The phenomenon of “urine leakage” in postpartum women is mostly caused by pelvic floor dysfunction, and many women also suffer from vaginal laxity, unsatisfactory sex life, abdominal cramps, frequent urination, and uterine prolapse after delivery.
The International Advisory Committee on Incontinence conducted a questionnaire survey of mothers-to-be at 6 to 8 weeks postpartum, asking them about the onset of urinary incontinence and postpartum lower urinary tract symptoms before pregnancy, during pregnancy and 42 days after delivery. The data showed that as many as 13.86% of the 368 mothers had urinary incontinence symptoms at least once during the 42 days after delivery, and the phenomenon of “urinary leakage” in postpartum women is mostly caused by pelvic floor dysfunction. In addition, many women have symptoms such as vaginal laxity, unsatisfactory sex life, abdominal swelling, frequent urination and uterine prolapse. Therefore, it is recommended to check the pelvic floor function during the routine review 42 days after delivery, and to intervene early to improve the quality of married life after delivery and to prevent abnormal urination during menopause.
A, maternal encounter “leakage” embarrassment pelvic floor dysfunction caused.
Lisa, a new mother, recently had a difficult problem, she found that every time she sneezed, urine would overflow from her lower body, and at first thought it was the “moon disease” left by not sitting well after childbirth, but with the passage of time, “leakage” phenomenon is not only not The problem of back pain and abdominal swelling was not alleviated, so the woman had no choice but to go to the hospital for an examination and found that it was a pelvic floor dysfunction problem. The prevalence of pelvic floor dysfunctional diseases in women is more than 45%, but the patient consultation rate is extremely low, an international non-profit organization has conducted a survey of 10,427 people, found that only 25-50% of patients with urinary incontinence to consult a doctor, and the treatment rate is only about 10%.
Why maternity has become a high prevalence of the disease, image that the pelvic floor functions like a hammock, holding up the bladder, uterus, rectum and other pelvic organs at the perineum and anus, maintaining a number of physiological functions such as conjugal pleasure, urination movements, defecation. However, normal people in the process of pregnancy and childbirth inevitably cause varying degrees of damage to the pelvic floor muscles, resulting in pelvic floor muscle dysfunction. “That means the elasticity of this ‘hammock’ becomes poor, the ‘hanging force’ is insufficient, and the organs within the ‘net’ cannot be fixed in their normal position, resulting in The corresponding dysfunction, such as incontinence, pelvic floor organ prolapse, etc.” The pelvic floor injury is manifested in the lighter cases as birth canal relaxation, unsatisfactory sex life or discomfort such as small abdominal cramps, frequent urination, constipation, etc. In the heavier cases, urinary incontinence, uterine prolapse, bladder prolapse, rectal prolapse and other diseases can occur, causing unspeakable pain and even family disharmony.
Second, only women in normal delivery need to worry about the emergence of pelvic floor dysfunction?
Most of the women in normal delivery have dilated birth canal, deformed muscle fibers, hypotonia, pelvic instability joint dislocation and other pelvic floor muscle relaxation problems, for this point we can easily understand, then whether the pelvic floor dysfunction only for women in normal delivery? Does it mean that women who give birth by cesarean section don’t need to worry about it? “It is true that some studies have concluded that vaginal delivery has a significantly higher incidence of urinary incontinence and pelvic organ prolapse than cesarean delivery, so vaginal delivery is an important cause of postpartum pelvic floor dysfunction, which may be related to direct damage to the fascial support structures in the pelvis and the vaginal wall, as well as direct or indirect damage to the pelvic floor muscles and nerves, but this is not the only cause. “
”Factors such as pregnancy, decreased estrogen levels, and weight gain during pregnancy and delivery are among the important causes of impaired pelvic function. Therefore, some patients with cesarean delivery also suffer from urinary incontinence and pelvic organ prolapse, which also require pelvic floor rehabilitation.”
Third, 42 days after delivery is the best time to repair the pelvic floor.
It is best for women to have a pelvic floor function check 42 days after delivery to find problems for early treatment, and no problems for timely pelvic floor rehabilitation training. “At present, most postpartum sufferers have pelvic floor disorders, only the degree of severity is different. After 42 days of delivery, most of the women’s dew has been drained, perineal laceration and mucosal destruction of the birth canal have basically healed, pelvic floor muscle tone is restored, and various parts of the body are gradually recovering. Therefore, after pelvic floor examination and assessment at 42 days after delivery, rehabilitation should be carried out in time to reduce the occurrence of pelvic floor dysfunction, urinary incontinence and organ prolapse diseases, to better restore the vaginal status after delivery and to improve the quality of sexual life.
In addition, although pelvic floor rehabilitation is called a “mandatory postpartum course”, in fact, as early as the planned pregnancy, women need to learn how to accurately position the muscle groups, contract correctly, and perform pelvic floor training in a gradual, timely and consistent manner. As pregnancy progresses and the uterus slowly increases in size, the pressure and damage to the pelvic floor increases with each passing day.
Fourth, for different pelvic floor dysfunction symptoms choose different rehabilitation training methods.
In fact, the treatment of pelvic floor dysfunction is not complicated, and the treatment effect is very good. “Mild patients only need to do pelvic floor muscle exercises at home by themselves under the guidance of doctors. And moderately severe patients can receive treatment such as electrical stimulation biofeedback in the hospital, and incontinence, for example, can be completely cured in 65% of people and relieved in more than 95%.” If they do not pay attention to receive any treatment, as they age and their hormone levels decline, the muscles will become more and more relaxed and the symptoms of pelvic floor dysfunctional disease will become more and more severe, and finally they will have to choose surgery.
At present, rehabilitation training takes five major treatment modalities.
1.Electronic biofeedback.
The use of bioengineering technology, bioinformatics principles, with high-tech treatment instruments, the development of personalized treatment plans, for different patients with different frequencies, different pulse widths, different intensity of electrical stimulation, different effects of biofeedback mode, combined with the training of the scene reflex, to awaken the damaged pelvic floor muscles, increase the muscle strength and elasticity of the pelvic floor muscles, so that the pelvic floor function back to normal, and enhance the vaginal tightness, improve the Sexual life quality, at the same time, is conducive to the prevention and treatment of urinary incontinence, uterine prolapse, vaginal relaxation and other pelvic floor disorders.
2. Functional electrical stimulation.
The treatment principle is to enhance the contraction ability of muscles through neuromuscular stimulation, so that the strength and elasticity of the pelvic floor muscles are enhanced, while reflexively inhibiting bladder excitation, so that urinary incontinence is completely controlled.
3.Exercise therapy.
① Kegel training (Kegel): conscious exercise of voluntary contraction of the pelvic floor muscle groups, mainly the pubic bone – tailbone (i.e. anal raphe). Repeatedly perform contraction of the anus, each contraction of not less than 3s, and then relax, continuous 15-30min as a group of exercise, 2-3 groups per day, 6-8 weeks as a course of treatment.
② use thera-band (elastic band, elastic ball, vibrator) for exercise.
4. Bladder training.
Patients are instructed to record daily water intake and urination, fill out bladder function training forms, and consciously delay urination intervals to finally achieve 1 urination in 2.5-3 hours so that patients learn to delay urination by suppressing urinary urgency.
5.Lifestyle intervention.
Weight reduction, regularity of life and living, avoiding strong physical labor, etc.