Kegel exercises for beginners: for strengthening the muscles of the small pelvis, for urinary incontinence, for hemorrhoids, for women and men. Pelvic floor exercises for women

The pelvic floor is a muscular structure that maintains the abdominal cavity in its normal anatomical state. It also serves as the basis for the pelvic organs (bladder, urethra, vagina, uterus, rectum). The pelvic floor consists of a muscular layer, fascia (sheaths of connective tissue that cover organs, vessels, nerves and form sheaths for muscles) and ligaments. This whole structure looks like a hammock, taking on the weight of all the internal organs. When the pelvic floor muscles are weakened, they are unable to hold the pelvic organs in their normal position, and the genitals may droop or prolapse. But even if you have any problems, pelvic floor exercise therapy will take care of everything.

10 323686

Photo gallery: Therapeutic exercise for the muscles of the pelvic floor

The so-called "gaping of the genital slit" may also occur, due to which pathogenic bacteria penetrate the vagina, which cause inflammation. By the way, the prolapse of the walls of the vagina can provoke varicose veins, especially during pregnancy.

A word about sex

The muscles of the pelvic floor are active participants in intimate life. During intercourse, their contraction causes contraction of the muscles of the vaginal canal, which increases the sexual satisfaction of both partners several times. Then the female orgasm is not a problem. If the pelvic floor muscles are weakened, the quality of sexual life suffers a lot due to a violation of tactile sensations. Often this is accompanied by a decrease in libido (sex drive). A woman goes for sexual contact not because she wants it, but in order to save her family. This condition can be accompanied by pain, especially often when the walls of the vagina are lowered, since they have many ligamentous structures that are stretched and can affect the nerve endings in the soft muscle tissue, causing pain during prolonged walking, straining, even just lying down. Those who have not yet given birth may have prolapse of the genital organs associated with congenital pathologies (but they practically do not have prolapse). Omission does not cause problems either with the onset or with the bearing of pregnancy, but after childbirth, the condition of the muscles and ligaments worsens, they stretch even more.

ABC of childbirth

Childbirth most often results in damage to the pelvic floor muscles, especially if there are tears. It is very difficult to restore them to their original state. It all depends on what method was used to connect the damaged tissues. Today, with difficult births, the best option is episiotomy (surgical dissection of the perineum to avoid arbitrary ruptures and birth traumatic brain injuries of the child, most often in cases where the size of the fetal head significantly exceeds the size of the vaginal opening). An episiotomy is beneficial because a surgical incision leaves less visible scars compared to lacerations, heals faster, and causes less blood loss.

With perineotomy, the perineum is dissected from the posterior commissure of the labia majora towards the anus, not reaching it. A few years ago, doctors preferred this type of operation, because after it the suture heals quickly. However, complications often occur after perineotomy - in the recovery period, the percentage of genital prolapse is high. If a woman after surgery violates the motor regimen: lifts weights, plays sports too actively, up to 30% of relapses occur.

To prevent such violations, you need to come to the doctor for a check-up in a month. Keep the rehabilitation process under control - and recovery will not take long.

How to check yourself?

You can easily determine if you have early signs of pelvic floor disorders. An indicator of anxiety symptoms - if true, at least one of these statements. During intercourse, sports, just squatting, you feel that air gets inside the vagina, a characteristic squelching sound is heard. When coughing or sneezing, urine is released involuntarily. Urination is difficult. You are prone to chronic sexual infections.

Diagnostics

Examination by a gynecologist once a year from the first day of menstruation (palpation, smear, cytology tests). Collection of anamnesis (information about the development of diseases, living conditions, past diseases of the patient). Ultrasound (a study using ultrasound - this is how the correct location of the uterus, internal organs, the presence of stones is determined). Examination with special devices to assess the strength of the muscles of the vagina (a pear inserted into the vagina is compressed by its muscles, their strength is assessed using an indicator). The method is not common, more effective - palpation and visual inspection. Devices for measuring the pressure of the urine stream (in violation of the function of the organs of urination).

Treatment

Physiotherapy exercises (exercise therapy) are special exercises for prevention and on the initial changes in the weakness of the muscles of the vagina, in the future this will help to avoid organ prolapse. By doing pelvic floor exercises regularly, you will help yourself and your body.

BFB (biofeedback) is a method of restoring weakened pelvic floor muscles (for four weeks, 30 minutes a day), teaching them how to work correctly - contraction at the moment when it is necessary, and with the necessary force. It is carried out in the form of exercises on a special apparatus. The sensor, fixed above the perineum, registers the bioelectric signal of the amplitude of muscle contraction, the image of their work is displayed on the monitor.

Electrical stimulation of muscles - bringing them into tone with the help of weak electrical impulses. This contributes to the restoration of nervous and muscle tissue. The method is comparable to complex physical exercises: it can be used to train different muscle groups.

Surgical intervention. In difficult cases, plastic surgery is used with the implantation of a synthetic implant under the vaginal mucosa - this frame supports the muscle structure. The implant is placed for life.

Prevention

Dosed physical activity: walking, swimming, cycling, running (if there is no large weight that causes increased intra-abdominal pressure). Vumbilding classes (we comprehend the art of controlling intravaginal muscles).

Latin American dances (we improve blood circulation in the tissues of the small pelvis). Vaginal balls (we increase the tone of the muscles of the vagina, in particular smooth muscles, which are very difficult to control without training).

Exercises to strengthen the muscles of the pelvis

By doing these exercises for just 5 minutes twice a day, you will avoid many pelvic floor health problems. The contractile strength of the muscles and their tone increase, the blood supply to the tissues improves, and tactile sensations during sex increase over time.

. "Bicycle" - lying on the shoulder blades (supporting the lower back with hands), we imitate the movement of a cyclist with our feet.

