KINESITHERAPIE BIJ
UROLOGISCHE EN
GYNAECOLOGISCHE
AANDOENINGEN
ragne deleu
[BEDRIJFSNAAM] [Bedrijfsadres]
,Evaluatie examen:
- Meerkeuze zonder giscorrectie
- Alles invullen
- 40 examenvragen
o 4 antwoordmogelijkheden
o Meest correcte antwoord
- Verhoogde cesuur: 62,5% => 10/20
- SBA: single best answer
INHOUDSOPGAVE
Inleiding ..................................................................................................................................5
Deel 1: continentie en incontinentie ........................................................................................7
1. Voorkomen van bekkenbodemdisfunctie: incontinentie ...............................................7
2. Anatomie van de blaas en urethra ..............................................................................8
2.1. Blaas ...................................................................................................................9
2.2. Urethra ..............................................................................................................11
3. Anatomie en functie van de bekkenbodemspieren ....................................................11
3.1. Spieren oppervlakkig plan .................................................................................13
3.2. Spieren middenplan: diafragma urogenitale ......................................................16
3.3. Spieren diepe plan ............................................................................................16
4. Fysiologie van de lagere urinewegen ........................................................................19
5. Urine-incontinentie: vormen, oorzaken en gevolgen ..................................................21
5.1. Symptoomgerichte indeling ...............................................................................22
5.2. Functionele indeling van UI ...............................................................................31
5.3. Gevolgen van incontinentie ...............................................................................32
6. Diagnose arts............................................................................................................32
6.1. Anamnese .........................................................................................................33
6.2. Klinisch onderzoek ............................................................................................33
7. Specifieke onderzoeken ............................................................................................34
7.1. Cystoscopie ......................................................................................................34
7.2. Uroflow en residubepaling .................................................................................34
7.3. Cystometrie: urodynamisch onderzoek .............................................................37
7.4. Echografisch onderzoek ....................................................................................38
8. Behandeling van incontinentie ..................................................................................38
8.1. Chirurgische bhandeling....................................................................................39
8.1.1. Behandeling voor reservoirstoornis ...............................................................39
8.1.2. Behadeling van ledigingstoornis ....................................................................39
8.2. Medicamenteuze behandeling ...........................................................................40
8.3. Incontinentiematerialen .....................................................................................42
8.4. Levensstijlinterventies .......................................................................................43
1
, 9. Invloed blaas/darm....................................................................................................45
Deel 2:bekkenbodemreëducatie ...........................................................................................47
Inleiding ............................................................................................................................47
1. Informatief gesprek ...................................................................................................48
2. Klinisch functioneel onderzoek ..................................................................................48
2.1. Anatomische evaluatie ......................................................................................48
2.2. Evaluatie kracht, uithouding, uitputbaarheid ......................................................49
2.3. Beoordeling van de tonus van de BB-spieren ....................................................50
2.4. Vaginal prolaps .................................................................................................50
3. Evaluatie van urineverlies .........................................................................................51
4. Functionele controle van de sfincter ..........................................................................52
5. Dagboek of plaskalender ..........................................................................................52
6. Bekkenbodemspieroefeningen: praktijk.....................................................................54
7. Biofeedback ..............................................................................................................55
7.1. Auditieve feedback ............................................................................................55
7.2. Sensiebele feedback .........................................................................................55
7.3. Visuele feedback ...............................................................................................55
8. Electrostimulatie .......................................................................................................57
9. Resultaten ................................................................................................................57
Deel 3: zwangerschap en bevalling ......................................................................................59
1. Obsterische anatomie ...............................................................................................59
1.1. Het baringskanaal .............................................................................................59
2. De zwangerschapsgraviteit (prenatale stadium) ........................................................61
2.1. Terminologie .....................................................................................................61
2.2. Zwangerschapstesing .......................................................................................62
2.3. Duur van de zwangerschap ...............................................................................62
2.4. Miskraam ..........................................................................................................63
2.5. Ontwikkeling van de foetus ...............................................................................64
2.6. Fysiologische veranderingen bij de moeder ......................................................65
2.7. Indicaties en contra indicaties tijdens de zwangerschap ....................................73
2.8. Pathologische situaties......................................................................................78
2.9. Kinesitherapie ...................................................................................................81
3. Partus .......................................................................................................................83
3.1. Inleiding ............................................................................................................83
3.2. Verschillende fasen van de bevalling ................................................................85
3.3. Verloskundige hulpmiddelen .............................................................................90
4. Het puerperium .........................................................................................................93
2
, 4.1. Inleiding ............................................................................................................93
4.2. Fysiologische aanpassingen .............................................................................94
4.3. Pathologie .........................................................................................................96
