THE INFLUENCE OF PHYSICAL THERAPY ON THE FUNCTIONAL STATE OF PELVIC FLOOR TISSUES IN WOMEN WITH DYSFUNCTION AFTER VARIOUS METHODS OF VAGINAL DELIVERY

Abstract

Purpose: to assess the effectiveness of the developed comprehensive physical therapy program for women after vaginal and abdominal delivery according to the dynamics of clinical indicators characterizing limitations in vital activity due to pelvic floor dysfunction. 175 women participated in the study. The control group consisted of 32 women who had no history of pregnancy and were not characterized by diagnosed pelvic floor dysfunction. The group with signs of pelvic floor dysfunction consisted of 143 women who were divided into two groups (comparison – gave birth vaginally and main – gave birth abdominally) with two subgroups in each. Subgroup 1 was restored according to the recommendations of clinical protocols, subgroup 2 – according to the developed physical therapy program lasting 3 months with the use of therapeutic exercises (for the lower extremities, pelvic girdle, torso, with a wireless Kegel trainer), preformed physical factors (pelvic floor muscle myostimulator), educational component. Determination of signs of pelvic floor muscle dysfunction (tonus mm. levator ani (palpation), strength (perineometry), specific signs of weakness and their severity (according to PFDI-20), impact on daily activity, social and emotional sphere (according to PFIQ-7), changes in sexual function (according to FSFI-19)) was carried out 8 weeks and 5 months after childbirth.In the postpartum period, pelvic floor dysfunction in women was manifested in the form of a decrease in muscle tone (according to the results of palpation), strength (according to perineometry), the presence of a number of pathological signs of their weakness (diagnosed by PFDI-20), a negative impact on daily activity, social and emotional spheres (determined by PFIQ-7), and a deterioration in sexual satisfaction (according to FSFI-19). Signs of pelvic floor dysfunction were more pronounced in women who had undergone vaginal birth, which is associated with sexual trauma to the perineal tissues. The use of a physical therapy program for three months improved the results of the tone of the levator ani muscle, perineal muscle strength by perineometry, PFDI-20, PFIQ-7, FSFI-19 in comparison with the initial parameters and the corresponding indicators of women who recovered independently. According to the baseline, the best condition of the pelvic floor according to the studied indicators was in women after cesarean section.Physical therapy is advisable to reduce the intensity of signs of pelvic floor dysfunction and prevent pelvic organ prolapse, which threatens with psychoemotional disorders, loss of work capacity, and a decrease in the quality of life, that is, for faster postpartum recovery of women and their return to full-fledged life activities.