Beckenboden- und Bauchmuskeltraining in der Peripartalperiode sinnvoll

Ulla Henscher

doi:10.1055/a-2025-3221

physiopraxis, Table of Contents

physiopraxis 2023; 21(05): 24-34
DOI: 10.1055/a-2025-3221

Therapie

Beckenboden- und Bauchmuskeltraining in der Peripartalperiode sinnvoll

Ulla Henscher

Abstract

Bewegung und Sport während und nach der Schwangerschaft sind sinnvoll. Dazu gehört auch das Training der Beckenboden- und Bauchmuskulatur. So lassen sich Risiken durch Schwangerschaft und Geburt für den Beckenboden reduzieren. Sah man früher besonders durch ein Training der Beckenbodenmuskulatur Nachteile für den Geburtsvorgang, weiß man heute, dass die Vorteile überwiegen. Dieser Artikel bietet dazu ein Update und auch zum effektiven Training des Rectus abdominis bei Rektusdiastase.

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References

Literatur
1 Lincová M, Neumannová H, Mikysková I. et al Obstetric anal sphincter injuries – review of our date between 2015–2017. Ceska Gynekol 2019; 84: 18-22
2 Tähtinen RM, Cartwright R, Vernooij RWM. et al Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes. Am J Obstet Gynecol 2019; 220: 181.e1-181.e8
3 Bisson M, Alméras N, Plaisance J. et al Maternal fitness at the onset of the second trimester of pregnancy: Correlates and relationship with infant birth weight. Pediatr Obes 2013; 08: 464-674
4 Syed H, Slayman T, DuChene Thoma K. Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, No. 804. Obstet Gynecol 2021; 137: 375-376
5 Vargas-Terrones M, Barakat R, Santacruz B. et al Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial. Br J Sports Med 2019; 53: 348-353
6 Davenport MH, Ruchat SM, Poitras VJ. et al Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52: 1367-1375
7 Mottola MF, Davenport MH, Ruchat SM. et al No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. J Obstet Gynaecol Can 2018; 40: 1528-1537
8 Chan SS, Cheung RY, Yiu KW. et al Pelvic floor biometry during a first singleton pregnancy and the relationship with symptoms of pelvic floor disorders: a prospective observational study. BJOG 2014; 121: 121-129
9 Shek KL, Kruger J, Dietz HP. The effect of pregnancy on hiatal dimensions and urethral mobility: an observational study. Int Urogynecol J 2012; 23: 1561-1567
10 Resende AP, Petricelli CD, Bernardes BT. et al Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women. Int Urogynecol J 2012; 23: 1041-1045
11 Kocaöz S, Eroğlu K, Sivaslıoğlu AA. Role of pelvic floor muscle exercises in the prevention of stress urinary incontinence during pregnancy and the postpartum period. Gynecol Obstet Invest 2013; 75: 34-40
12 Fritsch H, Fröhlich B. Development of the levator ani muscle in human fetuses. Early Hum Dev 1994; 37: 15-25
13 Mørkved S, Bø K, Schei B. et al Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol 2003; 101: 313-319
14 Szumilewicz A, Kuchta A, Kranich M. et al Prenatal high-low impact exercise program supported by pelvic floor muscle education and training decreases the life impact of postnatal urinary incontinence: A quasiexperimental trial. Medicine (Baltimore) 2020; 99: e18874
15 Salvesen KA, Mørkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 2004; 329: 378-380
16 Schreiner L, Crivelatti I, de Oliveira JM. et al Systematic review of pelvic floor interventions during pregnancy. Int J Gynaecol Obstet 2018; 143: 10-18
17 Johannessen HH, Frøshaug BE, Lysåker PJG. et al Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum – Follow up of a randomized controlled trial. Acta Obstet Gynecol Scand 2021; 100: 294-301
18 D’Souza JC, Monga A, Tincello DG. Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery. Int Urogynecol J 2020; 31: 621-625
19 Frohlich J, Kettle C.. Perineal care. BMJ Clin Evid 2015: 1401
20 Wesnes SL, Hannestad Y, Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand 2017; 96: 1214-1222
21 Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 2008; 247: 224-237
22 Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005; 106: 707-712
23 Kearney R, Miller JM, Ashton-Miller JA. et al Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 2006; 107: 144-149
24 Mogren I, Lindqvist M, Petersson K. et al Maternal height and risk of caesarean section in singleton births in Sweden – A population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PLoS One 2018; 13: e0198124
25 Leijonhufvud A, Lundholm C, Cnattingius S. et al Risk of surgically managed pelvic floor dysfunction in relation to age at first delivery. Am J Obstet Gynecol 2012; 207: 303.e1-7
