PERINEAL REHABILITATION THERAPY
The pelvic floor
The pelvic floor is the origin to three very important openings: the urethra, the vagina and the rectum. A healthy pelvic floor is a healthy function for the urine system, fecal system and sex system. If the muscles in this area are too short, tight, or too long and weak the function of this area will damage. Therefore, a lot of specialists in charge of the treatment for this area: urologist, uroginacologist, gynecologist, sexual therapists, gastro antrologists, midwives and physical therapists who were trained to treat this area.
The pelvic floor contains: connecting tissues, nerves, vessels and muscles. Together they are creating a “trampoline” at the lower open of the pelvic. Above this “trampoline” are the urethra and the uterus and above are the abdomen body parts. The pelvic floor muscles has a few very important rolls: when they contact the sphincters closes, the pelvic parts elevates and a few reflexes operate so that the urethra muscles and the rectum muscles relaxes to collect urine and stool with control of it. These muscles also help us to keep the urethra the uterus and the rectum in the right position when we are active and when we are not. These muscles also essential for our sex life (for erection and orgasm) and for delivery time (on these muscles the baby change his direction facing his head down in the delivery canal frontal and back towards the vagina.
When the pelvic muscles don't function properly, they can't support the pelvic organs properly and therefore every action that increase the intra abdominal pressure like cough, sneeze, jumping, running, laughing, lifting heavy carriage or children and more can cause a downward pressure towards the pelvic organs. Dysfunction muscles cannot prevent the stretching of connective tissues and or to bring to a complete closure of the sphincters, ending with urine incontinence and gas and fecal incontinence and different prolapses. In time, the whole pelvic floor can prolapse. Pelvic floor prolapse brings to constipation, difficulty in urinating, ending with worsening the prolapse and damage to the nervous system in the area.
When there is a damage to the pelvic floor muscles, it causes imbalance between the different muscles in the pelvic that can damage even more muscles in the area with or without pain with or without incontinence with or without prolapses.
One of the modest common problem among women is urine in continence. It is a social and hygienic problem that causes social, professional everyday actions difficulties to those who suffer from it. About 25%-30% of the women suffer from this problem, the percentage increase with age.
Although this problem is very common and wry easy to treat, a lot of the women are avoiding from talking about it and admit to the problem.
Fecal incontinence is when there is no control on the rectal sphincters and stool comes out involuntarily that happens in the past month in the age group of 4 and above and in volume of at least 10 cc. The people that suffer from this problem usually isolate themselves.
Fecal incontinence happens when there is no balance between the texture and the volume of the stool or a sensory decrease or a decrease in the pressure of the rectal sphincter.
Constipation is very common. 20% of the population suffer from constipation. Constipation is when: you didn't have bowel movement for at least 3 times a week, every day bowel movement that needed a lot of strength to have them, or incomplete hard bowel movement.
There are a few reasons for constipation: slow movement of the stool in the intestine, bad diet and eating habits (not enough fibers, not enough fat, not enough liquids), certain medications and or lack of exercise. Long lasting constipation usually caused from the first two reasons.
Long lasting constipation with putting a lot of pressure and strengthin it is the main reason for weak pelvic floor muscles and can result in fecal incontinence.
Prolapse happens when one of the organs of the pelvic or the abdomen falls into one of the openings in the pelvic floor. For example the rectum can fall towards the anus, or towards the vagina. Other organs that can prolapse are the uterus, the urethra and the urethral tube.
Prolapse can be accompanied by urine or fecal incontinence. The causes for prolapse can be: heredity, age, gender, diseases, life style that causes chronic abdominal pressure, trauma, traumatic deliveries, and a few deliveries.
There are different grades to prolapse and the grade is determined while testing the patient under initial strength, like cough, lying down or standing.
Pelvic muscle rehabilitation helps the patient to bring back the ability of using his muscles and joints in an harmonical way the closest to the norm. It helps to bring the organs that had been damaged to function correctly again and by that to help the organs that were working harder to compensate over the lack of work of the damage organ. The treatment is mainly on the damaged organ with an over look over the whole body, assuming that a local damage can affect and be connected on other body parts.
In pelvic muscle rehabilitation the corporation of the patient is extremely important. The patient needs to understand what is the damage in the pelvic floor that needs to be fixed, what are the goals of the treatment, and how together with the therapist they will do it with exercising, TENS, sEMG, behavioural treatment and more.