Pelvic dysfunction

In evaluating gross body movement, the phy-sieian must examine all three aspeets of lumbosacral rhythm. It is common to relate all forward-bending restrictions to lumbar dysfunction. This assumption is not correct. Hip joint or pelvic dysfunctions are often at fault. 

The diagnosis of pelvic dysfunction concentrates on two aspects of the innominate the ilium and the pubic components. Generally, the landmarks of the posterior superior iliac spine (PSIS), anterior superior iliac spine (ASIS), pubic rami, and their other relative structures can give some static findings as to the diagnosis. As with other regions of the body, motion testing indicates the side of the dysfunction. 

The tests for pelvic dysfunctions have fair specificity and variable sensitivity. The presence of a sacral dysfunction can obscure or exaggerate the findings for pelvic dysfunction. The standing flexion test can be falsely positive if there is an overwhelmingly positive seated flexion test and sacroiliac dysfunction. The depth of the sacral sulcus is not specific to pelvic dysfunction because a deep sulcus can also indicate a forward sacral torsion with the axis opposite to the deep sulcus, a unilateral sacral shear, as well as a posteriorly rotated ilium on the same side. A shallow sulcus can also indicate sacral dysfunction in addition to an anterior rotated ilium on that side. 

FIG. 61-1 Muscle energy technique for anterior iliac-innominate-pelvic dysfunction, patient prone. 

Proper sacral and pelvic joint motion should be achieved in all gait, posture, and spinal motion problems. Because the sacrum Is closely associated with cranial motion, the sacrum must be evaluated as pan of the cranial motion evaluation. Lower extremity dysfunction often results from or may cause pelvic dysfunctions. 

Constipation can be due to primary and secondary causes (Table 18-1). Primary or idiopathic constipation is typified by normal-transit constipation, slow-transit constipation, and dyssynergic defecation. In the normal-transit type, colonic motility is unchanged and patients tend to experience hard stools despite normal movements. In the slow-transit type, motility is decreased leading to infrequent harder, drier stools. In dyssynergic defecation (also known as pelvic floor dysfunction), patients have lost the ability to relax the anal sphincter while coordinating muscle contractions of the pelvic floor. Some causes of secondary constipation are listed in Table 18-1. 

UTI dyspareunia, sexual dysfunction, pelvic pain Dysuria, CVA tenderness, frequency... 

Significant adverse reactions include edema vaginitis nervousness emotional lability hepatic dysfunction elevated blood pressure pelvic pain carpal tunnel syndrome sleep disorders fatigue tremor visual disturbances anxiety depression gastroenteritis. 

Constipation may be caused by slow intestinal transition, pelvic floor dysfunction, bowel dysfunction like irritable Bowel syndrome and tumours, but can also be secondary to other diseases and life conditions. Many medicines cause constipation, for example opiates, calcium channel blockers and drugs with anticholinergic effects, e.g. antidepressants. 

McKenna, P.H., Herndon, C.D., Connery, S., and Ferrer, F.A. (1999) Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. / Urol 162 1056—1062 discussion 1062—1063. 

Rufford J, Hextall A, Cardozo L, Khullar V. A doubleblind placebo-controlled trial on the effects of 25 mg estradiol implants on the urge syndrome in postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct 2003 14 78-83. 

The use of lUDs in patients with CLD has complicating factors. Owing to reduced hepatic complement synthesis and reticuloendothelial system dysfunction, patients with cirrhosis and ascites are prone to develop repeated episodes of spontaneous bacterial peritonitis (SBP). Historically, the risk of pelvic inflammatory disease (PID) was considered to be increased in lUD users during the first year after insertion, therefore it was thought that the presence of an lUD in approximation with the peritoneal surface in a patient with cirrhotic ascites might lead to SBP... 

Echols KT, Chesson RR, Breaux EF, Shobeiri SA. Persistence of delayed hypersensitivity following transurethral collagen injection for recurrent urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2002 13(l) 52-4. 

Eleven patients referred for neurological evaluation after cisplatin infusion into the internal or external iliac arteries for pelvic or lower limb tumors aU developed symptoms within 48 hours of nerve or plexus dysfunction within the territory supplied by the cannulated artery (108). The lumbosacral plexus was affected in nine patients, the femoral nerve in one, and the peroneal nerve in one. The doses of cisplatin ranged from 50 to 160 mg/m and they did not correlate with the severity or course of the neuropathy. Small-vessel injury and infarction or a direct toxic effect are likely explanations. 

Drutz HP, Appell RA, Gleason D, Klimberg I, Radomski S. Clinical efficacy and safety of tolterodine compared to oxybutynin and placebo in patients with overactive bladder. Int Urogynecol J Pelvic Floor Dysfunct 1999 10(5) 283-9. 

The majority of patients with constipation related to pelvic floor dysfunction can benefit from electromyogram-guided biofeedback therapy. The value of biofeedback in children with chronic constipation has not been well demonstrated. ... 

Approximately 90%-95% of cases of childhood constipation are likely to represent functional constipation. Rectal distention is present in nearly all cases and failure of the external anal sphincter and/or pub-orectalis muscle to relax during defaecation attempts has been found in the majority of these children. Whilst delayed colonic transit time may be part of the problem, pelvic floor dysfunction seems to be the dominating factor (Loening-Baucke 1993). 

The pelvic floor constitutes the caudal border of the human s visceral cavity. It is characterized by a complex morphology because different functional systems join here. A clear understanding of the pelvic anatomy is crucial for the diagnosis of female pelvic diseases, for female pelvic surgery as well as for fundamental mechanisms of urogenital dysfunction and treatment... 

The clinical presentation of adenomyosis is unspecific and includes symptoms such as dysmenorrhea, menorrhagia, and pelvic pain, which are also common in disorders like dysfunctional bleeding, leiomyoma, and endometriosis. The uterus is frequently enlarged in women with adenomyosis but not distorted in its... 

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