Physiotherapy in lowering (prolapse) of the vaginal walls gives a chance for conservative treatment of this ailment, and also increases the effectiveness of surgical treatment. What is physiotherapy in the lowering (prolapse) of the vaginal walls?
The problem of lowering (falling out) of the walls of the vagina and other organsaffects women of all ages, most often those freshly after pregnancy and childbirth and in the perimenopausal age, which is directly related to the decrease in the level of hormones in the body. Other factors predisposing to its occurrence are:
- insufficient pelvic floor muscles
- weak connective tissue
- chronic constipation
- obesity
- lack of physical activity (but also excessive physical exertion)
- chronic cough respiratory diseases
- neurological disorders
- faulty toilet habits
- operations (e.g. removal of the uterus).
The pelvic organs, such as the urinary bladder, uterus and intestines, are kept in position on the one hand by the pelvic day muscles supporting them from below, and by "hanging" on the ligaments and fascia on the other. Failure of the above-mentioned structures leads to the fall of one of the organs, which is manifested by the prolapse of the vaginal walls. It can be a temporary process (often after pregnancy and childbirth) or permanent.
The clinical division according to DeLancey identifies 3 levels of damage to the pelvic floor structures. The consequence of the first is uterine prolapse (enterocele), the second - the bladder / intestine (cystocele / rectocele), and the third - the urethra (urethrocele). Patients report, inter alia, pressure, pain, vaginal discomfort (foreign body sensation), heaviness in the pelvic floor, disturbance in urination / emptying, friction or air in the vagina.
Physiotherapy offers the possibility of conservative treatment of the described ailments, until recently considered the only field of activity for surgery. Ideally, before starting the therapy, the patient should be examined by a urogynecologist who is able to determine the level of possible damage in an objective ultrasound examination. If it exists, the rehabilitation options are limited, but you should absolutely take advantage of them. Even if full success in treatment is possible only with the help of a scalpel - the patient willprepared for surgery as best as possible, and after it, it will recover faster and has a chance to enjoy better results for longer. And often forever.
Pelvic floor physiotherapy: rules
The therapy starts with an examination per vaginum / per rectum (through the vagina / anus). It allows the therapist to recognize the state of the tissues inside the pelvis:
- assess their continuity, structure, condition of muscles, fascia, nerves;
- find weakened / non-working areas, or overly tense ones and stimulate them to work immediately or relax them using manual techniques;
- plan pelvic floor muscle training, teaching the patient how to activate it beforehand.
If that's impossible, biofeedback and electrotherapy come in handy. Using biofeedback, the patient can control the activity of the pelvic floor on the screen of a special device, which allows her to train her muscles to work properly. In electrotherapy, special electrostimulators are used, which through vaginal / rectal and sometimes external electrodes support the weakened, conscious muscle contraction with electrical impulses.
However, in the fight against vaginal prolapse / lowering, one cannot focus solely on looking for pelvic disorders. The human body is a system of many interconnected structures and an abnormality in one place moves to adjacent areas. Therefore, by all methods used in physiotherapy, one should strive to restore the balance in the entire body. It is important to achieve success also in the treatment of comorbidities, e.g. those associated with chronic cough. It provokes an increase in pressure in the abdominal cavity, thus weakening the structures of the pelvic floor and aggravating the problem of lowering organs. Patients with these conditions must learn coughing techniques to reduce excessive pressure.
Particular emphasis should be placed on improving the body shape and posture, reducing its weight and changing the destructive habits of everyday life related to emptying the bladder and intestine. The most important prohibitions are:
- empty bladder "spare"
- displacing urine with the strength of the abdominal muscles to accelerate its flow
- strong pressure when defecating (you should take care of the correct amount of fluids, a diet rich in fiber - to eliminate constipation)
The patient must stop lifting heavy objects and learn to recognize and avoid situations that put stress on the pelvic floor, and to choose the right sports activity for herself. It is also worthwhile to take some relief positions (with the pelvis inabove).
Only when the above-mentioned methods do not bring the expected results, women are offered pessary therapy or the use of special support tampons. Modern pessaries used in various types of depression are cubes with concave walls made of surgical silicone. The aim is for the patient to independently administer the pessary in the morning and take it out in the evening. Thanks to this, the risk of pressure ulcer or other complications is minimized. If the patient tolerates functioning with the ankle well - she found an alternative to surgical treatment.
Occasionally, your doctor may order supportive local estrogen therapy in the form of suppositories, tablets, or ointments.
Only at the very end, after conservative treatment that is unsatisfactory for the patient, the implementation of surgical treatment is considered.References:www.terapiadnamiednicy.plwww.ag-ggup.dewww .ptug.pl