4.4. Kinesitherapie ...................................................................................................97
Praktijk Bekkenbodemspieroefeningen ...............................................................................106
Initiatiefase .....................................................................................................................106
Aanleren ......................................................................................................................106
Evaluatie .....................................................................................................................108
Tips en tricks bij het aanleren van de oefeningen ........................................................109
Specifieke bb-spieroefeningen ........................................................................................110
Kort versus lang ..........................................................................................................110
Analytisch ....................................................................................................................110
Liftoefeing....................................................................................................................110
Quick contraction – quick release ................................................................................111
Coördinatie-oefeningen ...............................................................................................111
Andere uitgangshouding..............................................................................................111
Weerstandsoefeningen................................................................................................ 111
Functionele oefeningen ...................................................................................................111
Zwangerschaps- en gerelateerde lage rug en pelvic pain ...................................................113
Evaluatie van peripartum lumbopelvicale pijn..................................................................113
Definitie .......................................................................................................................113
Pregnancy-related Lumbo-Pelvic Pain: PGP vs LBP ...................................................113
Variatie in terminologie ................................................................................................ 113
Lokalisatie van symptomen .........................................................................................113
Differentiaal diagnose ..................................................................................................113
Prevalentie ..................................................................................................................114
Symptomen .................................................................................................................114
Load transfer ...............................................................................................................114
Risico factoren ............................................................................................................116
Oorzaak ......................................................................................................................116
Psychologische factoren..............................................................................................117
Multifactorieel ..............................................................................................................117
Categorieën voor toewijzing van FCM – componenten ................................................117
Klinische assessment .....................................................................................................118
Historiek opnemen ......................................................................................................118
Inspectie + Klinische evaluatie ....................................................................................119
Conclusie klinische testen ...........................................................................................120
3
UROLOGISCHE EN
GYNAECOLOGISCHE
AANDOENINGEN
ragne deleu
[BEDRIJFSNAAM] [Bedrijfsadres]
,Evaluatie examen:
- Meerkeuze zonder giscorrectie
- Alles invullen
- 40 examenvragen
o 4 antwoordmogelijkheden
o Meest correcte antwoord
- Verhoogde cesuur: 62,5% => 10/20
- SBA: single best answer
INHOUDSOPGAVE
Inleiding ..................................................................................................................................5
Deel 1: continentie en incontinentie ........................................................................................7
1. Voorkomen van bekkenbodemdisfunctie: incontinentie ...............................................7
2. Anatomie van de blaas en urethra ..............................................................................8
2.1. Blaas ...................................................................................................................9
2.2. Urethra ..............................................................................................................11
3. Anatomie en functie van de bekkenbodemspieren ....................................................11
3.1. Spieren oppervlakkig plan .................................................................................13
3.2. Spieren middenplan: diafragma urogenitale ......................................................16
3.3. Spieren diepe plan ............................................................................................16
4. Fysiologie van de lagere urinewegen ........................................................................19
5. Urine-incontinentie: vormen, oorzaken en gevolgen ..................................................21
5.1. Symptoomgerichte indeling ...............................................................................22
5.2. Functionele indeling van UI ...............................................................................31
5.3. Gevolgen van incontinentie ...............................................................................32
6. Diagnose arts............................................................................................................32
6.1. Anamnese .........................................................................................................33
6.2. Klinisch onderzoek ............................................................................................33
7. Specifieke onderzoeken ............................................................................................34
7.1. Cystoscopie ......................................................................................................34
7.2. Uroflow en residubepaling .................................................................................34
7.3. Cystometrie: urodynamisch onderzoek .............................................................37
7.4. Echografisch onderzoek ....................................................................................38
8. Behandeling van incontinentie ..................................................................................38
8.1. Chirurgische bhandeling....................................................................................39
8.1.1. Behandeling voor reservoirstoornis ...............................................................39
8.1.2. Behadeling van ledigingstoornis ....................................................................39
8.2. Medicamenteuze behandeling ...........................................................................40
8.3. Incontinentiematerialen .....................................................................................42
8.4. Levensstijlinterventies .......................................................................................43
1
, 9. Invloed blaas/darm....................................................................................................45
Deel 2:bekkenbodemreëducatie ...........................................................................................47
Inleiding ............................................................................................................................47
1. Informatief gesprek ...................................................................................................48
