Clinical App in Ob/Gyn

Dysmenorrhea

Primary = Absence of Pelvic Dz
-Diagnosis of Exclusion
-Spasmatic
-50% females with history of: Early menarche, Long Menstrual Periods, and Heavy Menstrual Flow

Secondary = Menstrual pain d/t Anatomic Anomaly or definable pathology
-Women with Endometriosis or Chronic PID
-Age 30-45 yo
-Congestive

Hormonally regulated disintegration

Expulsion of Endometrial lining through VC and Contraction of the Uterus

-Ischemia (increased frequency or duration)
-Cervical Tone (stenosis)
-Psychological Factors

Endometrial disintegration and breakdown of cellular fats to Arachidonic Acid --> PGF2alpha --> Potent myometrial stimulant/tone and VC and uterine contractions

-Endometriosis
-Adhesions
-Uterine fibroids
-Anovulatory Menorrhagia
-Pelvic Congestion Syndrome
-Strictures
-Pelvic Inflammatory Disease (STD hx?)
-Ovarian cysts
-Adenomyosis
-Hydrosalpinx
-Ectopic Pregnancy

Physical deconditioning and/or Gravitational Strain of supporting structures

Has negative impact on uterine contraction and expulsion of endometrial contents

Ligamentous Strain

-Support
-Sphincteric
-Sexual

SD of these structures --> affects function

'Floor and Walls'

-Levator Ani m
-Pubococcygeus (support pelvic viscera)
-Pubovaginalis (sphincter of vagina and urethrae)
-Puborectalis (elevates and constricts anal canal)
-Fibrococcygeus (supports pelvic viscera)
-Coccygeus ischiococcygeus (flexes coccyx, supports pelvic viscera, stabilizes SI joint)
-Obturator internus (ext rotates hip)
-Piriformis (ext rotates hip, stabilizes hip joint)

-Ischiocavernosus (erection of clitoris)
-Bulbocavernosus (vaginal sphincter, erection of clitoris)
-Superficial Transverse Perineal (anchors Perineal body)

(urogenital sphincter muscles)
-Upper portion (Sphincter urethrae)
-Lower portion (Urethrovaginal sphincter, Compressor urethrae)

Superficial
Subcutaneous
Deep

-Voluntary Sphincter of Anal Canal
-Assists the Puborectalis muscle

Alterations in Vascular, Lymphatic, and Neuologic functions

Goal = normalize PSNS and SNS tone

--> Non-physiologic stimulation of ANS --> organ --> changes in cellular, tissue, organ, and systemic activity

T10-L2
Inferior Hypogastric Plexus
Uterine Contraction, Decreases Uterine Blood Flow, and Cervix relaxation (getting ready for labor)

T9-T10
Celiac AND Mesenteric Ganglia
Decreases Blood Flow (labor)

S2-S4
Pelvic Splanchnic
Uterine relaxation and Increases Blood Flow and Cervix constriction (majority of the time before labor begins)

S2-S4
Increases Blood Flow

-Remove Fascial restriction
-Restore Sacral/Pelvic motion
-Consider diaphragmatic restriction
(Focuses on blood flow and lymphatic restriction)

-Restore/Support Homeostatic mechanisms
(Example Fascia)

-The more efficient the body is, the less energy it wastes = increases homeostatic adaptability to stressors = can 'heal' itself better

-Determine stressors
-Pain tolerance/intolerance
-Pain = symptom or the disease?
(How is the disease/symptoms effecting their life?)

-Pelvic floor MFR or Balanced Ligamentous Tension (via Bimanual exam)
-Diaphragms
-Sacral Inhibition
-Thoracolumbar Kneading and Stretching

Kribs' Baby techniques:
-Balanced Ligamentous Tension to Sacrum
-MFR to Abdomen/Uterus

Requires a nurse in the room and communication/trust with the pt

DECREASE lymphatic congestion

-calms uterine contractions
-pt is prone, maintain steady pressure
-home exercise = lying supine with book under sacrum and bringing knees to chest (to increase pressure on the sacrum)

Normalizes tone of Uterus and Cervix