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Urinary incontinence is a common problem and getting rid of it is not always easy. Kegel exercises will be an excellent help in eliminating enuresis. If you perform the complex regularly, you can achieve good results. However, for this you need to familiarize yourself with all the advantages and disadvantages of exercise.
Advantages and disadvantages of the Kegel complex for urinary incontinence in women
Urinary incontinence is the involuntary leakage of urine that cannot be controlled. Such a pathology often occurs in the fair sex in the postpartum period, as well as during menopause. It is associated with muscle weakness. Bladder that support the body in the correct position. In order to get rid of this problem, you can perform Kegel exercises. The complex is based on actions aimed at toning the muscles that support the bladder.
Benefits of exercise:
- no side effects;
- safety;
- fast results with regular training;
- the ability to exercise at any time;
- additional strengthening of the muscles of the vagina.
The disadvantage of this complex is its inability to eliminate progressive enuresis, as well as urinary incontinence caused by inflammatory processes and tumors. Exercise will also be useless with significant uterine prolapse (requiring organ plastic surgery), which provokes urine leakage in large quantities. It will also not be possible to eliminate psychological enuresis with the help of the Kegel complex.
The bladder is supported by muscles, when they weaken, urinary incontinence occurs.
There is no age limit for Kegel exercises. The complex can be performed sitting, lying or standing. The main thing is to take a comfortable position.
Indications and contraindications
The indication for the implementation of the complex is a slight leakage of urine, as well as enuresis, which is caused by difficult childbirth and weakening of the bladder muscles as a result of age-related changes. Exercise is also recommended for those women whose incontinence is provoked by a slight prolapse of the uterus.
Contraindications to the implementation of the complex:
- Availability malignant tumors Bladder;
- acute cystitis and pyelonephritis;
- inflammation of the urethra;
- postoperative period.
To get the most out of your workout, you can combine Kegel exercises with other complexes aimed at strengthening the muscles of the pelvic floor.
Preparing for execution
The complex does not require any serious preparation, however, to achieve the best result, it is recommended to adhere to the following rules:
- Before doing the exercises, you need to empty your bladder.
- The complex should be started 1 hour after eating.
- Before training, it is not recommended to drink water, tea or coffee.
- Wear loose clothing that does not restrict the area of the bladder.
The complex should not be performed when feeling unwell. If the temperature is elevated or the pressure has risen, then classes should be postponed.
Basic exercises
There are 3 exercises in total. They should be done 2 times a day if possible. You should start small. Do not immediately do a large number of approaches and repetitions. To begin with, it is enough to perform each exercise 10 times. Then gradually increase the pace, adding 5 per week. The maximum number is 30 repetitions for each exercise.
It is necessary to take a comfortable position, the main thing is to relax. The first action is the alternate contraction and relaxation of the pelvic floor muscles. The buttocks are relaxed. This may tense the muscles of the vagina, but not the abdominals. This action is similar to the artificial restraint of the act of urination. First, the muscles tense for 10 seconds, then slowly relax.
Kegel exercises should be performed in the most comfortable position of the body.
The second exercise is identical to the first. It is necessary to alternately compress and relax the muscles, but only at a fast pace. At first, this will be difficult, but if you perform the complex daily, you can achieve excellent results. The third exercise is based on a slight strain, in which the muscles of the bladder and vagina contract. Then reverse action. Muscles must be sharply retracted.
The effect of training can be detected after 3-6 weeks of regular implementation of the complex.
Features of performance for different age groups
Women of reproductive age can perform Kegel exercises aimed at tensing the muscles of the pelvic floor and vagina during the act of urination. Thus, the result can be fixed. If you manage to completely restrain the act and the urine stops flowing, then this indicates that the muscles are well trained.
The author of these lines performs a complex in combination with the Planck exercise, which strengthens the muscles of the whole body. To do this, you need to take a horizontal position, resting on your toes and palms. In this position, you need to hold out as long as you have enough strength. In this case, the pelvis should not sag. If your arms are very hard or hurt, you can bend them at the elbows.
The plank strengthens the muscles of the whole body and can complement the Kegel complex.
