welfare. Evidence indicates that animal welfare is not a constant state, but rather it must be fulfilled several times a day. A theory is proposed arguing that well-being occurs when the proportion of desiring and obtaining something occurs in a 80-20% proportion, respectively. The neurobiological bases of motivated behaviors are discussed to support a new view on animal welfare. Key words: Dopamine, Opioids, Environmental enrichment, Well-being, Desire, Reward. Resumen Comúnmente se considera al bienestar animal cuando los animales están bien física y psicológicamente. Esto se logra cuando están libres: 1) de hambre, sed y malnutrición, 2) de incomodidad, 3) de dolor, 4) para expresar conducta normal, 5) de miedo y estrés. Este artículo tiene la intención de provocar al lector para reconsiderar el concepto de bienestar animal.
    [Show full text]
  • Association of Irritability and Anxiety with the Neural Mechanisms of Implicit Face Emotion Processing in Youths with Psychopathology
    Supplementary Online Content Stoddard J, Tseng W-L, Kim P, et al. Association of irritability and anxiety with the neural mechanisms of implicit face emotion processing in youths with psychopathology. JAMA Psychiatry. Published online November 30, 2016. doi:10.1001/jamapsychiatry.2016.3282 eAppendix. Prior Research. eMethods 1. Participant Assessment. eMethods 2. Image Acquisition and Processing. eMethods 3. Estimating Neural Activation and Amygdala Functional Connectivity. eResults 1. ANX vs HV Only: A Comparison to a Prior Study. eResults 2. DMDD vs HV Only: A Comparison to a Prior Study. eResults 3. Analysis by Primary Diagnosis Instead of Anxiety and Irritability Dimensions. eResults 4. Cross Validation. eTable 1. Dimensional Measures by Primary Diagnosis. eTable 2. Excluded Participants. eTable 3. Details of Post Hoc Analyses of Medication Effects. eFigure 1. Positive Control of Activation. eFigure 2. Accuracy is Related to Irritability When Viewing the Higher Intensities of Anger. eFigure 3 Significant Connectivity Effects Not Depicted in Main Text. eFigure 4. Activation Maps of the Effect of ARI by Emotion on Activation. eReferences This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 eAppendix: Prior Research Prior investigations involving youths with severe, chronic irritability (operationalized either as severe mood dysregulation (SMD)1-4 or DMDD5) suggest the neural basis of irritability-associated face-emotion processing impairments.2 Of note, these prior studies involved two categories of irritability-related disorders, bipolar disorder and SMD/DMDD, and were designed to investigate their shared or distinct pathophysiology.6 They generally found that chronic irritability is associated with aberrant neural responses to different face emotions in visual (e.g.
    [Show full text]
  • Understanding Grief
    Understanding grief A guide for those grieving the death of a loved one kp.org/wa © 2018 Kaiser Foundation Health Plan of Washington GP0002339-50-17 Contents Understanding the journey of grief | 2 5 common myths about grief | 3 What to expect from grief | 5 Anticipatory grief | 7 Grief attacks or memory embraces | 9 The work of grieving | 10 Self-care while you grieve | 11 Common questions about grief support groups | 13 Ways to be good to yourself | 16 When does grief become depression? | 18 Where to get help | 20 1 Understanding the 5 common myths journey of grief about grief Grief is a healing journey we travel Myth #1: Grief and mourning are the through the death of a loved one and same experience. back to wholeness. Understanding this Grief describes the thoughts and process and the intense emotions that feelings we experience when someone can accompany it may help you move we love dies. Mourning describes our toward a healthy recovery. While the outward expression of grief, like crying, journey through grief may be slow and talking about the person, or celebrating difficult, it can also be a strengthening anniversary dates. Different cultures have and growth-filled experience. different customs for mourning. We can’t control everything that happens to us or our loved ones during this lifetime. Myth #2: There is a predictable, orderly But we do have control over how we way that everyone experiences grief. respond to those experiences. We can Certain experiences are common among choose to live in sorrow and anger, or we people who are grieving.
    [Show full text]
  • Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention
    BETH-00899; No of Pages 15; 4C: Available online at www.sciencedirect.com ScienceDirect Behavior Therapy xx (xxxx) xxx www.elsevier.com/locate/bt Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention Spencer C. Evans Harvard University Jennifer B. Blossom Seattle Children’s Hospital and University of Washington School of Medicine Paula J. Fite University of Kansas depressive symptoms, anxiety, reactive aggression, opposi- Severe irritability is a common and clinically important tionality, intolerance of uncertainty, and poor emotion problem longitudinally associated with internalizing and coping. From T1 irritability to T2/T3 outcomes, mediation externalizing problems in children. To better understand was found for poor sadness coping leading to reactive these mechanisms and to inform treatment research, we tested aggression and oppositionality; poor anger coping to anxiety, cognitive-behavioral processes as candidate mediators in the depressive symptoms, and oppositionality; and intolerance of paths from irritability to later problems. Methods: A school uncertainty to anxiety. Results offer further evidence for sample (N = 238, 48% female, ages 8–10) was assessed at internalizing and externalizing outcomes of youth irritability ~6-month intervals in fall (T1) and spring (T2) of third to and new evidence suggesting underlying mechanisms. Irrita- fourth grade, and again the following fall (T3). Measures bility may confer risk for externalizing problems via poor assessed irritability (T1/predictor); anger and sadness sadness/anger coping, and for internalizing problems via poor coping, intolerance of uncertainty, and rumination; (T1– anger coping and intolerance of uncertainty. Theoretical T2/mediators); and anxiety, depressive symptoms, reac- models and psychosocial treatment should consider address- tive aggression, and oppositionality (T1–T3/outcomes).
