Traditionelle Beckenbodengymnastik führt häufig zum Blasenhalsdeszensus – eine Untersuchung mit perinealem Ultraschall

Zusammenfassung

Hintergrund Das Ziel der physiotherapeutischen Behandlung der Belastungsinkontinenz ist die Verbesserung der Beckenbodenmuskulatur und damit des Kontinenzmechanismus, deren Hauptfaktoren die Blasenhalsstabilität und der urethrale Verschlussdruck sind. Die Beckenbodengymnastik in Deutschland beinhaltet häufig unspezifische gymnastische Übungen, deren Wirkungen auf Beckenboden und Blasenhals nicht geklärt sind. Das Ziel dieser Studie ist es, perineal-sonografisch zu untersuchen, welche Auswirkungen ausgewählte Beckenbodenübungen auf die Blasenhalsposition haben.

Methoden Fünfzehn gesunde kontinente Frauen ohne vaginale Geburten, die den Beckenboden willkürlich anspannen konnten, führten Schulterbrücke, Bauchpresse, Zehenspitzenstand und Pilates-Muschelübung aus. Eine 1. Übungsserie erfolgte ohne Hinweise zum Beckenboden, die 2. mit Anleitung zur Beckenbodenkontraktion vor und während der Übung. Mittels perinealem Ultraschall wurden die Blasenhalsbewegungen mit einem validierten Verfahren mit der Symphyse als Referenzpunkt ausgemessen.

Ergebnisse Die Frauen waren im Median 32 Jahre alt und hatten einen medianen BMI von 23. Acht Frauen waren nullipar, 7 hatten 1 – 2 Kinder via Sectio caesarea geboren. Während der Übungen ohne willkürliche Beckenbodenkontraktion deszendierte der Blasenhals im Mittel zwischen 2,3 und 4,4 mm; mit Beckenbodenkontraktion vor der Übung nur zwischen 0,5 und 2,1 mm (p > 0,05 bis auf Bauchpresse p = 0,007). Die Pilates-Muschelübung und der Zehenspitzenstand stabilisierten den Blasenhals am besten.

Diskussion Bei Übungen der traditionellen deutschen Beckenbodengymnastik deszendiert der Blasenhals häufig und kann nicht immer durch eine willkürliche Beckenbodenkontraktion vor der Übung stabilisiert werden.

Schlüsselwörter

Beckenbodengymnastik - Beckenbodenrehabilitation - Blasenhals - perinealer Ultraschall - Beckenbodenkontraktion

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