Women over 50 are advised to supplement the complex with other exercises. The first is aimed at strengthening the muscles of the bladder and abdominal wall. To do this, lie on your back and, bending your knees, imitate cycling. The second action is performed from the same position. Only this time you need to try to strain and relax the muscles of the vagina and buttocks at the same time. Perform each action 30 times.
Exercise "Bicycle" enhances the effect of the Kegel complex
For women over 70 years old, the complex is best performed in a prone position with bent knees. This makes it easier to tighten your pelvic floor muscles. For older people, it will be optimal to perform one set of 10 repetitions. If discomfort arises, then you can take a break.
How younger woman the faster the effect will be. Older people need to be patient and perform the complex for at least 2-3 months, depending on the intensity of incontinence.
Urinary incontinence exercises - video
Kegel complex - available for everyone, will help get rid of enuresis. Additional exercises will enhance the effect of gymnastics. Simple rules of preparation will help to achieve good results during the training. Compliance with all the recommendations that are necessary during the implementation of the complex will help eliminate urinary incontinence.
For urinary incontinence in women, Kegel exercises, which are a set of simple exercises available at home, will become effective way restore the tone of the muscles of the small pelvis.
Initially, the American obstetrician-gynecologist Arnold Kegel developed this complex for his patients, but practice has shown that it is no less useful for men.
The exercises are very easy to perform and do not require a lot of time. But although the first result will be noticeable after a few sessions, the main condition for solving the problem of incontinence and preventing diseases of the genital area is the regularity of the complex. You need to devote time to Kegel exercises up to five times a day.
The essence of charging is to train the pelvic floor by alternating compression and relaxation. It should be performed at a uniform speed, at a fairly fast pace. For the first lesson, the compression interval is 3 seconds, then gradually its duration is increased to 20 seconds.
Doctors recommend starting training in a standing or lying position. Then, when all the exercises are well mastered, you can practice in any position. There are several types of Kegel exercises. The following are the most popular ones.
The meaning of the contraction exercise is to alternately contract and relax the muscles. In a variation called "Content" is added to keep the muscles in a tense state for a set period of time. "Pushing out" engages the muscles involved in bowel movements and childbirth.
The most optimal exercises for women are "Lift" and "Waves". The first of these is to alternately compress the rings that make up the muscular tube of the vagina. Performing the exercises correctly, you can learn to feel each of them separately.
The second is for the muscles that form the so-called extended figure eight of the pelvic floor. This "eight" consists of three loops, which must be tightened and relaxed during training. They are located around the urethra, vagina and anus.
Kegel exercises for urinary incontinence for women
The pelvic muscles that hold the bladder up and down can weaken with age or for other reasons. This leads to a change in the position of the organs and.
Regular exercise helps to strengthen the muscles and correct the location of the bladder. This method of restoring control over urination is non-drug, and, therefore, the safest. Therefore, when problems arise, doctors recommend it in the first place.
In addition to getting rid of urinary incontinence, the complex allows you to increase the tone of the muscles of the vagina, thereby preparing the body for childbirth or reducing the manifestations of menopause by improving blood circulation in the pelvic organs and increasing tissue elasticity.
Important: Kegel exercises for urinary incontinence are recommended even for older women, since all exercises are easily accessible and do not require initial physical preparation.
However, their effectiveness is undeniable.
Kegel exercises for urinary incontinence
To obtain healing effect, and not harm yourself and aggravate the disease, when doing it, it is important to remember a number of basic rules:
- Perform Kegel exercises only with an empty bladder. This will avoid the development of infection and inflammation of the urinary tract.
- It is dangerous to do them while taking a hot bath, this leads to a sharp increase in pressure.
- The load should be increased gradually, you can not overload undertrained muscles. If you feel tired, you should immediately take a break.
- The maximum number of repetitions in one approach should not exceed 30.
- Do not use the muscles of the thighs, buttocks and abs.
- Breathe evenly and relaxed.
- Compression should always be done on the exhale, relaxation on the inhale.
