Physiotherapeutic theory for neurorehabilitation
of pelvic reeducation
Introduction
Pelvic reeducation: becoming as independent as possible as patient à relevant for physiotherapist
Indications for pelvic reeducation
Children
• Enuresis (noctura) = bedplassen, > 5j
• Dysfunctional voiding
• Daytime incontinence
• Obstipation
• Pain
• Recurrent urinary tract infections
Women
• Stress urinary incontinence
• Urgency urinary incontinence, overactive bladder
• Prolaps (organ comes downwards)
• Urgency
• Pain
• Sexual problems: vaginismus (unvoluntary contractions of muscles), dyspareunia (pain)
• After surgery: neo-bladder, prolaps-surgery
Men
• Post-prostatectomy, post-micturitional dribbling
• Neo-bladder (learn continence again)
• Elderly: urgency incontinence, lower urinary tract problems
• Pain: prostatodynia (pain in prostate), dysuria (burning sensation while peeing)
• Sexual problems: erectile dysfunction, premature ejaculation
Neurological patients
• Cerebrovascular accident
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Spina bifida
,Anatomy of pelvic floor
Function
• Closure function: closing urethra and rectum
o Micturition-stoptest: try to interrupt peeing
o Don’t do this test as an exercice (bladder learns to contract less hard à residual urine
à infections)
• Support function
o Analogy: boat (organs) with ropes (ligaments), water (pelvic floor)
o When pelvic floor impaired à ligaments have to carry, but not strong enough
• Sexual function
o Orgasm
o Evacuating sperm
Vessels
Slow twitch vessels
• Type I, red or tonic vessels
Fast twitch vessels
• Type II, white or phasic vessel
• Prevent urine loss during vasalva maneuver
Muscles
Superficial muscles: more closure and sexual function
Deeper muscles: more support function
Superficial layer
M. sphincter ani externus (subcutaneous and superficial part)
• Circular muscle of 3 parts
• Voluntary contraction of the anus
M. bulbospongiosus (m. bulbocavernosus)
• Woman: compression of the deep dorsal vein
• Men: rhythmic contractions during ejaculation to evacuate the sperm via the urethra
M. ischiocavernosus
• Prohibiting venous reflux
M. transversus perinei superficialis
• Stabilizing the perineal central tendon
• Mainly support function
,Arterial and venous system in a normal erection
• Arterial blood via a. cavernosa to corpus cavernosum
• Inhibition of venous outflow via contraction of ischiocavernosus
Middle layer
M. transversus perinei profundus
• Support function
• Fixation of the perineum
• Sexual function
M. sphincter urethra externus
• Horseshoe-shaped, at ventral side of urethra
• Support urethra
M. sphincter ani externus (deep part)
• Voluntary contraction of the anus
, Deep layer
M. levator ani
• M. puborectalis Important support function
• M. pubococcygeus = diaphragma pelvis
• M. iliococcygeus
M. coccygeus
Diaphragma urogenitale
• Superficial part
o M. ischiocavernosus
o M. bulbospongiosus
o M. transversus perinei superficialis
• Deeper part
o M. transversus perinei profundus
o M. sphincter urethra
Diaphragma pelvis
• M. coccygeus
• M. levator ani
• (M. sphincter ani externus (deep part))
Other pelvic muscles
M. obturator internus
• Exorotation, abduction
of pelvic reeducation
Introduction
Pelvic reeducation: becoming as independent as possible as patient à relevant for physiotherapist
Indications for pelvic reeducation
Children
• Enuresis (noctura) = bedplassen, > 5j
• Dysfunctional voiding
• Daytime incontinence
• Obstipation
• Pain
• Recurrent urinary tract infections
Women
• Stress urinary incontinence
• Urgency urinary incontinence, overactive bladder
• Prolaps (organ comes downwards)
• Urgency
• Pain
• Sexual problems: vaginismus (unvoluntary contractions of muscles), dyspareunia (pain)
• After surgery: neo-bladder, prolaps-surgery
Men
• Post-prostatectomy, post-micturitional dribbling
• Neo-bladder (learn continence again)
• Elderly: urgency incontinence, lower urinary tract problems
• Pain: prostatodynia (pain in prostate), dysuria (burning sensation while peeing)
• Sexual problems: erectile dysfunction, premature ejaculation
Neurological patients
• Cerebrovascular accident
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Spina bifida
,Anatomy of pelvic floor
Function
• Closure function: closing urethra and rectum
o Micturition-stoptest: try to interrupt peeing
o Don’t do this test as an exercice (bladder learns to contract less hard à residual urine
à infections)
• Support function
o Analogy: boat (organs) with ropes (ligaments), water (pelvic floor)
o When pelvic floor impaired à ligaments have to carry, but not strong enough
• Sexual function
o Orgasm
o Evacuating sperm
Vessels
Slow twitch vessels
• Type I, red or tonic vessels
Fast twitch vessels
• Type II, white or phasic vessel
• Prevent urine loss during vasalva maneuver
Muscles
Superficial muscles: more closure and sexual function
Deeper muscles: more support function
Superficial layer
M. sphincter ani externus (subcutaneous and superficial part)
• Circular muscle of 3 parts
• Voluntary contraction of the anus
M. bulbospongiosus (m. bulbocavernosus)
• Woman: compression of the deep dorsal vein
• Men: rhythmic contractions during ejaculation to evacuate the sperm via the urethra
M. ischiocavernosus
• Prohibiting venous reflux
M. transversus perinei superficialis
• Stabilizing the perineal central tendon
• Mainly support function
,Arterial and venous system in a normal erection
• Arterial blood via a. cavernosa to corpus cavernosum
• Inhibition of venous outflow via contraction of ischiocavernosus
Middle layer
M. transversus perinei profundus
• Support function
• Fixation of the perineum
• Sexual function
M. sphincter urethra externus
• Horseshoe-shaped, at ventral side of urethra
• Support urethra
M. sphincter ani externus (deep part)
• Voluntary contraction of the anus
, Deep layer
M. levator ani
• M. puborectalis Important support function
• M. pubococcygeus = diaphragma pelvis
• M. iliococcygeus
M. coccygeus
Diaphragma urogenitale
• Superficial part
o M. ischiocavernosus
o M. bulbospongiosus
o M. transversus perinei superficialis
• Deeper part
o M. transversus perinei profundus
o M. sphincter urethra
Diaphragma pelvis
• M. coccygeus
• M. levator ani
• (M. sphincter ani externus (deep part))
Other pelvic muscles
M. obturator internus
• Exorotation, abduction
