Physiotherapeutic theory for neurological rehabili
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the bowel problems lesson in the pelvic rehab section given by prof. I.Geraerts of the physiotherapeutic theory course. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as possib...
Physiotherapeutic theory for neurological rehabili
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Physioth. Theory: pelvic reëducation:bowel problems
ANORECTAL DYSFUNCTION
Faecal incontinence
- Complaint of involuntary loss of feces: solid, liquid, flatus
- Passive fecal incontinence: such as soiling without sensation or warning or difficulty wiping clean
Soiling= veeg in de broek
Difficulty wiping clean: vb. Kunnen blijven vegen en vuil papier blijven hebben
- Coital fecal incontinence: occuring with vaginal intercourse
Constipation
- Complaint that bowel movements are infrequent and/or incomplete and/or there is a need for frequent
straining or manual assistance to defecate
1. Prevalence bowel symptoms
Prevalentie in normale populatie
Clustering
- Meerdere keren binnen 1h
Flatus incont.
- vaak menopause
- post.zwangerschap
incontinence for liquid stool
- vb: prikkelbaar darm syndroom
2. Evaluation of anorectal (dys)function/bowel symptoms
2.1. STOOL DIARY
Eerste kolom = bristol stool chart
Tweede kolom = drang
Derde kolom = soiling
Hard stool is worse for patient because it should be easier to hold
than liquid
2.2. Bristol stool chart
Type3-4-5= normaal
2.3. ANAL MANOMETRY
Evaluation of pressure in the anus and the last part of the rectum, to check for
abnormalities in the anorectum
Ballon in rectumopblazendruk meten
Sensoriek gescoord: Een ballon in rectum -> druk verhogen -> gevoel van stoelgang
- Laat pt aangeven wanneer er voor het eerst drang is1st urge defecation
Wij zouden dit vrij snel aangeven
Bij ↓sensibiliteit zal dit vele langer duren voor ze het voelen -> vaak is de druk al
zo hoog dat ze het te laat voelen waardoor er incontinentie zal zijn
(mango) rectum
- Vnl. bij kinderen
- Moeilijker legen
- Ipv mooie koker= soort bolvormig deel voor einde rectum
Hierin hoopt alles op
- Sneller aangeven 1st urge
- Normaal= rectum met mooie anorectale hoek
Normaal per keer +/- 250 gr defeceren
Duwen voor initiatie defeceren
- Niet cte duwen
- Indien wel
↑ kans op prolaps & hemorrhoids
3. MEDICATION
Type medicatie kennen maar niet de naam van het medicament
- Anti-diarrhea:
R/Loperamide, Imodium, Transityl
- Laxativa:
R/ Colofiber, Normacol, Spagulax (zwelmiddelen)
R/ Lansoyl paraffine (vloeibare paraffine)
R/ Lactitol, Lactulose, Sorbitol, Macrogol (osmotische/contact laxativa)
R/ Resolor, Constella (Pricalopride/ Linaclotide)
R/ Cleen enema, Fosfaatlavement, Glycerine, Laxavit, Microlax, Norgalax (Rectale laxativa)
EVALUATION OF THE PELVIC FLOOR
Peri-anal sensibility/reflexes
Palpation: rest tone, force, endurance, exhaustion, relaxation…
Hemorrhoids
Prolaps
Rectal laesions
- Fissuren
Door elke keer te moeten controleren of rectum leeg is
Extra-rectal mass
TREATMENT OF THE PELVIC FLOOR
Pelvic floor muscle training
Biofeedback
Electrostimulation
Proprioceptive training/press technique: rectal balloon
Abdominal massage
1. PELVIC FLOOR MUSCLE TRAINING
Education
- Anatomy
- Eating and drinking habits
- What is a normal defecation pattern?
Maar ook houding op toilet! voeten ondersteund en eventueel op een klein bankje o Normale freq van
deficatie: 3x/d– 3x/w
- Continence aids?
Nodig? Welke is best voor P
Nala Melis Pagina 2
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