Example of gymnastics
- Exercises with the starting position lying on your back:
- raise your legs and arms. Reach for the ceiling for one minute;
- one leg is straight, the other is bent at the knee joint. On exhalation, squeeze the muscles of the pelvic floor;
- bending your knees and resting your feet on the floor, bring and spread your knees, working with the muscles of the pelvic floor. Reduction and tension is carried out on exhalation. Breeding and relaxation on inspiration. There is a variation performed with the help of a partner. The exercise consists in resisting the attempts of another person to bring and spread the practitioner's knees;
- bring legs bent at the knees together. With an exhalation, raise one leg to an angle of 45 degrees and smoothly straighten it. With a breath, return to the starting position;
- both legs are extended. With an exhalation, working with the muscles of the pelvis, bend one leg at the knee, directing the toe to the opposite shoulder.
- Sitting Starting Exercises:
- feet are together, hands are relaxed on the seat. Bend slightly and with an exhalation transfer the weight to the back of the pelvis. Stay in this position;
- sit straight, cross straightened legs. With an exhalation, work with the muscles of the pelvis and squeeze the legs;
- sitting on a small pillow filled, for example, with cereals, on the exhale imagine that you are drawing grains into yourself with the help of tense muscles. You can raise and lower your arms at the same time;
- grab one knee with your hands, pull it to the body. Stay in this position. Then quickly lower your leg and raise your arms up.
- Exercises with other starting positions:
- standing on your knees and elbows, rest your forehead on the floor. Gently straining the muscles, it is necessary to feel the movement of compression deep into the body;
- stand up straight, legs shoulder-width apart, hands on the buttocks. In this position, work with the muscles of the pelvic floor;
- in the lotus position, move the pelvis up and inward with simultaneous contraction of the muscles of the small pelvis.
To better understand the sequence of actions, to grasp the correct pace of breathing and movements, it will be useful to watch a video of gymnastics for urinary incontinence in women.
To benefit from Kegel exercises, it is important to be clear about which muscles to work. You can feel them in the following ways:
- Hold the stream while urinating. This will allow you to feel the pubococcygeal muscles, which you need to train. You can also alternate relaxation and contraction, but it is not recommended to do this regularly.
- Insert a finger into the vagina and try to squeeze it. The stronger the muscles, the more noticeable the pressure they can exert.
Before starting the practice, it is important to familiarize yourself with the list of contraindications:
- recent abdominal surgery;
- acute infectious process in the body;
- exacerbation of diseases of the cardiovascular system;
- inflammation and the last stage of prolapse of the pelvic organs;
- haemorrhoids;
- pregnant women should not perform this gymnastics with the threat of miscarriage, increased uterine tone.
Finally
It is important to remember that although Kegel exercises for women with urinary incontinence are a safe means of solving the problem, you can only get results if you perform them correctly, in compliance with all the rules and regularity of classes. In case of suspected contraindications, you should not practice gymnastics before consulting a doctor.
The concept of urinary incontinence, classification
Urinary incontinence is a condition in which there is involuntary leakage of urine.
Urinary incontinence affects almost all aspects of the life of patients, significantly worsening their social, domestic, professional and family adaptation, that is, what is commonly referred to as the term "quality of life".
The problem of urinary incontinence is at the junction of several areas of medicine. Patients are treated by both urologists and gynecologists and neurologists. In addition, urinary incontinence is not an independent disease, but a manifestation of various pathological processes, approaches to the treatment of which differ significantly.
There are several types of urinary incontinence:
- Stress urinary incontinence - involuntary leakage of urine during coughing, laughing, running and other physical activities, leading to an increase in intra-abdominal and, therefore, intravesical pressure. characteristic feature Stress urinary incontinence is the absence of the urge to urinate.
- Urge incontinence is characterized by involuntary leakage of urine associated with an irresistible strong urge to urinate. Such an urge is called "imperative" or "imperative." Patients complain that they do not have time to run to the toilet when an urge occurs. Sometimes the leakage of urine occurs almost suddenly, with a very short or even no previous urge.
Physiology
To name the causes of urinary incontinence, consider how normal urination is carried out.
When urinating, fluid is removed from the body along with unnecessary metabolic products. Urine is formed in the kidneys, which filter the fluid of the vascular bed and "capture" these unnecessary substances. The urine then flows through the ureters to the bladder.
It is he who is the central organ on which normal urination largely depends. Together with the urethra, the bladder forms the so-called lower urinary tract.
