Pelvic floor rehabilitation: when it is needed, how and where to do it

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Carlos Laforet Coll
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Pelvic floor rehabilitation: what is it for and who can we turn to in case of problems?

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Pelvic floor rehabilitation: what is it for and who can we turn to in case of problems?





Pelvic floor rehabilitation, this unknown! We all know the figure of the physiotherapist and are used to thinking about rehabilitation only in the orthopedic or neurological field; in reality for every medical specialization, or almost, there is a rehabilitation specialization.

When it comes to pelvic floor rehabilitation, you go into a bit of a crisis, you don't really know what it is or who the person in charge of doing it is, nor do you know the problems for which you should actually start it. However, pelvic floor dysfunctions affect about a quarter of the adult population, mostly women, and it is important to talk about it because finding a solution to the problems it is linked to is possible!

Let's find out what it is, how and when it should be done.

Index

History of pelvic floor rehabilitation

The first studies on the subject date back to the late 1800s with different international authors. In the following years, several medical researchers (mainly gynecologists and urologists) dictated guidelines on different approaches to pelvic floor problems.
But it was only in 1948 that the American gynecologist Arnold Kegel placed women's problems at the center of his studies.

In fact, Kegel advocated the use of perineal exercises to prevent and / or treat genital prolapse and urinary incontinence.
To date, perineal rehabilitation techniques have progressively established themselves in various countries to deserve scientific recognition by theInternational Continence Society (ICS) in 1992 and, above all, by the International Consultation on Incontinence (ICI) in 1998 which indicated the "strengthening of the pelvic muscles" as the first therapeutic approach to urinary incontinence.

What is perineal rehabilitation?

Perineal rehabilitation can be defined as a set of specific non-surgical and non-pharmacological rehabilitation techniques that are suitable for treating pathologies in the sector:



  • urological
  • gynecological
  • colon-proctologico
  • sexological
  • postural e
  • neurological

for both female and male sex, using the activation of the perineal muscles commonly referred to as the "pelvic floor".

What problems is it recommended for?

  • Urinary incontinence (exertion, urgency and mixed)
  • Prolapse (of the rectum, uterus and bladder)
  • Faecal incontinence
  • Constipation
  • Menstrual pain
  • Pain during sexual intercourse
  • Erectile dysfunction
  • Premature ejaculation
  • Painful problems in the pelvis and lower back
  • Before and after childbirth
  • Before and after interventions on the prostate, bladder, urethra and uterus.

What does rehabilitation actually consist of?

Perineal rehabilitation uses a series of techniques aimed at improving the contractility (strength) and tone (resistance) of the pelvic floor muscles. The main rehabilitation techniques are represented by kinesitherapy, biofeedback and functional electrostimulation.

The goal is to improve perineal "performance", so as to allow the pelvic floor to perform its functions correctly.

Rehabilitation develops within a clinical reasoning and includes the following moments:

  • the formulation of the diagnosis (carried out by the specialist doctor),
  • functional assessment,
  • intervention planning,
  • therapeutic intervention,
  • the evaluation of the results.

The stages of rehabilitation

Evaluation

Functional evaluation aims to identify the specific condition of the patient. This is for the purpose of personalizing physiotherapy, thus identifying short, medium and long-term therapeutic goals, as well as the most suitable techniques and tools to achieve them.
Functional evaluation consists of anamnesis and physical examination.



The anamnesis is carried out through the verbal interview
And next, physical examination is done, which includes assessment of sensitivity, reflex activity, and muscle parameters of the pelvic floor. The physical examination consists of visual observation of the perineal area and manual evaluation of the pelvic floor and other related musculoskeletal structures.

Planning

The planning of the physiotherapy intervention is dedicated to the elaboration of the therapeutic goals in the short, medium and long term and to the choice of the means to reach them.

Therapeutic intervention

the rehabilitation and physiotherapy intervention is carried out in three consecutive phases:

  1. awareness of the motor activity of the pelvic floor muscles;
  2. normalization of altered muscle parameters;
  3. functional recovery.

What are the tools of the physiotherapist?

The techniques and tools that can be used in pelvic floor physiotherapy and rehabilitation are:

  • therapeutic exercise;
  • manual therapy;
  • self-treatment and home treatment;
  • behavioral treatment and lifestyle modifications;
  • il biofeedback;
  • functional electrical stimulation;
  • non-pharmacological products
  • therapeutic aids

Who can you contact?

The healthcare professionals of reference for the rehabilitation of the pelvic floor are the physiotherapist and the midwife (suitably trained in the matter).
The physiotherapist is a first contact person and rehabilitation can be started even without a doctor's prescription.
To get a diagnosis it is however advisable to contact the competent specialist doctor who, depending on the problem, will be the gynecologist, the urologist, the proctologist or the neurologist.

Davide Romano

Physiotherapist

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