26 Hage-Fransen MAH, Wiezer M, Otto A. et al Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100: 373-382
27 Wilson D, Dornan J, Milsom I. et al UR-CHOICE: Can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction?. Int Urogynecol J 2014; 25: 1449-1452
28 Grobman WA, Bailit JL, Rice MM. et al Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol. 2015; 125: 1460-1467
29 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Hebammenwissenschaft (DGHWi), AWMF-Institut für Medizinisches Wissensmanagement. S-3 Leitlinie: Vaginale Geburt am Termin. 2020. Im Internet (Stand: 19.1.2023) www.awmf.org/uploads/tx_szleitlinien/015-083l_S3_Vaginale-Geburt-am-Termin_2021-03.pdf
30 Gupta JK, Sood A, Hofmeyr GJ. et al Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017; 05: CD002006
31 Walker KF, Kibuka M, Thornton JG. et al Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev 2018; 11: CD008070
32 Méndez-Bauer C, Arroyo J, García Ramos C. et al Effects of standing position on spontaneous uterine contractility and other aspects of labour. J Perinat Med 1975; 03: 89-100
33 Gupta J, Hofmeyr G. Position for women during second stage of labour. Cochrane Database Syst Rev 2004; 01: CD002006
34 Terry RR, Westcott J, O’Shea L. et al Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives. J Am Osteopath Assoc 2006; 106: 199-202
35 Mørkved S, Bø K.. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up. BJOG 2000; 107: 1022-1028
36 Chiarelli P, Cockburn J. Preventing urinary incontinence in postpartum women. Neurourol Urodyn 2001; 20: 448-449
37 Markwell S, Sapsford R. Physiotherapy Management of Pelvic Floor Dysfunction in Women’s Health. London: Saunders 1998
38 Laycock J. Pelvic muscle exercises: physiotherapy for the pelvic floor. Urol Nurs 1994; 14: 136-140
39 Laycock J, Jerwood D.. Pelvic Floor Muscle Assessment: The PERFECT Scheme, Physiotherapy. 2001; 87: 631-642
40 Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 2014; 100: 1-8
41 Liaw LJ, Hsu M-J, Liao C-F. et al The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther 2011; 41: 435-443
42 Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther 1996; 76: 750-762
43 Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother 2000; 46: 301-307
44 Mota P, Pascoal AG, Carita AI. et al The Immediate Effects on Inter-rectus Distance of Abdominal Crunch and Drawing-in Exercises During Pregnancy and the Postpartum Period. J Orthop Sports Phys Ther 2015; 45: 781-788
45 Bø K, Hilde G, Tennfjord MK. et al Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn 2017; 36: 716-721
46 Benjamin DR, Frawley HC, Shields N. et al Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019; 105: 24-34
47 Fei H, Liu Y, Li M. et al The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study. BMC Womens Health 2021; 21: 68
48 Wang Q, Yu X, Chen G. et al Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J 2020; 31: 277-283
49 Gluppe S, Ellström Engh M, Kari B. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy 2021; 111: 57-65
50 Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths. I. General scheme and morphological aspects. J Surg Res 2001; 96: 127-134 PMID: 11181006
51 Blotta R, Dos Santos Costa S, Neubarth Trindade E. et al Collagen I and III in women with diastasis recti. Clinics (Sao Paulo) 2018; 73: e319
52 Noble E. Essential Exercises for the Childbearing Year: A Guide to Health and Comfort before and after Your Baby is Born. Harwich: New Life Images 1995
53 Theodorsen NM, Strand LI, Bø K.. Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy 2019; 105: 315-320
54 Culbertson EJ, Xing L, Wen Y. et al Loss of mechanical strain impairs abdominal wall fibroblast proliferation, orientation, and collagen contraction function. Surgery 2011; 150: 410-417
55 Kjaer M, Magnusson P, Krogsgaard M. et al Extracellular matrix adaptation of tendon and skeletal muscle to exercise. J Anat 2006; 208: 445-450
56 Kjaer M, Langberg H, Heinemeier K. et al From mechanical loading to collagen synthesis, structural changes and function in human tendon. Scand J Med Sci Sports 2009; 19: 500-510
57 Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther 2016; 46: 580-589
58 Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol (1985) 2000; 89: 967-976
59 Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn 2007; 26: 362-371
60 Sapsford R, Hodges PW, Richardson CA. et al Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 2001; 20: 31-42 (2001)20:1<31::aid-nau5>3.0.co;2-p