The entire urination cycle can be divided into two components: the bladder filling phase and the urine output phase. During the filling phase, the bladder acts as a reservoir and collects urine. During filling, the sphincter of the bladder is in a contracted state, providing high pressure in the urethra and prevent the flow of urine. When urinating, the muscle layer of the bladder contracts, and at the same time, the sphincter relaxes, reducing the resistance to urine flow in the urethra. This provides a sufficiently easy and free urination, which can be arbitrarily started and also arbitrarily interrupted. Thus, urinary incontinence occurs as a result of dysfunction of the bladder sphincters, in which anatomical hormonal changes occur. According to many researchers, one of the factors in the development of stress urinary incontinence is a decrease in anatomical length urethra (3 centimeters - the critical length of the urethra, allowing a woman to hold urine).
The filling and emptying of the bladder is regulated by nerve cells in the brain and spinal cord. A person has several divisions nervous system that play a leading role in the regulation of urination - the so-called centers of urination. Usually a healthy person urinates five to six times a day. There should be no urge to urinate at night. Why do people urinate during the day but not at night? At night, the kidneys produce less urine than during the day, and more hormones are released that reduce fluid excretion through the kidneys. If a person has a nighttime urge to urinate, then this can be considered as a deviation from the norm.
Causes of urinary incontinence in adults
stress urinary incontinence
Weakening of the pelvic floor muscles is the main cause of stress urinary incontinence in women. The function of the pelvic floor can be impaired due to one or a combination of several reasons: weakening of the pelvic muscles, damage to the connective tissue structures of the pelvic floor, impaired coordination of various muscle groups.
At healthy people any significant physical activity, such as lifting weights, running, coughing, can lead to an increase in intra-abdominal pressure, high blood pressure transmitted to the bladder and leads to an increase in intravesical pressure. The pressure in the urethra greatly exceeds intravesical pressure and urine is retained in the bladder. With sharp and strong rises in intra-abdominal pressure, for example, with a very strong cough, the muscular elements of the pelvic floor can contract reflexively, thereby further increasing the pressure in the urethra. It is this active retention mechanism that is the leading one in healthy people. A decrease in the tone of the pelvic floor leads to prolapse of the pelvic organs: uterus, vagina, bladder, urethra, rectum. With an increase in intra-abdominal pressure, intravesical pressure will increase to a greater extent, and may exceed the pressure in the urethra. This circumstance is the cause of the outflow of urine from the bladder, that is, stress urinary incontinence.
In women with stress urinary incontinence, the content of collagen in the pelvic ligaments and in the skin is 40% less than in healthy women of the same age. The consequence of a decrease in the amount of collagen is the weakening of the pelvic floor and the occurrence of prolapse of the pelvic organs. A low collagen content can be an innate, individual feature of the body. Therefore, urinary incontinence can develop in young nulliparous women, in whom all other causes of weakening of the pelvic floor are practically excluded.
Another explanation for collagen imbalances may be hormonal changes seen in menopausal women. Some researchers attach great importance to the lack of vitamin C (ascorbic acid) in the body. This leads to a decrease in the strength of any structures that contain collagen. It has been established that smoking leads to a decrease in the content of vitamin C in the body. This fact may explain the higher frequency of stress urinary incontinence in smokers compared to non-smokers of the same age.
One cause of incontinence may be direct damage to the sphincter structure. More often, the external sphincter is damaged in severe concomitant injuries, accompanied by fractures of the pelvic bones. Spinal cord injury can lead to sphincter insufficiency.
Weakening of the closing function of the sphincters of the bladder and urethra usually occurs as a result of birth trauma (accompanied by muscle ruptures and scars in the area of the sphincter of the bladder), severe physical work, gynecological operations and hormonal disorders. The main link in the pathogenesis of this disease is the weakening of the musculoskeletal apparatus of the pelvic floor and the violation of the trophism of the tissues of the urethrovesical segment. The cause of functional urinary incontinence in women may also be the prolapse of the anterior wall of the vagina, the low standing of the bottom of the bladder.
Relative urinary incontinence is more common and easier to treat functionally, which appears with sudden muscle effort, jumping, coughing, sneezing. Complete, or absolute, urinary incontinence is one of the most severe psychological suffering. Patients with urinary incontinence are depressed by their condition, constrained in movements, inhibited, and often lose hope for recovery.
