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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

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Importance & Position of Physiotherapy In Pelvic Floor Muscle Dusfunction

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  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

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