What is perineal rehabilitation ?

The perineal rehabilitation concerns and interests the fonctional perineum readaptation called also pelvic floor. The perineum is the whole of the soft and muscular parts, of rhombic form, located between the pubis (anterior part and upper part of the pelvis) in front, and the sacro-coccygeal unit (terminal part of the spinal column) behind.

 

The rehabilitation consists in particular of but not only to gives back the tone and strength of the perineal muscles so that patients are able to regain control of their perineal occlusive function, particularly during abdominal efforts. The perineal muscles are like all other muscles in the body: they must be maintained. The practice of a few simple and easy daily exercises will help maintain tonic activity. However, a perineal rehabilitation should not be decided lightly and should not be practiced alone, isolated or based on more or less well written and explicit documentation. It must be advised and followed by health professionals, physiotherapists or midwives duly trained in this technique.

The perineum helps to keep the bladder in good position, from the uterus to the rectum. The muscles around the urethra (the urinary tract that carries urine from the bladder to the outside), when they contract, trigger the continence reflex by the closing action of a sphincter and relaxation of the bladder muscle.

The muscles of the perineum can become weakened over time, and can no longer perform their supporting function. The most common cause is pregnancy, especially vaginal delivery. Bladder weakness can be a sign of the first signs of deterioration of the perineal system.

In some cases, if treatment does not occur in time, some women may experience what is generally referred to as "organ descent", the medical name for which is "prolapse" ("falling" of an organ), which may involve the bladder, uterus or rectum, or even all three. At this stage it will most of the time require surgery to be corrected.

Three rehabilitation techniques are the most used :

Manual re-education: it consists of a repeated voluntary contraction of the anus lifting muscles against a resistance operated by the therapist's fingers in the vagina.

Electrostimulation: a painless technique when done properly, which consists of an electrical stimulation of the perineal muscles by means of a vaginal (or anal) probe, which causes their passive contraction.

Biofeedback: a technique of awareness of a dysfunction with the corollary of its voluntary correction by the patient. By means of a specific vaginal or anal probe, the contraction generated by the patient is associated with a signal, most of the time visual and secondarily sound, which highlights on a screen (computer type) the effect of its contraction and/or muscle relaxation. This non-invasive and playful technique will initially help to raise awareness of the normal or erroneous functioning of the perineum, and then to correct it in stages.