A new approach to postpartum rehabilitation of patients with pelvic floor dysfunction

Objective. To determine the efficiency of portable electrical myostimulation of perineal muscles and radio wave vulvar tissues lifting using a combined method for the prevention and conservative correction of pelvic floor dysfunction in patients in the late postpartum period. Subjects and methods. The investigation enrolled 34 reproductive-aged patients with early manifestations of pelvic floor dysfunction and with clinical types of no higher than Pelvic Organ Prolapse Quantification System (POP- Q) grade 1 genital prolapse. A study group consisted of 18 women; 6 patients of them were found to have POP- Q grade I genital prolapse. A control group included 16 women; 5 patients were observed to have POP-Q grade 1 colpoptosis. The inclusion criteria were the desire of a patient to participate in the study; the manifestations of pelvic floor dysfunction in the late postpartum period. The exclusion criteria were pregnancy; POP- Q grade 2 or higher genital prolapse; severe extragenital pathology; congenital abnormalities of the genitourinary system; pelvic surgery; acute or chronic inflammatory diseases of the pelvis and urogenital tract during an exacerbation; cancers; active-phase skin diseases; sexually transmitted diseases; and neuropsychiatric disorders. The investigation methods included a detailed history data collection to identify risk factors for perineal muscular incompetence both before and after birth; a thorough analysis of complaints; an objective examination; a visual inspection of the perineum by functional tests and perineometry; bimanual vaginal abdominal examination; laboratory examination; and transvaginal and transperineal ultrasonography. The patients were interviewed using the Pelvic Floor Distress Inventory-Short Form 20) (PFDI-20), the Female Sexual Function Index with 19 items (FSFI-19), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). To restore pelvic floor functions and to improve their quality of sexual life in the late postpartum period, after preliminary training the study group patients underwent pelvic floor muscle training with a SensaTONE portable electromyostimulator (China) and a parallel cycle of radio wave lifting with a Surgitron DFS5 radio wave generator (USA) at 4.0MHz according to the Pelleve technology. After completing the cycle of postpartum pelvic floor rehabilitation, the authors analyzed the complaints made, the results of evaluating the perineum and those of perineometry, and the data of transperineal ultrasonography. Statistical data processing, plotting, and result analysis were made on a personal computer using Microsoft Word programs and Microsoft Excel spreadsheets. Statistical calculations were done using the application package Statistica version 7.0. Nonparametric statistical techniques (the MannWhitney U test) were used when the distributions differed from normal. Results. The results of the survey, perineometry, and estimation of the contraction force of the pelvic floor muscles according to the Oxford scale showed that the study group patients unlike the controls showed a significant reduction in the symptoms of pelvic floor dysfunction (p < 0.05) during electrical myostimulation in conjunction with radio wave perineal lifting procedures. The transperineal ultrasound changes in the study and control groups at 3 months after the beginning of the rehabilitation program proved statistically insignificant. Conclusion. Exposure of vulvar and perineal tissues to radio wave radiation of a certain spectrum, by using a Surgitron DF S5 radio wave generator at 4.0 MHz according to the Pelleve technology (USA) in combination with portable electromyostimulation of the pelvic floor muscles, is quite effective to the author’s opinion, as it is a combined technique and has an impact at several levels: the vulva, perineal tissues, and cross-striated pelvic floor muscles.

pelvic floor dysfunction, relaxed vagina, postpartum prolapse, electromyostimulation, radio wave lifting