Kurz Jenny, Borello-France Diane
Phys Ther. 2017 Apr 1;97(4):464-477. doi: 10.2522/ptj.20160035.
Women with postpartum pelvic organ prolapse (POP) and urinary incontinence are often treated by physical therapists specializing in women's health. Movement system impairments often coexist in this patient population. The purpose of this case report is to describe the physical therapist treatment of a woman with postpartum POP complicated by additional pelvic symptoms.
A 31-year-old woman presented with postpartum POP, diastasis recti, urinary incontinence, and constipation. Movement system impairments were consistent with a physical therapist diagnosis of femoral adduction-medial rotation syndrome exacerbated by levator ani muscle weakness and incoordination and impaired intra-abdominal pressure regulation. Interventions, based on a movement system guided approach, included postural correction; pelvic-floor, abdominal, and hip muscle strengthening; functional training to correct identified movement faults; and patient education.
Movement system impairment outcomes included: correction of femoral adduction-medial rotation and knee hyperextension during standing at rest, ambulation, and exercise; increased hip muscle strength; and effective regulation of intra-abdominal pressure (resolution of breath holding with the Valsalva maneuver) during all transitional movements and therapeutic exercise. The patient also demonstrated reductions in POP, urinary, and colorectal symptom severity that exceeded the minimal clinically important difference. Additionally, she demonstrated a reduction in diastasis rectus distance.
A movement system impairment-guided approach led the physical therapist to consider impairments outside the pelvic floor that could have contributed to the patient's pelvic symptoms. Using this approach, the patient achieved resolution of musculoskeletal and movement impairments and reductions in POP, urinary and colorectal symptoms, and symptom-related distress.
患有产后盆腔器官脱垂（POP）和尿失禁的女性通常由专门从事女性健康领域的物理治疗师进行治疗。该患者群体常伴有运动系统功能障碍。本病例报告的目的是描述一名患有产后POP并伴有其他盆腔症状的女性的物理治疗过程。
一名31岁女性，患有产后POP、腹直肌分离、尿失禁和便秘。运动系统功能障碍与物理治疗师诊断的股内收-内旋综合征相符，该综合征因肛提肌无力、不协调以及腹内压调节受损而加重。基于运动系统指导方法的干预措施包括姿势矫正；盆底、腹部和髋部肌肉强化训练；纠正已识别运动错误的功能训练；以及患者教育。
运动系统功能障碍的改善结果包括：在静立、行走和运动时，股内收-内旋和膝关节过度伸展得到纠正；髋部肌肉力量增强；在所有过渡运动和治疗性锻炼过程中，腹内压得到有效调节（瓦尔萨尔瓦动作时屏气现象消失）。患者还表现出POP、泌尿系统和结直肠症状严重程度的降低，且超过了最小临床重要差异。此外，她的腹直肌分离距离减小。
基于运动系统功能障碍指导的方法使物理治疗师考虑到盆底以外可能导致患者盆腔症状的功能障碍。采用这种方法，患者的肌肉骨骼和运动功能障碍得到缓解，POP、泌尿系统和结直肠症状以及与症状相关的痛苦均有所减轻。
