lecture notes for physiotherapy students

1. Women's health
A.THANGAMANI RAMALINGAM
PT, MSc(PSY),PGDRM, ACspss, MIAP

2. C. Climacteric Phase -
 a) Menopause, Osteoporosis & Physiotherapy management
 b) Gynecological conditions like Incontinence & its types,
Prolapse & displacement along with its PT management

3. Menopause/stages
 The word ‘menopause’
comes from the Greek
words ‘menos’ meaning
month and ‘pause’ meaning
to cease. Menopause
means the monthly period
stops.
 between 45-55 years

5.  menopause-related
complaints: joint and
muscle pains, mood
swings, sleep disturbances
and sexual dysfunction
 Relaxation: practising
relaxation and controlled
breathing may help hot
flushes .
 Hormone replacement
therapy (HRT )
 antidepressants, serotonin
 norepinephrine reuptake
inhibitors (SNRIs)
 and anti-epileptic medicine
can reduce hotflushes.
 Lifestyle, diet and exercise

6. Osteoporosis
 Osteoporosis is a systemic
skeletal disease characterized
by diminished bone strength
with the risk of sustaining a
fracture.
 Hip and vertebral fractures
 Accelerated postmenopausal
bone loss is induced by
estrogen deprivation.
 Although skeletal health is a
function of genetic
predisposition, it can be
modified by lifestyle factors
such as diet, weight-bearing
exercise and the avoidance of
bone-toxic substances

7.  The diagnosis of osteoporosis is based on assessment of
bone mineral density (BMD) by dual X-ray absorptiometry
(DXA).

8. Management
 Menopausal hormone therapy
 Calcium and vitaminD
 Bisphosphonates
 Selective estrogen receptor modulators(raloxifene and
bazedoxifene)
 Parathyroid hormone

9. Incontinence & its types
 Genuine stress incontinence
 Urge incontinence
 Mixed
 Chronic urinary retention and overflow incontinence
 Functional incontinence
 Miscellaneous (UTI, dementia)

10. Symptoms
 Frequency
 Nocturia
 Dysuria
 Incomplete emptying
 Incontinence
 Urgency
 Recurrent infections
 Dyspareunia
 Prolapse

11. Non-surgical
Treatment
 Fluid management
 Reduce caffeine, alcohol,
and smoking
 Bladder retraining
 Pelvic floor exercises
 Pessaries
 Continence devices
 Hormone replacement
therapy
 Medication to help
strengthen the urethra
 Medication to help relax the
bladder

12. Non-surgical Treatment:
Fluid management
 Avoid caffeine and alcohol
 Avoid drinking a lot of fluids in the evening

13. Non-surgical Treatment:
Bladder retraining
 Regular voiding by the clock
 Gradual increase in time between voids
 Double voiding

14. Non-surgical Treatment:
Physiotherapy
 Pelvic floor exercises
 Vaginal cones
 Devices for reinforcement

15. Non-surgical Treatment:
Pessaries
 Support devices to correct the prolapse
 Pessaries to hold up the bladder

16. Non-surgical Treatment:
Hormone replacement
 Systemic
 Local
Vaginal cream
Vaginal estrogen ring

17. Non-surgical Treatment:
Medication to strengthen the urethra
 Cold medication
– Ornade

18. Non-surgical Treatment:
Medication to relax the bladder
 Oxybutynin (ditropan)
 Toteridine (detrol)
 Flavoxate (urispas)
 Imipramine (elavil)

19. Surgery:
 For stress incontinence
 Theories:
 1) bladder neck elevation
 2) integral theory (ulmsten)

20. Surgery:
 Burch repair
 Marshall-marchetti-krantz repair
 Sling
 Needle suspension
 Injections
 Tension free vaginal tape

21. Quality of Life Impact:
 Impact on lifestyle and avoidance of activities
 Fear of losing bladder control
 Embarrassment
 Impact on relationships
 Increased dependence on caregivers
 Discomfort and skin irritation

22. Impact of Overactive Bladder on Quality ofImpact of Overactive Bladder on Quality of
Life Compared to Other ConditionsLife Compared to Other Conditions
Kobelt-Nguyen et al. 27th annual meeting of ICS, 1997.
0
40
50
60
70
80
90
Physical
Functioning
Physical
Limitations
Bodily
Pain
General
Health
Vitality
Social
Function
Emotional
Limitations
Mental
Health
Normal
Hypertension
Diabetes
Overactive bladder
Depression

23. Transvaginal electrical simulator

24. Pelvic Floor Muscle Biofeedback

25. Aims of physical therapy
 To improve dietary and micturition routine
 To improve proprioception and body awareness of PF: focus
on relaxing the PF and voluntary sphincter control
 To decrease any associated hypertonicity or pain in the PF
 To optimize functional use of PF

26. Prolapse
Prolapse
 It is a form of hernia and occurs through failure of some of the supporting
tissues of the muscular origin and transverse cervical ligaments of the
uterus.
Types
 Vault prolapse or uterine prolapse
 Vaginal prolapse
 1. Rectocele- a prolapse of posterior wall of the vagina
including rectus
 2. Cystocele- a prolapse of anterior wall of vagina including bladder with
stress incontinence
 Uterovaginal prolapse
 Enterocele
 A true herniation of peritoneum through the utero-sacral
ligaments appearing as a high rectocele and often containing a small
bowel.

Surgeries/ repairs
 Anterior& posterior Colporrhaphy ( repair of vaginal tissue or fascia)
 Monchester/ fothergill repair (it combines colporrhaphy &amputation of
the cervix and shortening of the transverse cervical ligaments).
 Vaginal hysterectomy &repair.

27. physiotherapy
Aims of post -operative
physiotherapy
 To prevent circulatory and
respiratory complications
 To strengthen pelvic floor,
abdominal &back muscles
 To correct posture
 Back care advices
 To return to normal ADLS
Means of physiotherapy
 Deep breathing exercise
 Foot &leg exercise
 Coughing &huffing
 Cough reflex stimulation &support
during cough
 Pelvic rocking exercises.
 Pelvic tilts to reduce spasm of
muscles
 Abdominal muscles contraction
 Pelvic floor exercises.
 Posture correction /bed mobility
 Regular day wise protocol followed
for returning normal function.