Treatment of patients with urinary incontinence
Currently, there are three main methods of treatment for urinary incontinence: non-drug, medical and surgical. There are certain indications for each of them, and the choice of the optimal approach to the treatment of a particular patient with urinary incontinence is made by the doctor after a thorough examination of the patient. Surgical treatment is used only when conservative therapy fails.
Non-drug treatment of urinary incontinence
Non-drug treatment of urinary incontinence includes bladder training, exercises for the pelvic muscles.
Bladder training
The bladder training methodology includes three main components: training, creating a voiding plan, and executing it.
The main point of the training is the patient's compliance with the urination plan previously established and agreed with the doctor, that is, the patient must urinate at certain intervals. In patients for several years of the disease, a peculiar stereotype of urination is formed, which consists in the desire to empty the bladder when even a slight urge occurs. This desire is due to the fear of possible incontinence, which can occur in an inappropriate environment.
The bladder training program aims to progressively increase the interval between urination. In this case, the patient should try to urinate not when the urge to urinate occurs, but in accordance with his individual plan for the day. On this day, patients must control the urge to urinate through a strong contraction of the anal sphincter.
Treatment with a bladder training program usually lasts several months. It is recommended to increase the interval between urination by half an hour every 2-3 weeks until a period of 3-3.5 hours is reached.
Bladder training is most often done in combination with medication. By the end of the course of drug therapy, which usually lasts 3 months, a new psychological stereotype of urination should be formed. Discontinuation of the drug as a result should not lead to the resumption of frequent urination and urinary incontinence.
Bladder training is prescribed for all patients with urination disorders.
In patients with severe intellectual impairment and lack of control of the lower urinary tract and urinary incontinence, it is recommended to use a specially adapted "urination on prompt" technique. It consists of three main steps:
- At the first stage, it is necessary to teach a mentally retarded patient to note the states when he is wet due to urination in bed, and when he is dry. If the goals of the first stage are successfully achieved, you can proceed to the second stage of treatment.
- The most important task of the second stage is to teach the patient to perceive the urge to urinate and let others know about it.
- The goal of the third stage of training is to achieve complete control over urination by the patient.
It is noted that it is very effective when treating such a category of patients to encourage them in any way at each stage of treatment.
It is also recommended to perform exercises to train the pelvic muscles. In recent years, exercises for the pelvic muscles have been widely used to prevent urinary incontinence, even before the first symptoms appear.
Medical treatment
Drug treatment is used for all forms of urinary incontinence, but the greatest effectiveness is observed in patients with urge incontinence.
tasks drug treatment in such patients, there is a decrease in the contractile activity of the bladder and an increase in its functional capacity.
Clinically, this should be expressed in a decrease in urination, a decrease in the intensity of urges and the disappearance of urinary incontinence.
One of the most effective drugs is Driptan. Its effect is due to a direct relaxing effect on the bladder muscle, in addition, Driptan interrupts annoying irregular impulses from the central nervous system. Under the action of Driptan, the bladder "calms down", "relaxes", its volume increases, it begins to accumulate urine, due to which urgent urges disappear. You will go to the toilet less often.
Driptan after taking the required dose begins to act within 30 minutes -1 hour. The disappearance or weakening of painful symptoms occurs after 1 month from the start of treatment. For each of you, an individual selection of the dose of Driptan is necessary. For some, it will be 1/2 tablet 1-2 times a day, for others a little more. In each case, only the doctor selects the effective dosage. Do not try to take Driptan on your own.
The duration of one course of treatment for patients with urge urinary incontinence usually does not exceed 3 months.
After the end of treatment, its effect usually lasts for several months, rarely longer. With insufficient effectiveness of the first course of treatment or the development of resumption of incontinence, it is possible to conduct one or more repeated courses of therapy.
Surgical Cookies
Although the majority of patients with urinary incontinence achieve good results with the use of conservative methods treatment, some of them have to use surgical methods. The choice of surgical method is determined by the form of urinary incontinence and the effectiveness of previous non-surgical treatment. Most often, surgical treatment is used in patients with stress urinary incontinence and overflow incontinence, less often - with an urgent form of incontinence. An effective method for the treatment of stress urinary incontinence using a free synthetic loop (TVT).
