DYNAMICS OF ULTRASOUND PARAMETERS OF PELVIC FLOOR TISSUES IN PELVIC FLOOR DYSFUNCTION UNDER THE INFLUENCE OF A PHYSICAL THERAPY PROGRAM IN WOMEN FOLLOWING VAGINAL AND ABDOMINAL DELIVERY.

Abstract

Objective. To evaluate the effectiveness of a comprehensive physical therapy program developed for women with pelvic floor dysfunction following vaginal and abdominal delivery, based on changes in ultrasound parameters. Material and Methods. The study involved 175 women. The control group consisted of 32 nulligravid women without a diagnosed pelvic floor dysfunction. The pelvic floor dysfunction group included 143 women and was divided into two main groups according to mode of delivery (comparison group – vaginal delivery; main group – abdominal delivery), each comprising two subgroups. Subgroup 1 received standard rehabilitation according to clinical protocol recommendations, whereas Subgroup 2 participated in the developed 3-month comprehensive physical therapy program. The program included therapeutic exercises (targeting the lower extremities, pelvic girdle, and trunk, with the use of a wireless Kegel trainer), preformed physical factors (pelvic floor muscle electrical stimulation), and an educational component. Assessment of pelvic floor muscle dysfunction (subjective symptoms and pelvic floor ultrasound examination) was performed at 8 weeks and 5 months postpartum. Results. Baseline ultrasound examination demonstrated a statistically significant (p<0,05) reduction in the width of the muscle bundles of the bulbocavernosus muscles, decreased thickness of the puborectalis muscle, reduced height of the perineal body, decreased Young’s modulus, as well as increased diastasis of the bulbocavernosus muscle crura and pathological enlargement of the α and β angles compared to the control group. The clinical presentation of pelvic floor dysfunction was characterized by a high prevalence of complaints, indicating a systemic impact on the urogenital, proctologic, and psychoemotional domains, with a consequent decline in quality of life. Implementation of the developed comprehensive physical therapy program resulted in statistically significant (p<0,05) improvement in ultrasound parameters (increased muscle thickness and width, increased Young’s modulus, reduced diastasis, normalization of α and β angles) and a substantial reduction in symptom frequency over three months compared to baseline values and to women who underwent standard self-directed recovery. A greater reduction in the frequency of major symptoms was observed in the intervention subgroups, whereas spontaneous recovery was associated with less pronounced positive dynamics. Conclusions. The developed physical therapy program is recommended for reducing structural and functional manifestations of pelvic floor dysfunction, which are associated with psychoemotional disturbances, reduced work capacity, and diminished quality of life. Its implementation contributes to enhanced postpartum recovery and facilitates women’s return to full functional activity