2. Klinisch functioneel onderzoek ..................................................................................48
2.1. Anatomische evaluatie ......................................................................................48
2.2. Evaluatie kracht, uithouding, uitputbaarheid ......................................................49
2.3. Beoordeling van de tonus van de BB-spieren ....................................................50
2.4. Vaginal prolaps .................................................................................................50
3. Evaluatie van urineverlies .........................................................................................51
4. Functionele controle van de sfincter ..........................................................................52
5. Dagboek of plaskalender ..........................................................................................52
6. Bekkenbodemspieroefeningen: praktijk.....................................................................54
7. Biofeedback ..............................................................................................................55
7.1. Auditieve feedback ............................................................................................55
7.2. Sensiebele feedback .........................................................................................55
7.3. Visuele feedback ...............................................................................................55
8. Electrostimulatie .......................................................................................................57
9. Resultaten ................................................................................................................57
Deel 3: zwangerschap en bevalling ......................................................................................59
1. Obsterische anatomie ...............................................................................................59
1.1. Het baringskanaal .............................................................................................59
2. De zwangerschapsgraviteit (prenatale stadium) ........................................................61
2.1. Terminologie .....................................................................................................61
2.2. Zwangerschapstesing .......................................................................................62
2.3. Duur van de zwangerschap ...............................................................................62
2.4. Miskraam ..........................................................................................................63
2.5. Ontwikkeling van de foetus ...............................................................................64
2.6. Fysiologische veranderingen bij de moeder ......................................................65
2.7. Indicaties en contra indicaties tijdens de zwangerschap ....................................73
2.8. Pathologische situaties......................................................................................78
2.9. Kinesitherapie ...................................................................................................81
3. Partus .......................................................................................................................83
3.1. Inleiding ............................................................................................................83
3.2. Verschillende fasen van de bevalling ................................................................85
3.3. Verloskundige hulpmiddelen .............................................................................90
4. Het puerperium .........................................................................................................93
2
, 4.1. Inleiding ............................................................................................................93
4.2. Fysiologische aanpassingen .............................................................................94
4.3. Pathologie .........................................................................................................96
4.4. Kinesitherapie ...................................................................................................97
Praktijk Bekkenbodemspieroefeningen ...............................................................................106
Initiatiefase .....................................................................................................................106
Aanleren ......................................................................................................................106
Evaluatie .....................................................................................................................108
Tips en tricks bij het aanleren van de oefeningen ........................................................109
Specifieke bb-spieroefeningen ........................................................................................110
Kort versus lang ..........................................................................................................110
Analytisch ....................................................................................................................110
Liftoefeing....................................................................................................................110
Quick contraction – quick release ................................................................................111
Coördinatie-oefeningen ...............................................................................................111
Andere uitgangshouding..............................................................................................111
Weerstandsoefeningen................................................................................................ 111
Functionele oefeningen ...................................................................................................111
Zwangerschaps- en gerelateerde lage rug en pelvic pain ...................................................113
Evaluatie van peripartum lumbopelvicale pijn..................................................................113
Definitie .......................................................................................................................113
Pregnancy-related Lumbo-Pelvic Pain: PGP vs LBP ...................................................113
Variatie in terminologie ................................................................................................ 113
Lokalisatie van symptomen .........................................................................................113
Differentiaal diagnose ..................................................................................................113
Prevalentie ..................................................................................................................114
Symptomen .................................................................................................................114
Load transfer ...............................................................................................................114
Risico factoren ............................................................................................................116
Oorzaak ......................................................................................................................116
Psychologische factoren..............................................................................................117
Multifactorieel ..............................................................................................................117
Categorieën voor toewijzing van FCM – componenten ................................................117
Klinische assessment .....................................................................................................118
Historiek opnemen ......................................................................................................118
Inspectie + Klinische evaluatie ....................................................................................119
Conclusie klinische testen ...........................................................................................120
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