Therapeutic exercises in the treatment of stress urinary incontinence in women
Among the conservative methods of treatment, the leading place is occupied by physiotherapy exercises.
Therapeutic effect physiotherapy exercises due to the fact that gymnastic exercises, increasing the tone of the entire muscles of the body, increase the tone of the muscles of the bottom of the pelvic cavity, which significantly improves their function. A number of special exercises directly affecting the muscles of this area also have a beneficial effect on their contractile properties, which gives a general therapeutic effect.
Of great importance is the alternating increase and decrease in intra-abdominal pressure observed during exercise, which also reflexively affects the muscles of the bottom of the pelvic cavity.
- to stimulate compensatory-adaptive reactions in the damaged tissues of the closure apparatus of the bladder and urethra in order to normalize its activity;
- improve the trophism of the pelvic organs, eliminate uncontrolled contractions of the detrusor;
- strengthen the muscular-ligamentous apparatus of the pelvic floor, muscles of the urethra, pelvis, abdomen and back;
- contribute to the restoration of the anatomical and topographic relationships of the pelvic organs;
- contribute to the removal of pathological dominant in the cerebral cortex;
- have a general strengthening effect on the body.
These tasks are best solved when performing exercises in abduction and breeding of the hips in the initial position lying on the back with an elevated pelvis; exercises for the lower extremities with resistance in the same starting position; exercises performed in the initial standing position with tightly closed hips and tension of the adductor muscles of the thighs; walking with short and cross steps, walking with a stuffed ball sandwiched between the legs. When obvious signs improvements can be incorporated into exercises with wider abduction of the hips, squats, as well as exercises that imitate fencing steps and skiing.
When using exercise therapy in the correction of stress urinary incontinence in women, along with general principles physical training, it is necessary to consider the following guidelines:
- Differentiation of exercise therapy depending on the severity (mild, moderate and severe) and the form (pure, combined) of the disease according to the classification of D.V. Cana (1978).
- Use starting positions:
- with a mild degree - various (standing and sitting - only from the second half of the course of treatment);
- with an average degree - the same, excluding the standing position (kneeling and sitting can be included from the second half of the course of treatment);
- in severe cases - knee-elbow, lying horizontally on the back, anti-orthostatic (lying on the back on an inclined plane with a raised leg end, the angle of which can be changed up to 30 degrees depending on the tolerance of negative gravitational load), lying on its side (sitting, leaning back , and knee-carpal can be used from the second half of the course of treatment).
- standing, kneeling and sitting,
- kneeling and sitting
- knee-carpal.
- In order to prevent an increase in intra-abdominal pressure and the outflow of urine during exercise, it is advisable to use the anti-orthostatic position along with other starting positions. This position is contraindicated in patients with concomitant arterial hypertension, cerebrovascular accidents.
- Apply special dynamic physical exercises and isometric tension in order to maximize the strengthening of the musculoskeletal apparatus of the pelvic floor, the muscles of the urethra, pelvis, deep back muscles, as well as to restore the closing function of the sphincters of the bladder and urethra, to eliminate anatomical and topographic changes in the pelvic organs. Most special dynamic exercises should be performed with contraction and relaxation of the muscles of the perineum, which is carried out, respectively, in the inhalation and exhalation phases. For a full contraction of all the muscles of the perineum - the muscles of the urogenital and pelvic diaphragms - it is necessary to simultaneously retract the anus, compress the vagina and try to close the external opening of the urethra.
- Isometric muscle tension must be performed each time with maximum intensity. Depending on the period of the course of exercise therapy, the number of such muscle tensions varies from 1 to 4 (with a combined form of the disease, they increase to 6-7 in the procedure of therapeutic exercises), the duration of the tension is 2-7 seconds.
When performing isometric stresses, the following guidelines must also be taken into account:- apply mainly initial positions lying on the back and "antiorthostasis";
- breathing should be uniform, deep and with some lengthening of the exhalation, not to allow breath holding;
- "dissipate" and alternate tension with dynamic physical exercises;
- after each repetition of the exercise and their cycles, perform breathing exercises and in voluntary muscle relaxation.
- Exclude running, fast walking, jumping, jumping, jerky movements, sudden changes in position, straining, any holding of the breath, and at the beginning of treatment - forward bending. All exercises should be performed rhythmically, at a slow or medium pace.