    [Show full text]
  • Help for Anxiety and Panic Disorders
    Information O from Your Family Doctor Help for Anxiety and Panic Disorders What are generalized anxiety disorder • Numbness or tingling and panic disorder? • Feeling that your body or things around Generalized anxiety disorder (GAD for short) and you are not real panic disorder (PD for short) are different types • Fear of going crazy or losing control of anxiety, or worry. It is normal to sometimes • Fear of dying worry or feel panicked, but you might have GAD or PD if these feelings frequently affect your life. How are GAD and PD treated? People with GAD worry much more than It is important to tell your doctor if you are having normal about everyday things. People with symptoms of GAD or PD. Some symptoms can GAD also have at least three of these symptoms: also be signs of other serious problems. • Feeling keyed up or on edge Medicines and psychological or behavioral • Tire easily talk therapy are the two main treatments of • Trouble focusing GAD and PD. Many people do best when treated • Irritability with both medicine and therapy. Your doctor • Feeling tense might also talk to you about how to avoid • Trouble sleeping situations that trigger your panic or anxiety. People with PD have panic attacks, which Making lifestyle changes is often helpful. These are sudden feelings of fear or anxiety. Sometimes changes include getting more exercise, drinking panic attacks happen for a reason, like being in less coffee, or getting better sleep. Tell your a busy public place, but people with PD can also doctor what medicines you are taking because have a panic attack out of the blue.
    [Show full text]
  • Mood Changes in Multiple Sclerosis
    MOOD CHANGES IN MULTIPLE SCLEROSIS Acknowledgments The National Multiple Sclerosis Society and the Multiple Sclerosis Society of Canada wish to acknowledge the support of the physicians, researchers, therapists, nursing staff and support staff from the following institutions: • MS Center at Holy Name Medical Center, Teaneck, N.J. • Sunnybrook Health Sciences Centre, Toronto State • University of Washington, Seattle We’d also like to thank the following individuals for so graciously giving their time and sharing their stories with us: • Ann Marie Johnson • Maria Reyes-Velarde • David Rosen Author Laurie Budgar was the editor of Momentum, the magazine of the National MS Society, from 2012–2017. She authored the original Society book, “Mood and Cognition in MS: What You Can Do,” from which this publication is excerpted and updated. Budgar specializes in health-related writing and editing, and is also a certified speech-language pathologist. Preface Though clinicians noted mood changes associated with multiple sclerosis as early as the 19th century, symptoms associated with mood disorder have only recently begun to receive the same degree of attention from clinicians as physical symptoms. Mood disorder is a complex issue and despite greater awareness, continues to be under-diagnosed and under-treated. This “invisible symptom” can be a direct result of the disease process, and can change over time. We now understand that mood and physical functioning are intricately entwined, and treating one area often brings profound improvement to other aspects of an individual’s life—and to the lives of their families. We also now recognize that while changes in mood may not be readily apparent to outside observers, their impact on a person’s life can be profound, affecting physical, social, emotional, occupational and spiritual functioning.
    [Show full text]
  • Anxiety Disorders: Diagnosis & Treatment
    Anxiety Disorders: Diagnosis & Treatment David Liu MD, MS Health Sciences Assistant Clinical Professor UC Davis Department of Psychiatry and Behavior Sciences Disclosures • I have no financial relationships to disclose relating to the subject matter of this presentation Learning Objectives 1. Review the DSM-5 diagnostic criteria for Generalized Anxiety Disorder and Panic Disorder 2. Recognize differential diagnosis of GAD and Panic Disorder 3. Appreciate common co-morbidities to Anxiety disorders 4. Understand approach towards management and treatment options for Anxiety disorders in the primary care setting Primary Care is the ‘De Facto’ Mental Health System What is Anxiety? Begins as ordinary, day-to-day Begins to effect situation. daily life Excessive DSM-5 Diagnostic Criteria for Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance) B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (With at least some symptoms having been presents for more days than not for the past 6 months). Note: Only one item is required in children – 1. Restlessness or feeling keyed up or on edge. – 2. Being easily fatigued. – 3. Difficulty concentrating or mind going blank. – 4. Irritability. – 5. Muscle tension. – 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) DSM-5 DSM-5 Diagnostic Criteria for Generalized Anxiety Disorder (cont.) D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social occupational, or other important areas of functioning.
    [Show full text]