Physiotherapeutic theory for neurological rehabili
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the urinary 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 pos...
Physiotherapeutic theory for neurological rehabili
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Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
minder
CONTENT
Aim: to gain insight in
- anatomy, physiology and pathophysiology of the urogenital/colo-proctological system
- the intact innervation of bladder, bowel and sexual function
- the pathologic innervation of bladder, bowel and sexual function in different neurological diseases
- the principles of pelvic floor muscle reeducation
- different types of incontinence and other problems in the urogenital and colo-proctological region
- Specific urinary, sexual and bowel problems in different neurological diseases (CVA, Parkinson’s
- Disease, Multiple Sclerosis, Spinal Cord Injury)
Specialisation after master: Interuniversity course in pelvic reeducation and perinatal physiotherapy
INTRODUCTION
INDICATIONS FOR PELVIC REEDUCATION
In children
- Enuresis (nocturna) bedplassen
- Dysfunctional voiding
- Enuresis diurna
- Obstipation
- Pain tijdens plassen of stoelgang
- Recurrent urinary tract infections
In women
- Stress urinary incontinence
- Urgency urinary incontinence, overactive bladder
- Prolaps
- Urgency
- Pain
- Sexual problems: vaginismus, dyspareunia
- After surgery: neo-bladder (na blaaskanker), prolaps-surgery
In men
- Post-prostatectomy, post-micturitional dribbling
- Neo-bladder
- Elderly
- Pain, prostatodynia, dysuria teveel spanning dat pijn geeft
- Sexual problems: erectile dysfunction, premature ejaculation
ANATOMY OF THE PELVIC FLOOR
1. FUNCTION
closure function
- test: micturition-stoptest
dit is een test, geen oefening! We willen niet dat de blaas leert om in stukken te legen maar we willen dat
dit in 1x gebeurd
Als je dit zou oefenen dan zal de blaas zich niet volledig kunnen legen en blijft er steeds een klein beetje
urine in de blaas zitten
- Micturition-starttest:
als je heel dringend naar toilet moet dan moet je kunnen ophouden totdat je op toilet zit
Nala Melis Pagina 1
, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
support function
- stabiliteit: man (2 openingen) > vrouw (3 openingnen)
- organen
sexual function
- orgasme
- ejaculatie
2. VESSELS
slow twitch vessels (type I, red or tonic vessels)
- ophouden van urine voor lange tijd
fast twitch vessels (type II, white or phasic vessels)
- bij hoesten of niezen (P op pelvic floor) urine ophouden
beide zijn nodig in pelvic floor
3. MUSCLES
3.1. THE SUPERFICIAL LAYER
M. Sphincter ani externus (subcutaneous and superficial part)
- Aim: voluntary contraction of the anus
- Als kring rond anus kringspier
M. Bulbospongiosus (M. bulbocavernosus)
- Woman: compression of the deep dorsal vein
- Men: during ejaculation through rithmic contractions evacuate the sperm via the urethra
M. Ischiocavernosus ( erection)
- Aim: prohibit venous reflux
- belangrijk voor man
M. Transversus perinei superficialis
- Aim: stabilise the perineal central tendon
3.1.i. ARTERIAL AND VENOUS SYSTEM IN A NORMAL ERECTION
Tijdens erectie zal arterieel bloed in de penis vloeien en deze moet hier ook blijven
- Vasthouden bloed
Bij erectieproblemen gaat het bloed erin en direct terug eruit
- bij ouderen mannen= vaak te snelle outflow
viagra etc. voorkomt veneuze outflow
arteriën zich vullen & venen zich sluiten = bloed niet kan terugvloeien
Ischiocavernosus kan hierbij helpen, dit ligt aan de basis van de penis
- Het kan op de venen drukken en dus een terugvloei voorkomen
Nala Melis Pagina 2
, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
- Bij problemen leren we deze spier aan te spannen om te compenseren
Corpus cavernosum & spongiosum
3.2.
THE MIDDLE LAYER
M. Transversus perinei profundus
- Aim: support function, fixation of the perineum, sexual function
M. Sphincter urethrae externus (horseshoe-shaped)
- Aim: support urinary
- niet cirkelvormig hoefijzer
M. Sphincter ani (deep part)
- Aim: voluntary contraction of the anus
Nala Melis Pagina 3
, Physioth. Theory: pelvic reëducation in neuroP: urinary
problems
Laatste fig (rechts onderaan)
- Subcutanious & superficial sfincter ani
- M.puborectalis
Constipatie door niet kunnen ontspannen van de spier
3.3. THE DEEP LAYER
M. Levator ani
M. puborectalis
- van os pubis cirkelvormig rond ureter & anaal kanaal
M. pubococcygeus
M. iliococcygeus
M. Coccygeus
= important support function
= diaphragma pelvis
Spanning in m.puborectalis te hoog
- scherper worden anorectale hoek
Te hoge spanning in BB= problemen
geven
3.4. DIAPHRAGMA UROGENITALE/PELVIS
Diaphragma urogenitale
- Superficial part
M. ischiocavernosus
M. bulbospongiosus
M. transversus perinei superficialis
- Deeper part
M. transversus perinei profundus
M. sphincter urethrae
Diaphragma pelvis
- M. coccygeus
- M. levator ani
- (M. sphincter ani externus (deep part))
Other important pelvic muscles
- m.obturator internus
exorot heup
- m.piriformis
exorot geextendeerd been
abd geflexteerd been
Nala Melis Pagina 4
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