- Increase the duration of therapeutic exercises during the course from 20 to 50 minutes. Classes are carried out 3 times a week (weekly add one independent lesson before the daily procedures), preferably with musical accompaniment. After classes, both group and individual, it is necessary to make a toilet of the perineum and change clothes.
- Based on periodic studies of intra-abdominal pressure, indicators of urodynamics of the lower urinary tract and perineotonography, to individualize the appointment of individual starting positions, physical exercises and the degree of inclination of the plane used for performing exercises in the course of treatment.
- Apply to patients simultaneously with therapeutic gymnastics self-study, including cycles of rhythmic isometric tension of the pelvic floor muscles: maximally contract these muscles - inhale, relax them - exhale. This exercise can be performed in starting positions standing, sitting and lying down. The following scheme of classes is recommended: on the 1st week - 10 exercises plus a rest of 30 seconds. (perform 2 times in a row), during the day 3-5 lessons; on the 2nd week - 13 exercises plus a rest of 30 seconds. (perform 3-4 times in a row), during the day 6-8 lessons; from the 3rd week - 15 exercises plus rest 30 sec. (perform 5 times in a row), during the day 10 lessons.
- After 1-1.5 months, there is usually a significant improvement.
- In the absence of complete recovery and detection of improvement in urinary retention during physical exertion in patients, repeat the course of treatment. In patients with severe stress urinary incontinence, exercise therapy should be performed for the purpose of comprehensive preoperative preparation and more stable postoperative results.
- At the end of the polyclinic course of exercise therapy, patients should be advised to continue therapeutic exercises at home for at least 4-6 months.
- To obtain a greater effect, use exercise therapy in combination with functional electrical stimulation of the pelvic floor muscles, drug therapy and acupuncture.
In addition to general strengthening, breathing and relaxation exercises, the patient is recommended special physical exercises (for the muscles of the perineum, pelvis, abdomen and back), which contribute to the effective restoration of the closing function of the sphincters of the bladder and urethra.
Special physical exercises for urinary incontinence in women (according to Epifanov V.A., 1989)
Pelvic floor exercises
A. Isotonic exercise
- Retraction of the anus, vagina and attempt to close the external opening of the urethra, followed by relaxation of the muscles.
- Raising the pelvis and lower back up with support on the heels of straight legs and the shoulder girdle.
- Bend your legs at the knees. Raise the pelvic girdle as high as possible with contraction of the pelvic floor muscles.
- Turning the pelvis and legs bent at the knees to the left (right) until lowering to the floor.
- The institution of the right (left) leg behind the opposite thigh with contraction of the pelvic floor muscles.
- Alternately and simultaneously pulling up to the chest of the legs bent at the knees.
Lying on side
- Pulling the bent leg to the chest.
- The maximum lifting up of the straight leg, followed by its slow lowering.
- Alternately abducting the straight leg forward, then back.
In a sitting position on the floor
- Bent legs are pulled to the chest with the hands, roll onto the back and return to the starting position.
- The legs are bent and pulled up to the pelvis, hands are in support behind. Breeding and bringing knees.
- Legs bent, hands on the legs. Rearranging the legs, move forward and backward on the buttocks.
In a kneeling position
- Hands behind your head. Alternately sit to the right and left of the feet.
- Rearranging the palms on the floor, turn the body to the right, then to the left.
- The knees are apart. Sit between your heels.
- Bend the spine with the support of the hands behind, then lean forward.
In the knee-elbow position
- Straightening your arms, lift up the pelvic girdle and arch your back while simultaneously contracting the muscles of the pelvic floor.
- Straightening the arms and legs, lift up the pelvic girdle with contraction of the pelvic floor muscles.
- Circular movements of the straight left (right) leg laid back.
- Exercise "Swallow".
In the supine position horizontally and on an inclined plane with a raised foot end
- Bring the legs as much as possible, contract the muscles of the pelvic floor and buttocks for 3-7 seconds.
- Bend your legs at the knees, raise your pelvis up. As much as possible bring the hips and lower legs, contract the muscles of the pelvic floor and buttocks for 3-7 seconds.
- Bring the legs to the maximum, contract the muscles of the pelvic floor and buttocks with simultaneous retraction of the anterior abdominal wall and pressing the lumbar region on the plane for 3-7 seconds.
