Wang Yangai (Department of Obstetrics and Gynecology, Yuzhou Central Hospital, Henan)

【Summary】 

Purpose:

To explore the effect of pelvic floor muscle exercise combined with biofeedback electrical stimulation in the treatment of postpartum uterine prolapse.

Method:

A total of 98 patients with postpartum uterine prolapse admitted to Yuzhou Central Hospital from May 2016 to January 2018 were selected and divided into a control group and an observation group according to a random number table, with 49 cases in each group. Patients in the control group received biofeedback electrical stimulation, and patients in the observation group received pelvic floor muscle exercise combined with biofeedback electrical stimulation. The treatment effect, the degree of uterine prolapse and pelvic floor muscle potential before and after treatment were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group, and the difference was statistically significant (P <0.05). After treatment, the degree of uterine prolapse of the two groups of patients was lower than that before treatment, and the degree of uterine prolapse of the observation group was lower than that of the control group, the difference was statistically significant (P <0.05). After treatment, the pelvic floor muscle potential of the two groups of patients was higher than that before treatment, and the pelvic floor muscle potential of the observation group was higher than that of the control group. The difference was statistically significant (P <0.05). Conclusion Pelvic floor muscle exercise combined with biofeedback electrical stimulation has a significant effect on patients with postpartum uterine prolapse, which can effectively relieve clinical symptoms and enhance pelvic floor muscle strength.

Postpartum uterine prolapse means that the uterus descends along the vagina, and the outer cervix descends to below the level of the ischial spine, usually accompanied by bulging of the posterior or anterior vaginal wall. Its occurrence is mostly related to factors such as increased abdominal pressure, impaired delivery, and degeneration of pelvic floor tissues, which seriously affect women's physical and mental health and quality of life [1]. Related studies have found that early pelvic floor muscle exercise has a significant advantage in reducing the clinical symptoms of postpartum uterine prolapse [2]. This study explored the effect of pelvic floor muscle exercise combined with biofeedback electrical stimulation in the treatment of postpartum uterine prolapse.

Materials and Methods

1. 1 General information Select 98 patients with postpartum uterine prolapse admitted to Yuzhou Central Hospital from May 2016 to January 2018. Inclusion criteria: Diagnosed as postpartum uterine prolapse. Exclusion criteria: Past delivery history of deformity or macrosomia; accompanied by diseases such as postpartum depression and pregnancy-induced hypertension; urinary and reproductive system infections; combined with insufficiency of the heart, brain, liver, and kidney; past history of mental illness. This study was approved by the hospital medical ethics committee. All patients and their families voluntarily participated in this study and signed informed consent. According to the random number table method, the patients were divided into control group and observation group, with 49 cases in each group. Control group: 20 to 38 years old, average (29.84 ± 4. 23) years old; body mass index 20 to 25 kg/m2, average (22. 93 ± 1.03) kg/m2; newborn weight 3 376 ～ 3 928 g, average

(3 696. 84 ± 132. 84) g; 19 cases of cesarean section and 30 cases of natural delivery. Observation group: age 21 ~ 39 years old, average (30. 18 ± 4.05) years old; body mass index 20 ~ 26 kg/m2, average (23. 05 ± 1. 12) kg/m2; newborn weight 3 378 ~ 3,931g, average (3 697. 13 ± 132. 92) g; 20 cases of cesarean section, 29 cases of natural delivery. There was no statistically significant difference in general information between the two groups of patients (P>0.05).

1. 2 Treatment method

1. 2. 1 The control group received biofeedback electrical stimulation treatment. Use the Weihai Bohua Medical Equipment Co., Ltd. neuromuscular electrical stimulator to perform electrical stimulation, insert a female probe, set the electrical stimulation parameters, and gradually increase the electrical stimulation frequency from 8 Hz to 80 Hz with a degree of 20 ~ 740 μs , It is mainly to feel the obvious muscle beating or contraction, and adjust the current. When the patient's tolerance to electrical stimulation intensity gradually increases, readjust the electrical stimulation parameters. Use Changsha Tengjian Medical Equipment Co., Ltd. Electromyography Biofeedback Therapy Instrument RT8802 for biofeedback, transform muscle activity information into auditory or visual signals through electromyography, pressure curves and other forms, and use the above signals to assist patients in muscle, bladder and other biological Feedback.

1. 2. 2 Observation group Exercise the pelvic floor muscles on the basis of the treatment of the control group, instruct the patient to lie down, relax fully, take deep and slow breathing, contract the urethra and anus when inhaling, and inhale for 5-8 s, repeat the exercise

15 minutes and perform 3 to 5 rapid contractions, 3 times/d.

1. 3 Significant improvement in the criterion of efficacy is that the clinical symptoms have basically disappeared or been significantly relieved, the external cervix has reached the level of the ischial spine, the uterus has returned to its normal prenatal position, and has not relapsed within 6 months; relief means that the clinical symptoms have been relieved and the uterus has returned The condition of the vagina is alleviated and the cervical ostium is close to the level of the ischial spine, but it is still accompanied by a sense of swelling. Ineffectiveness means that there is no obvious change or aggravation of clinical symptoms and uterine position. Total effective treatment rate = (Significant improvement

Number of cases + number of remission cases) /49 ×100%.

1. 4 Observation indicators ① Treatment effect. ②Using the pelvic organ prolapse quantitative evaluation system (P0P ~ Q) to evaluate the degree of uterine prolapse before and after treatment.

③Pelvic floor muscle potential before and after treatment.

