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Principles and Methods of Physiotherapy After Delivery

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Childbirth-Related Pelvic Floor Dysfunction
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Abstract

According to a number of epidemiological studies, one of the most socially devastating sequels of vaginal delivery is pelvic floor muscle’s damage [1]. It can cause pelvic organ prolapse with loss of bladder and bowel control, making life very hard to manage and painful: child-care, walking, sitting, sleeping, and human relationships may become problematic [2–3]. The conservative treatment is universally considered as the first line intervention, and the British National Institute for Health and Clinical Excellence (NICE) with the International Continence Society (ICS) recommend it as the first step [4–7]. As a matter of fact, a damaged pelvic floor can be improved through re-education exercises [9], and after them, approximately 65 % of women will improve, with 30–50 % ending up to surgery [8, 10, 11].

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References

  1. MacLennan AH, Taylor AW, Wilson DH (2000) The prevalence of pelvic floor disorders and their relationship to gender, parity and mode of delivery. BJOG 107:1460–1470

    Article  CAS  PubMed  Google Scholar 

  2. UustalFornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83:383–389

    Article  Google Scholar 

  3. Fitz FF, Costa TF, Yamamoto DM, Resende AP, Stupp L, Sartori MG, Girao MJ, Castro RA (2012) Impact of pelvic floor muscle training on quality of life in women with urinary incontinence. Rev Assoc Med Bras 58(2):155–159

    Article  PubMed  Google Scholar 

  4. Morkved S, Bo K (2014) Pelvic floor muscle training after childbirth can prevent and treat urinary incontinence. A supervised training protocol following strength-training principles, emphazising close to maximum contractions and lasting at least 8 weeks is recommended. PFMT should be incorpored as a routine part of women’s exercise programs in general. 2013 Systematic Review. Br J Sports Med 48(4):299–310

    Article  PubMed  Google Scholar 

  5. Consensus conference. Urinary incontinence in adults (1989) JAMA. 261:2685–2690.

    Google Scholar 

  6. Fantl JA, Newman DK, Colling J (1996) Urinary incontinence guideline panel. Urinary incontinence in adults: acute and chronic management. Clinical practice guideline. No.2 1996 update AHCPR Publication No.96-0682 6(3):19–24. Rockville: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services

    Google Scholar 

  7. Abrams P, Cardozo L, Wein A, Khoury S (2009) Conservative management is the main approach to UI in men at the primary care level, and is often considered to be simple and low cost. The term ‘conservative management’ describes any treatment that does not involve pharmacological or surgical intervention. However, for conditions, such as OAB, conservative strategies are often combined with drug treatment. 4° International Consultation on Incontinence Paris, pp 5–8

    Google Scholar 

  8. Labrie J, van der Graaf Y, Buskens E, Tiersma SE, van der Vaart HC (2009) Protocol for physiotherapy Or TVT Randomized Efficacy Trial (PORTRET): a multicenter randomized controlled trial to assess the cost-effectiveness of the tension vaginal tape versus pelvic floor muscle training in women with symptomatic moderate to severe urinary incontinence. BMC Womens Health 9:24

    Article  PubMed Central  PubMed  Google Scholar 

  9. Carneiro EF, Araujo Ndos S, Beuttenmull L, Vieiria PC, Cader SA (2010) The anatomical-functional characteristics of the pelvic floor and quality of life of women with urinary incontinence subjected to perineal exercises. Actas Urol Esp 35(9):788–793

    Google Scholar 

  10. Dumoulin C, Martin C, Elliott V (2013) Randomized control trial of physiotherapy for post partum stress incontinence:7.years follow-up. Neurourol Urodyn 32(5):449–454

    Article  PubMed  Google Scholar 

  11. Ahlund S, Nordgen B, Wilander EL (2013) Is home-based pelvic floor muscle training effective in treatment of urinary incontinence after birth in primiparous women? A randomized controlled trial. Acta Obstet Gynecol Scand 92(8):909–915

    Article  PubMed  Google Scholar 

  12. Stasa D, Derek G, Werner S, Cathy C, Neil M (2009) Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency incontinence severity. J Urol 08(155)

    Google Scholar 

  13. Di Gangi Herms AM, Veit R, Reiseenauer C (2006) Functional imaging of stress urinary incontinence. Neuroimage 29:267–275, 200