- Cross your legs and lift up on the gymnastic rail. Squeeze your legs as much as possible, contract the muscles of the pelvic floor and buttocks for 3-7 seconds.
- Bend your legs at the knees, place the ball between them. Maximally squeeze the ball with your knees while simultaneously contracting the muscles of the pelvic floor and buttocks for 3-7 seconds.
A list of special exercises that strengthen the muscles of the abdomen and pelvic floor (according to Vasilyeva V.E.)
Exercises from the starting position lying on your back
Exercises from the starting position lying on the stomach
Exercises from the starting position "sitting on the floor"
Exercises from various starting positions (standing on all fours and kneeling)
List of special exercises proposed by D.N. Atabekov
General developmental exercises
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Pelvic floor exercises
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Exercises for the abdominal muscles and adductor muscles of the thigh
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Exercises for the muscles of the back and abdominals
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It occurs as a result of a weakening of the tone of the sphincter of the bladder due to a violation of tissue trophism. The reasons are similar to those for the prolapse of the internal genital organs: birth trauma, severe physical work, gynecological operations, as well as hormonal disorders.
Tasks of exercise therapy and massage
Increasing the general tone of the body, including the sphincter of the bladder; reduction of trophic disorders by improving blood and lymph circulation in the pelvis; restoration of disturbed conditioned reflex connections and cortical regulation of functional disorders.
Features of exercise therapy
IP is selected individually. With a mild degree, different IPs are used, with a moderate degree, a standing position is excluded. In all forms, the position lying on the stomach, sudden changes in position, straining, holding the breath, running, jumping, jumping, and at the beginning of treatment, bending forward are excluded. Apply special exercises to strengthen the adductor muscles of the thigh (walking with a cross step, holding the medicine ball between the knees, exercises for the legs with resistance), the muscles of the abdominal wall, the pelvic floor (contraction of the muscles of the perineum - inhale, relaxation - exhale). The duration of the LH class is 40-50 minutes. The course of treatment is 4-6 months. Useful contrast shower, swimming, cycling, training on simulators. Improvement is noted after 1.5-2 months.
Physical exercise for the treatment of women with stress urinary incontinence.
- torso inclinations;
- circular movements of the pelvis;
- springy squats;
- alternating turns of the body to the right and left;
- adduction of the knees and tension of the muscles of the perineum, followed by their relaxation;
- lying on the back, rolls;
- rotation of the legs inward with contraction of the muscles of the perineum, rotation of the legs outward with relaxation of the muscles of the perineum;
- imitation of movements, as when riding a bicycle;
- isometric tension of the muscles of the perineum, thigh, lower leg;
- cross leg movement;
- alternate bending of the legs at the knee joint;
- squeezing the ball with your knees;
- elevation of the pelvis;
- alternately sit to the right, to the left;
- lifting the right (left) straight leg with touching it with the left (right) hand;
- deflection, arching in the thoracic region with simultaneous contraction of the muscles of the perineum;
- turning the body to the right and left, rearranging the palms;
- alternately bringing the knee to the chest with simultaneous contraction of the muscles of the perineum;
- movement on the buttocks;
- breathing dynamic exercise.
Massage
Apply general massage, gynecological massage, vibration massage of the lumbosacral region and perineum.
Menstrual irregularities
Occur in disorders of the regulation of menstrual function at various levels; cerebral cortex, hypothalamus, pituitary gland, ovaries, uterus. The reasons are different: diseases of the nervous and endocrine systems; nutritional errors, infectious, genital and extragenital diseases. Methods of treatment are different, depending on the etiology.
Tasks of exercise therapy and massage
Normalization of menstrual function through improved blood circulation and increased metabolism, general strengthening of the body.
Features of exercise therapy
Treatment is usually long-term. Exercises are used for all muscle groups with the obligatory inclusion of exercises for the muscles of the anterior abdominal wall and the belt of the lower extremities. Particular attention is paid to static exercises - “inverted postures”, which increase blood flow to the brain and upper body, improve the function of the cerebral cortex, autonomic regulation, the pituitary gland, and, consequently, all other endocrine glands.
Massage
Carry out general massage, segmental-reflex, gynecological.
