GLUP_Gardone_Lettura Magistrale: “La riabilitazione perineale nella donna” – P. Di Benedetto

1. GLUP (Gruppo di Lavoro Uroginecologia Pavimento Pelvico) Pavimento Pelvico ed Evento Ostetrico Gardone Val Trompia, 16 Aprile 2011 P. Di Benedetto, 2011

2. La Riabilitazione Perineale nella Donna Paolo Di Benedetto, Udine P. Di Benedetto, 2011

5. P. Di Benedetto, 2011

13. Pelvic Floor Dysfunction Pathophysiology P. Di Benedetto, 2011

14. JO DeLancey . Editorial. Current Opinion in Obstetrics and Gynecology 1994;6:313-6 The interaction between the pelvic floor muscles (PFM) and the supportive ligaments is critical to support of the pelvic organs. As long as the PFMs function normally, the pelvic floor is closed and the ligaments and fascia are under no tension. The fascia simply act to stabilize the organs in their position above the levator ani muscles. P. Di Benedetto, 2011

15. JO DeLancey . Editorial. Current Opinion in Obstetrics and Gynecology 1994;6:313-6 When the PFMs relax or are damaged, the pelvic floor opens and the vagina lies between the high abdominal pressure and low atmospheric pressure. In this situation it must be held in place by the ligaments. Although the ligaments can sustain these loads for short period of time, if the PFMs do not close the pelvic floor, then the connective tissue will became damaged and eventually fails to hold the vagina in place. P. Di Benedetto, 2011

18. P. Di Benedetto, 2011

20. Boath in Dry Dock ( Norton PA, 1993) P. Di Benedetto, 2011

21. P. Di Benedetto, 2011

27. INCITE childbirth nerve damage muscle damage radiation tissue disruption radical surgery PREDISPOSE gender racial neurologic anatomic collagen muscular cultural enviromental PROMOTE constipation occupation recreation obesity surgery lung disease smoking menstrual cycle infection medication menopause INTERVENE behavioral pharmacologic devices surgical DECOMPENSATE aging dementia debility environment medication normal support or function abnormal support or function Model for the development of pelvic floor dysfunction in women (Bump et al, 1998) P. Di Benedetto, 2011

30. INTRAPARTUM INJURY CONNECTIVE TISSUE Breakage Stretching LEVATOR ANI MUSCLES Muscles Tears Pudendal Nerve Acute Denervation Loss of muscle tone Chronic Denervation Aging Connective tissue failure GENITAL PROLAPSE Proposed mechanism for acute injury to pelvic supportive structures at childbirth that may result in chronic denervation and pelvic organ prolapse (from Strohbehn, 1998) P. Di Benedetto, 2011

53. ” Alternative” methods to PFMT? P. Di Benedetto, 2011

55. The core of PFR is the pelvic floor muscle awareness associated to pelvic floor muscle training. P. Di Benedetto, 2011

56. Nowadays some non-medical pelvic floor grouped activities are rising, in order to widely offer PFMT as already happening in forms of adapted physical activity (APA) in other fields (low back pain, Parkinson, stroke, fibromyalgia). P. Di Benedetto, 2011

57. It should be very important also a sensitization of both patients and health care professionals that often underestimate pelvic floor dysfunction ( prevention and negative effects on quality of life). P. Di Benedetto, 2011