Possibilities of objectivization of pelvic floor muscle exercises in patients with urine leakage after delivery.

BACKGROUND: Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles. METHODS: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements. CONCLUSION: The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

[Functionality of pelvic floor in patients after vaginal and abdominal hysterectomy, valuation by EMG-Biofeedback according to Perfect Scheme]. / Hodnotenie funkcného stavu panvového dna metódou EMG-Biofeedback podl'a Perfect schémy u pacientiek po abdominálnej a vaginálnej hysterektómii.

OBJECTIVE: Our research deals with the efficiency of rehabilitation in patients after vaginal and abdominal hysterectomy. The activation of pelvic floor muscles has been evaluated and comparison of individual parameters according has been carried out. Also the occurrence of incontinence has been assessed. Subjects consisted of 66 women, out of which there were 21 women after vaginal hysterectomy and 45 women after abdominal hysterectomy. TYPE OF STUDY: Prospective experimental study. METHODS USE: EMG-biofeedback has been used for the evaluation of the functionality of pelvic floor according to Perfect Scheme. For the quantification of leaked urine one hour PW test has been used. REHABILITATION METHODS: We applied the individual exercise on strengthening and relaxation of pelvic floor muscles with the aid of repeated, selective voluntary contractions or relaxation of pelvic floor muscles conducted two times a week, with the duration time of 15 minutes. Group exercise on strengthening and relaxation of pelvic floor muscles conducted two times a week, with the duration time of 30 minutes. Biofeedback (EMG-Module) as a therapeutic method was applied. RESULTS: In patients after vaginal hysterectomy there was a higher occurrence of incontinence than in women after abdominal hysterectomy. In both groups a significant increase in pelvic floor muscle strength has been achieved after the therapy. In both of these groups there was no statistically significant relaxation of m. rectus abdominis after the therapy. The patients after abdominal hysterectomy had more statistically significant relaxed abdomen muscles before treatment than patients after vaginal hysterectomy. It means, that performed exercise in the right manner, with reduction of intra abdominal pressure. We suppose that this phenomenon may be related to the higher percentage of occurrence of incontinence in patients after vaginal hysterectomy.