    Article  PubMed  Google Scholar 

  14. Cundiff G, Addison A (1998) Management of pelvic prolapse. Obstet Gynecol Clin N America 25(4):90:19–26

    Google Scholar 

  15. Salvioli B, Bharucha AE, Rath-Harvey D (2001) Rectal compliance capacity, and rectoanal sensation in fecal incontinence. Am J Gastroenterol 96(7):2158–2168

    Article  CAS  PubMed  Google Scholar 

  16. Cescon C, Raimondi E, Merletti R (2014) Characterization of the motor units of the external anal sphincter in pregnant women with multichannel surface EMG. Int Urogynecol J 25:1097–1103

    Article  PubMed  Google Scholar 

  17. Enck P, Franz H, Azpiroz F, Fernandez-Fraga X, Hinninghofen H, Kaske-Bretag K, Bottin A, Martina S, Merletti R (2004) Innervation zone of the external anal sphincter in healthy male and female subjects. Digestion 69:123–130

    Article  CAS  PubMed  Google Scholar 

  18. Cescon C, Riva D, Zacesta V, Drusany Staric K, Martsidis K, Protsepko O, Baessler K, Merletti R (2014) Effect of vaginal delivery on the external anal sphincter muscle innervation pattern evaluated by multichannel surface EMG: results of the multicentre study TASI-2. Int Urogynecol J 25:1491–1499

    Article  PubMed  Google Scholar 

  19. Spitznagle TM, Leong FC, van Dillen LR (2007) Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J 18(3):321–8

    Article  Google Scholar 

  20. Munariz R, Kim NN, Goldstein I et al (2002) Biology of female sexual function. Urol Clin North Am 29:685–693

    Article  Google Scholar 

  21. Laycock J, Standley A, Crothers E (2001) Patient education and management. In: Clinical guidelines for the physiotherapy management of females aged 16 to 65 years with stress urinary incontinence. Chartered Society of Physiotherapy, London, p 19

    Google Scholar 

  22. Locher JL, Roth DL, Goode PS (2001) Reliability assessment of the bladder diary for urinary incontinence in older women. J Gerontol A Biol Sci Med Sci 56:M32–M35

    Article  CAS  PubMed  Google Scholar 

  23. Petros PP, Skilling PM (2001) Pelvic floor rehabilitation in the female according to the integral theory of female urinary incontinence. First report. Eur J Obstet Gynecol Reprod Biol 94:264–269

    Article  CAS  PubMed  Google Scholar 

  24. McNevin N, Gabriele W, Carlson C (2000) Effects of attentional focus, self control and dyad training on motor learning: implications for physical rehabilitation. Phys Ther 80(4):373–385

    CAS  PubMed  Google Scholar 

  25. Bourcier AP, Burgio KL (2004) Biofeedback therapy. In: Bourcier AP, McGuire EJ, Abrams P (eds) Pelvic floor disorders. Sauders-Elsevier, Philadelphia, pp 297–311

    Google Scholar 

  26. Hobday DI, Aziz Q, Thacker N (2001) A study of the cortical processing of ano-rectal sensation using functional MRI. Brain 124:361–368

    Article  CAS  PubMed  Google Scholar 

  27. Jones R, Comerford M, Sapford R (2002) Pelvic floor stability and trunk muscle co-activation. In: Layock J, Haslam J (eds) Therapeutic management of incontinence and pelvic pain. Springer, London, pp 66–71

    Google Scholar 

  28. Sapsford RR, Richardson CA, Stanton WR (2006) Sitting posture affects pelvic floor muscle activity in parous woman: an observational study. Aust J Physiother 52:219–222

    Article  PubMed  Google Scholar 

  29. Bleijenberg G, Kujipers HC (1987) Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 50(2):108–111

    Article  Google Scholar 

  30. Whitehead WE, Wald A, Norton N (2001) Treatment options for fecal incontinence: consensus conference report. Dis Colon Rectum 44:131–144

    Article  CAS  PubMed  Google Scholar 

  31. Hosker G, Norton C, Brazzelli M (2002) Electrical stimulation for fecal incontinence in adults. Cochrane Database Syst Rev 2007(3):CD001310

    Google Scholar 

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Correspondence to Simonetta Minoli .

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Minoli, S. (2016). Principles and Methods of Physiotherapy After Delivery. In: Riva, D., Minini, G. (eds) Childbirth-Related Pelvic Floor Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-18197-4_13

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  • DOI: https://doi.org/10.1007/978-3-319-18197-4_13

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18196-7

  • Online ISBN: 978-3-319-18197-4

  • eBook Packages: MedicineMedicine (R0)

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