PELVIC FLOOR DYSFUNCTION AND VAGINAL RELAXATION SYNDROME AFTER CHILDBIRTH IN YOUNG WOMEN: REHABILITATION PROGRAM AND RECOMMENDED PRACTICES

A significant number of publications demonstrate the impact of pregnancy and childbirth on the structure and function of the pelvic floor, stating the fact of diagnosing stress urinary incontinence and other manifestations. The aim of this study was to evaluate the effectiveness of the proposed rehabilitation techniques for restoring the pelvic floor in primiparous women with minimal symptoms of functional failure of the pelvic muscles after urgent delivery through the natural birth canal. Materials and methods. The effectiveness of the proposed complex of recommended practices, physiotherapeutic procedures, physical therapy and training with the use of Kegel cones in the postpartum period was evaluated in two groups of patients with minimal manifestations of pelvic floor muscle dysfunction after the first delivery: the main group (40 women) and the comparison group (40 women) who led a normal lifestyle. Results. The data indicating pelvic floor dysfunction were identified in 86.3 % of cases only by a thorough questioning. The proposed rehabilitation therapy contributed to a significant regression of symptoms: complaints of urinary incontinence and intestinal gas incontinence in almost all patients of the main group, as well as manifestations of sexual dysfunction. Without statistical difference, the percentage of symptoms such as increased vaginal discharge and clinical manifestations associated with vaginal gaping both at rest and during exertion decreased. Changes in the echographic picture are presented, which demonstrated the correction of muscle diastasis, an increase in the height of the perineal tendon centre, an increase in muscle mass and a reduction of urethral hypermobility. Conclusions. The proposed rehabilitation complex improves the tone of the abdominal muscles and pelvic floor, improves bowel and bladder function, but is not effective enough to restore the closure function of the genital slit and the clinical manifestations associated with this factor.