1 / 27

Importance & Position of Physiotherapy In Pelvic Floor Muscle Dusfunction

Importance & Position of Physiotherapy In Pelvic Floor Muscle Dusfunction. Dehghan FM,PT,PhD Associate Prof. Shaheed Beheshti Medical Unicersity. 5 Ws:. What are PFMD? When PT? Who can? To whom? How?. General role of Physiotherapy In Public Health. 1- حفظ و برقراری فانکشن

rachel
Download Presentation

Importance & Position of Physiotherapy In Pelvic Floor Muscle Dusfunction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Importance & Position of Physiotherapy In Pelvic Floor Muscle Dusfunction Dehghan FM,PT,PhD Associate Prof. Shaheed Beheshti Medical Unicersity

  2. 5 Ws: • What are PFMD? • When PT? • Who can? • To whom? • How? Dr.Dehghan

  3. General role of PhysiotherapyIn Public Health 1- حفظ و برقراری فانکشن 2- بهبود و ارتقاء حرکت 3 - کاهش درد 4-پیشگیری یا محدود نمودن نا توانی های جسمی از این روی فیزیو تراپیستها به عنوان عضوی از تیم بهداشتی در ارتقاء و حفظ سلامت و بهداشت عمومي جامعه مداخله دارند. Dehghan FM,PT,Ph.D

  4. Women’s Health & Physiotherapy PT has important role in 3 stages of Women’s life: 1-Adolescence 2-The Child-Bearing year 3-The Mature women Dehghan FM,PT,Ph.D

  5. The Mature woman In this stage PT attends to: 1- Pelvic Floor Dysfunction(Urogenital,Anorectal & sexual) 2-Rehabilitation After Breast Cancer 3-PT & Gynecological Surgery 4-PT Management of Lymphoedema 5-Musculoskeletal Changes related to Menopause (Osteoporosis) Dehghan FM,PT,Ph.D

  6. Why Pelvic Floor?! Do We know? How much? A little or …? Prevalence of dysfunctions - 1/10 of every Gyn. Visit has sever PFD & needs surgery -UI: 35-50% in IRAN - FI :1.1-10% or 15-30%/ Mixed 5-10% - POP:50% of parous women,10-20% seek medical care -PFM Trigger points? Dehghan FM,PT,Ph.D

  7. Muscles Inferior to the Pelvic Floor:TheUrogenital Diaphragm • Muscles inferior to the pelvic floor Stretches between two sides of the pubic arch in the anterior half of the perineum • Contains • Deep transverse perineal muscle • External urethral sphincter muscle • The ischiocavernosus and bulbospongiosus assist in erection of the penis and clitoris; lie superficial to the urogenital diaphragm

  8. Dehghan FM,PT Ph.D

  9. The pelvic floor muscles have several functions: Maintain alignment and support of the internal organs. Control of urine flow. Sexual enhancement. Eliminate waste from the rectum. If the pelvic floor is weak, it can contribute to: Fall of the bladder or uterus through the pelvic floor muscles due to lack of support. Urinary/Anal incontinence Limited sexual pleasure during intercourse. Delayed recovery of tissue in the case of an episiotomy

  10. Synergic Activation of Trunk & PFM Muscles: Sapsford 2001Devreese 2004,Smith,Madil 2007 2

  11. Different Aspects of Function Dehghan FM,PT Ph.D

  12. Dehghan FM,PT Ph.D

  13. Effects of pregnancy on the LUT 1- Anatomical 2-Hormonal 3-Connective tissue changes/Biomechanical Dehghan FM.

  14. Effects of Delivery on LUT 1- Endopelvic Fascial tears/defects 2-Levator damage 3-Pudendal nerve trauma ( Freeman2001) Dehghan FM.

  15. Dehghan FM.

  16. Musculoskeletal Conditions seen in Pregnancy and Postpartum • bony pelvic malalignment • perineal trauma • diastasis recti, abdominal trauma • change in arch support, ligamentous support of feet and ankles • malalignment of ribs • back pain related to poor posture, infant care, post epidural

  17. Pelvic floor muscle dysfunction Symptoms 1-LUTS UI,Urgency &Frequency, Slow or intermittent stream & straining, Feeling of incomplete Emptying 2-Bowel symptoms Obstructed defecation,Functional Constipation, FI,Rectal/anal prolapse POP:3-Vaginal Symptoms 4-Sexual Function ,In women:Dyspareunia-In men: ED,PE ,In both :Orgasmic dysfunction 5-Pain CPP & Pelvic Pain Syndrome Dehghan FM,PT,Ph.D

  18. Urinary incontinence • Any uncontrolled loss of urine of any amount • Urgency & frequency of urination are not considered incontinence unless there is loss of bladder control, even a few drops of urine. 1-Stress UI (Pelvic Floor Instability) Loss of urine during/after Increase in IAP or Failed(Inefficient) Load Transfer(Lee 2004) Leaking urine during or after pregnancy while/after Increase in IAP ,e.g: running, sneezing, laughing, coughing or straining 2-UrgeUI 3-Mixed UI 4-Overflow UI 5-Functional UI Dehghan FM,PT,Ph.D

  19. Types of Urinary Incontinence • Urge Incontinence • “Overactive Bladder”, Detrusor overactivity • A strong sense to void followed by involuntary loss of urine • Usually idiopathic, but can be due to infection, bladder stones, bladder cancer

  20. Types of Urinary Incontinence • Mixed Incontinence • Most common in women overall • Exact mechanism not well understood • Characteristics of both Urge and Stress Incontinence • Overflow Incontinence • Due to overdistension of the bladder • Frequent or constant “dribbling” • Either due to an outlet obstruction (prostate) or detrusor underactivity (medications, spinal chord injury, diabetic neuropathy, MS) • Post void residual is often elevated

  21. Complications of dysfunctions -Pain and sexual disturbances Up to 60% of sexually active attending a urogynecology clinic suffer from FSD -In USA around 400,000 operations per year for PFD & 30% of them are Re-operations -How many operations & Re-Op.for PFD in Iran?! -Social effects/ Psychological effects/costs…QOL… Dehghan FM,PT,Ph.D

  22. Types of Prevention * Primary -Aims to remove the cause of a disease *Secondary - Aims to detect asymptomatic dysfunction and treat it early to avoid progression *Tertiary - The treatment of existing symptoms to prevent progression of a disease Dehghan FM.

  23. Prevention/Treatment Strategies1-Lifestyle Interventions - Weight Reduction - Relieving Constipation -Cessation of Smoking -Treatment of Chronic Cough - Caffeine Reduction/fluid management -Reduction of excessive physical Forces Dehghan FM.

  24. 2-Electrotherapy Methods 3-Pelvic Floor Muscle Training Knack Maneuver Kegel Exs. Lumbo-Pelvic Stabilization Exs. Strong evidences to suggest that for women with stress, urge and mixed incontinence PFMT is better than no treatment (Hay-Smith et al 2001) • Biofeedback Therapy • Electrical Stimulation (Neuromodulation/ Neurostimulation/PFES) • Electromagnetic Stimulation Therapy

  25. Recommendation Integrative Approach :Coordinated effort of Biomechanical Engineering, Biologists, Neuroscientists,epidemilogists,Physiotherapiststo increase knowledge about PF & PFD AND Multidisciplinary Approach on Prevention & Treatment ( De Lancey 2005) Dehghan FM.

  26. Thanks for your Attention Dr.Dehghan

More Related