Pelvic floor rehabilitation

Pelvic floor rehabilitation or perineal rehabilitation means carrying out physiotherapy to restore the proper functioning of the pelvic floor.

It helps to solve the problems of urinary incontinence and fecal incontinence, as well as prolapse, pelvic pain and pain during sexual intercourse.

This therapy was launched by Kegel in the United States in the 50’s and quickly spread throughout the Western world.

During childbirth, the pelvic floor undergoes severe stretching at the expense of nerves, muscles, tendons, ligaments, etc., especially if the newborn weighs more than 3.5 kg.
The stretching of the nerves and muscles affects the functioning of the genital organs and urinary tract.
In most cases, this can cause urinary and faecal incontinence, but usually the symptoms disappear in a few days.
Patients who do not should allow one hour a day to return to their prenatal condition without suffering from any longer ailments, such as:

  • unwanted loss of urine;
  • bladder or uterine prolapse;
  • fecal incontinence;
  • discomfort during sexual intercourse;
  • Ache.

The exercises are not complex. There must only be the will to resolve these disturbances.
Pelvic floor rehabilitation (diaphragm pelvis) can be performed in three ways: active kinesitherapy, biofeedback and electrostimulation.
In reality, only the specific exercises are performed, because clinical studies have shown that active participation is the most effective.
Electrostimulation is painful and poorly tolerated by patients. And the results achieved through biofeedback can also be achieved with good physiotherapy.
Electrostimulation is done with needles inserted into the patient’s muscle, as in electromyography.

You send out a series of pulses of different frequencies and thus provoke the contraction of some muscles.
In order to achieve the hoped-for results, this therapy must be carried out simultaneously through the active participation of the patient.
Biofeedback is done by a machine capable of using electrodes to measure the intensity of the signal the nerve sends to the muscle and then sending the signal to a device via cables.
The patient is asked to tense the muscles. The electrodes detect “the force” that is being developed and the device displays a series of colored LEDs proportional to the intensity achieved.
In this way, the patient gets a visible and audible stimulus, so he is motivated to work even more to achieve the goal.
Active kinesitherapy consists of a series of exercises designed to restore muscle strength that existed before the birth event.
If the muscles are strong, the muscle contraction can withstand the increased abdominal pressure that occurs when the patient coughs, sneezes and exerts an effort.
In addition, physiotherapy sends out necessary nerve stimuli to restore the functioning and control of the sphincter; the control of the muscles depends on the nerve structure, especially the pudendal nerve.
The levator ani muscle (lifter of the anus) is the most important muscle in rehabilitation because it is the main support of the lower abdominal organs and a structure that prevents incontinence.
Perineal rehabilitation has no side effects when performed without electrostimulation.


What is the Perineum?

The perineum is defined as the area bounded on the front by the pubic bone, in the back by the coccyx and laterally by the thighs.
The perineum includes anatomical structures that regulate micturition, bowel movements and the birth process: muscles, tendons, ligaments, nerves, etc. The perineum is the outside of the pelvic floor, a muscle junction that contains and supports organs and intestines of the abdomen: bladder, vagina and rectum.
It has the function of preventing or allowing micturition, bowel movements and the birth process.
The most important muscle of the pelvic floor is the levator ani.

Who is pelvic floor rehabilitation aimed at?

Pelvic floor rehabilitation is intended for those who suffer from urinary incontinence, a loss of urine through the urethra. This leads to poor intimate hygiene and discomfort during sexual intercourse.

Pelvic floor physiotherapy is also used in the following cases:

  • mild uterine prolapse,
  • pelvic pain,
  • Disorders with frequent urination or sudden urge to urinate.

These disorders affect 1-2 million women throughout Italy, especially after childbirth.
Often the patient complains of unwanted discharge of urine due to an increase in abdominal pressure, for example, when coughing or sneezing.
In men, perineal rehabilitation is indicated after prostatectomy (removal of the prostate).
In most cases, this type of rehabilitation eliminates the problems and avoids surgical intervention.

How is pelvic floor rehabilitation performed?

The best course of action of this therapy is a cycle of 10 sessions in the physiotherapy practice of about 30 minutes duration, during which patients are explained the need to continue with the exercises at home even after the sessions have ended.
People who lack the stamina to perform the exercises at home should take two more courses of treatment in practice.
One can start therapy one month after childbirth, in men immediately after the operation of a prostatectomy.

What exercises should I follow?

The program includes a series of exercises for the pubococcygeal muscles and their synergists, i.e. those muscles that work together to perform certain movements.
At home, not all of these exercises are done regularly. Therefore, one should contact a therapist who specializes in this field.
The therapist supervises the proper performance of the exercises and actively participates to build up manual resistance.
The therapy consists of pubococcygeal muscle contractions and movements of the pelvic floor, abdominal, lumbosacral and hip muscles.
Every time you go to the toilet, when urinating, it is necessary to perform an exercise, which consists in stopping the stream of urine and letting it flow again.
This procedure must be carried out several times during urination.
Every day, the pelvic floor muscles should be tensed for 3-4 seconds and relaxed again over 5-10 seconds, in the same way that the flow of urine is interrupted during urination; perform this in different positions:

  • standing, knees slightly bent and lower extremities slightly spaced;
  • while sitting;
  • lying down with bent knees.

If the patient is told to tense the pelvic muscles, he usually tends to push the pelvis down. On the other hand, he should learn to lift it upwards.
The contractions must become selective by keeping the abdominal muscles, gluteal muscles and hip muscles relaxed.
In rehabilitation with the physiotherapist, vaginal cones are particularly suitable. There are objects of different sizes and weights, some of which must be inserted into the scabbard and held against gravity.

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