1. 5 Statistical methods SPSS 24.0 statistical software was used to process the data. Quantitative data conforming to the normal distribution are expressed as mean ± standard deviation (x 珋 ± s), and t test is used for comparison between groups; qualitative data is expressed as rate (%), and χ2 test is used for comparison between groups. P <0.05 is considered statistically significant.

result

2. 1 After the curative effect treatment, the control group made significant progress in 23 cases, alleviated 14 cases, and 12 cases were ineffective, and the total effective rate of treatment was 75.51% (37 /49); in the observation group, 30 cases were significantly improved, 16 cases were relieved, and 3 cases were ineffective. The total effective rate of treatment was 93.88% (46/49). The total effective rate of treatment in the observation group was higher than that in the control group, and the difference was statistically significant (χ2 = 6.376, P =0. 012 <0.05).

2. 2 The degree of uterine prolapse before and after treatment in the control group were (-3.01 ± 0. 23) and (-3.87 ± 0. 15) cm; the degree of uterine prolapse before and after treatment in the observation group were (--3.87 ± 0.15) cm 2. 92 ± 0. 26), (-4. 62 ± 0. 12) cm. There was no significant difference in the degree of uterine prolapse before treatment between the two groups of patients (P>0.05). After treatment, the degree of uterine prolapse of the two groups of patients was lower than that before treatment, and the degree of uterine prolapse of the observation group was lower than that of the control group. The difference was statistically significant (P <0.05).

2. 3 Pelvic floor muscle potentials before and after treatment in the control group were (2.98 ± 0.67) and (11.84 ± 3.62) μV; in the observation group, the pelvic floor muscle potentials before and after treatment were (3 . 03 ± 0. 69), (19. 92 ± 6. 49) μV. Before treatment, there was no significant difference in pelvic floor muscle potential between the two groups of patients (P>0.05). After treatment, the pelvic floor muscle potential of the two groups of patients was higher than before treatment, and the pelvic floor muscle potential of the observation group was higher than that of the control group, and the difference was statistically significant (P <0.05).

discuss:

≥14. 29% of parturients are accompanied by uterine prolapse, which seriously affects the quality of life of patients [3]. Uterine prolapse is related to huge babies, device-assisted delivery, and the number of full-term births [4]. At present, there are two methods for clinical treatment of uterine prolapse: surgery and conservative treatment. However, surgery is prone to be complicated by weakening of pelvic floor muscle strength and stress urinary incontinence. Conservative treatment can make up for the shortcomings of surgery and improve clinical practice.

symptom.

Related studies have found that applying biofeedback electrical stimulation to patients with postpartum uterine prolapse can improve muscle contractility [5]. Muscle electrical stimulation mainly stimulates the patient’s pelvic and perineal nerves repeatedly, which helps to wake up proprioception, thereby increasing muscle strength and muscle contractility; biofeedback uses visual or auditory signals to accurately train patients with abnormal conditions, which can effectively stimulate muscles Group and organization movement [6]. Through the sensation exercise of the pubic bone and coccyx muscle group, it can effectively improve the pelvic floor microcirculation and muscle function [7]. The pelvic floor muscle exercise is not affected by the environment, work, etc., and the operation is convenient. The results of this study show that pelvic floor muscle exercise combined with biofeedback electrical stimulation for the treatment of postpartum uterine prolapse can enhance the therapeutic effect. The results of this study showed that the degree of uterine prolapse in the observation group was lower than that in the control group, and the pelvic floor muscle potential was higher than that in the control group. This suggests that pelvic floor muscle exercise combined with biofeedback electrical stimulation can effectively alleviate the clinical symptoms of patients with postpartum uterine prolapse and enhance pelvic floor muscle strength.

In summary, the pelvic floor muscle exercise combined with biofeedback electrical stimulation has a significant effect on patients with postpartum uterine prolapse, which can effectively relieve clinical symptoms and enhance pelvic floor muscle strength.

references

Feng Ziya, Liu Yinglin, Chen Shaoqing. The effect of pelvic floor muscle electrical stimulation combined with biofeedback, Kegel training and chest-knee position in the treatment of postpartum uterine prolapse [J]. Journal of Tropical Medicine,

2017, 17(10): 1314 -1317.

Luo Jun, Ouyang Ziting, Wu Fei, etc. Observation on the efficacy of pelvic floor muscle training combined with traditional Chinese medicine in the treatment of mild to moderate pelvic organ prolapse [J]. Chinese Physician Journal, 2015, 17(6):

868 -871.

Hu Mengcai, Zheng Xueqin, Zhao Bing, et al. Observation of pelvic floor function and pelvic floor organ prolapse from 6 to 8 weeks postpartum of primiparous women by perineal lateral incision [J]. Shandong Medicine, 2017, 57(35): 53-55.

Li Min, Zhang Qiao. Analysis of related influencing factors of early postpartum pelvic organ prolapse in primipara[J]. Chinese Journal of Family Planning, 2016, 24(6): 399-403.

Zhao Shuang, Shi Yulin. Electric stimulation biofeedback combined with Buzhong Yiqi Decoction in the treatment of postpartum first-degree uterine prolapse [J]. Journal of Liaoning University of Traditional Chinese Medicine, 2017, 19 (3):

199 -201.

Hu Daoqin. Analysis of the efficacy of biofeedback combined with electrical stimulation in the treatment of uterine prolapse [J]. in

China Maternal and Child Health Care, 2017, 32(14): 3353 -3355.

Lu Jiahong, Xiao Yunyue, Zhang Yi, etc. Clinical study of electrical stimulation biofeedback therapy combined with pelvic floor muscle functional exercise rehabilitation for pelvic floor dysfunction diseases［J］. Advances in Modern Obstetrics and Gynecology, 2017, 26(2): 133 -135.