In the presence of some alarm bells such as the incontinence of urine, gas or stool, pain during relationships, prolapse or chronic pelvic pain, it is important to start a personalized path of rehabilitation of the pelvic floor.
The pelvic floor It corresponds to the parent-urinary-anal area and is made of muscles and a particular fabric, called a connective, which together constitute a sort of hammock, which connects the publishing pubis and the coccyx behind. It is a area of particular importance for the health and well -being of the woman because it has an action of support bottom up.
In the presence of some alarm bells, in post-parto but not only, it is essential to contact a specialist to start a path of rehabilitation of the pelvic floor.
In fact, the pelvic floor exactly like the floor on which we walk is sensitive to what happens on the upper floors, such as weight gain linked to pregnancy or a lifting of a heavy object or even because of the pressure as for cough or a sneezing. Some factors predispose to dysfunctions of the pelvic floor, such as the number of pregnancies, childbirth, the increase in abdominal pressure, menopause, surgical interventions on the pelvis and chronic constipation. All these factors can influence the health of the pelvic floor and, it is appropriate to contact a specialist for an evaluation and in case a rehabilitation path. Let’s see what to do and when necessary.
How does the rehabilitation of the pelvic floor work?
At the end of the puerperium (about 40 days after childbirth), the execution of a control visitin which an evaluation of the pelvic floor is also carried out.
On that occasion, the midwife or the gynecologist, after a anamnestic interview, will perform the clinical evaluation: first observing the genitals (lacerations and scars, status of the skin and mucous membranes) and then performing an evaluation test of the Pelvic floor muscles (strength, resistance, points of tension, contractures).
In the presence of some alarm bellslike incontinence of urine, gas or feces, pain during relationships e pain chronic pelvic, it will be important to start a path of rehabilitation of the pelvic floor after childbirthwhich always includes a personalized evaluation and treatment. First choice treatments provide that the woman performs Exercises for rehabilitation of the pelvic floor at home, after adequate training by a professional.
The consequences of a “Not healthy” pelvic floor they can lead to the failure and consequent downhill descent of one or more pelvic structures: this condition takes the name of urogenital prolapse And it can affect the bladder, the rectum, the vagina and the uterus, in different combinations and levels of gravity.
The muscle exercises for the pelvic floor In women with prolapse they have shown an improvement of both symptomatology and the prolapse stadium. Nice guidelines recommend a training program of the muscles of the pelvic floor supervised by a healthcare professional for at least 4 months for women with symptomatic prolapse that does not extend for more than 1 cm beyond the hymen during the effort. There are other methods which can be used on the rehabilitative path, among which we find the Biofeedback and electrostimulation.
The rehabilitation path It is enriched by several re -educational/rehabilitative elements: different professional figures, adequately trained, are involved in the re -education of the pelvic floor And the recovery of female health: gynecologist, obstetric, physiotherapist and psychologist.
How long does the rehabilitation of the pelvic floor last?
There rehabilitation cannot be standardizedindeed to be effective it must be highly personalized: for this reason the Duration of the rehabilitation path of the pelvic floor is very variable. The guidelines published by the National Institute for Health and Care Excellence (Nice) (Great Britain) (1) include a first choice treatment phase for urinary incontinence in women of at least 3 monthsin which exercises for the pelvic floor muscles take place.
In the post, the path can have a longer duration, from 6 to 10 months, as it also involves the recovery of weight, of an adequate posture and the improvement of physical conditions (increase in lean mass). This “medium” time interval scheduled for the rehabilitation It depends on the mother and the methods of childbirth and any complications (hematomas, lacerations, episiotomies, I start with suction cup).
Therapies and exercises for the rehabilitation of the pelvic floor: what is really effective
The pelvic floor It can be strengthened through specific exercises, among the most effective ones we find the Kegel exercisesof which you will probably have already heard. These are simple Muscle exercises of contraction and releasewhich have the aim of strengthening the muscles of the pelvic floor, fundamental in the containment and release of urine and feces.
First of all it is important become aware of the pelvic floor: where he is, how to hear it and activate it. In fact, it is essential recognize the muscles to be exercised To ensure that the rehabilitation of the pelvic floor is effective. For this reason it is possible to become aware of possibly by introducing a finger in the vagina and contracting the muscles: if they close around the finger, the correct ones are being used.
After a careful evaluation, a professional may advise you to perform these exercises, always with the empty bladder. To start it is recommended to perform them in Location lying with the bent legs or in a sitting positionpaying attention not to contract legs, abdomen and buttocks during gymnastics, but moving only perineum muscles. The reference health professional will tell you with which timing to perform the exercises, for example it may advise you to start Contracting the pelvic muscles for 5-10 secondsand release them for the same time, repeating the series 10 times.
A tool can also be used, which takes the name of Biofeedbackwhich consists of a small probe that is inserted in the vagina and allows you to measure themuscle activity of the pelvic floorgiving a visual or sound signal when the right muscles are activated. It can be useful as a guide to perform the exercises correctly, giving precise instructions on the intensity and rhythm of execution of the exercises.
When physiotherapy rehabilitation it is not sufficientit is possible to move on to instrumental rehabilitation, which provides for the use of electrostimulators that act on the musculature. Electrostimulation is one of the most effective tools And it is part of a personalized path of treatment of women, favoring the awareness of the perineal muscles and activation.
It is performed with a device equipped with vaginal probes, which emit electric current that stimulates the musculature of the pelvic floorfavoring their spraying of the tissues. The intensity of the current is increased until they reach the degree of activity for single woman: pain should not appear during treatment, otherwise the intensity of the current is decreased. The duration is of about 10-15 minutesfollowed by the second phase of the treatment, the real gymnastics of the pelvic floor, associated with respiratory exercises.
Very important thing: Do not demand too much from yourself and your body. The rehabilitation path needs time and patience.