. "Birch" - lying on the shoulder blades (supporting the lower back with hands), raise the legs vertically up to an angle of 90 ° relative to the body - excellent unloading for the pelvis.

Lying on your back, lifting and spreading your legs to the sides - we strengthen the muscles.

We get into a knee-elbow position - like a cat - we bend as much as possible, we swing our legs from the floor in the direction of the back. The muscles of the perineum work.

We walk in a straight line with a book on our heads, like a model - the muscles of the perineum, the inner thighs are trained. Attention: if the exercises are difficult for you, do not do them or replace them with lighter ones. Physical activity should be enjoyable. And do not forget that regular sex life at least once a week will noticeably improve your health: it activates the blood supply to the muscles, improves hormonal levels, and promotes the release of endorphins - hormones of happiness. What else does a woman need?

Enemies of the pelvic floor

Strengthened physical activity; heavy lifting work.

Constant exercise and then a sharp cessation (this causes muscle atrophy - unclaimed tissue loses its activity and structure).

Prolonged chronic cough.

Congenital features - hyperelastosis (from birth, all ligaments and tissues are very elastic).

Dysplasia (violation of the structure) of muscle and connective tissue.

Menopause (as soon as the level of estrogen falls, the structure of tissues and ligaments is destroyed). Estrogens accumulate in adipose tissue. The more it is, the higher the likelihood that menopause will come softer, later and more painless.

Exercises for the uterus to strengthen should be performed regularly by all women. Due to the constant physical exertion on this zone, the organs located in the small pelvis will remain in their anatomical place. If at any time, under the influence of various factors, a decrease in muscle tone occurs, various gynecological diseases may begin to develop.

In the complexes of physiotherapy exercises, various exercises have been developed to raise the uterus and strengthen muscles, which will allow in the future to avoid problems with urination, bearing a child, and also act as a prevention of pathologies. Let us consider in more detail how to strengthen the walls of the uterus and its cervix.

Properly selected and regularly performed gymnastics for the pelvic organs for women will achieve the necessary muscle tone of the reproductive organs. Against this background, the overall balance will be restored and the condition of the whole organism will improve.

Today, many different complexes are known, but first you need to learn a few basic exercises. Therapeutic exercise for the pelvic organs should be developed by an experienced specialist. Initially, the doctor shows how to perform actions, and after mastering these skills, they can be implemented at home.

A woman needs to take a position lying on her back, while choosing a completely flat surface. Exercises for the uterus are best performed on the floor, after laying a special rug. The arms should be extended along the body, and then alternately raise the right and left legs up, exhaling when lowering the limbs.

Raising your legs will help strengthen your pelvic muscles. Source: topfit-trainer.ru

When the exercise is mastered, and the body is prepared, two legs should be raised at once. After a few days of regular exercise, you need to change the angle. If initially it was 90 degrees, then gradually it is brought to 45-50. This exercise for the pelvic organs of women will help strengthen the muscles.

Further, without changing the starting position, the girl should exhale, and at the same time raise two legs up. Having reached the peak point, the limbs are spread apart and inhale. After holding for a few seconds, an exhalation is performed, connecting the legs, after which, while inhaling, they are returned to the initial plane. Such exercises to strengthen the uterus are first done five times, gradually increasing to 8-10.

Lying on the floor, arms outstretched along the body, you need to perform a “bicycle”, which has been known to everyone since school days. This, one might say, is the best exercise for the uterus, since exercises help to quickly strengthen the muscle fibers of the organ. It is done quite simply by raising the lower limbs at an angle of 45 degrees, and starting to imitate the rotation of the pedals. Initially, it is enough to do it for 30 seconds, gradually increasing the time.

Starting position, lying on your back, arms extended along the body, knees bent. Next, you need to start lifting the pelvis up, where at the peak point it is worth tensing the muscles for a few seconds, and then gradually go down. A minimum of 8 repetitions is recommended.

Training of the muscles of the pelvic organs. Source: suplementfitnessmalang.blogspot.ru

Exercises for the pelvic organs can also be performed in the knee-elbow position. Having taken this position, you should lower your head down, while arching your back up. Then an inversely proportional action is done, that is, the head is raised and the back is arched. It is very important to perform pelvic muscle tension during all repetitions.

And at the end of the complex, you can perform an exercise in which you need a ball. To do this, a woman needs to lie on her back, bend her knees, and place the ball between them and press it tightly. Hands are located along the body. Next, the pelvis is lifted upward, while the stomach is drawn in. During the stance, you should squeeze the object well with your knees.

Some women are interested in how the exercise ball for the vagina helps. Experts answer that it strengthens the muscles of the inner thigh, which, in turn, help the cervix to stay in its anatomical place.

Yoga

Recently, with the development of problems in the reproductive system, the representatives of the weaker sex are wondering if yoga can help for the pelvic organs of women. This ancient teaching has found application in this branch of modern alternative medicine. Experts identify several asanas in which there are exercises to strengthen the muscles of the uterus.

You need to start with Baddha Konasana, which will help open the pelvis, strengthen the bladder and the main reproductive organ, and stabilize the blood circulation process in the pelvic organs. Experts recommend performing this asana during menstrual bleeding. To get started, you will need a special bolster.

Technique for performing Baddha Konasana. Source: yoga-world.ru

So, they take a pillow, move it tightly against the wall, and sit on it. Then the legs are bent, connecting them together with the feet and spreading the knees to the sides. The natural curvature of the spine must be maintained. Then they lean with their backs, the area of ​​​​the shoulder blades and the sacrum against the wall. The fingers are placed on the edge of the pillow, and, leaning on them, they stretch the spine.

Along with this, hip movements should be performed: the inner side goes up, the front back, the outer one down, the back forward. Due to this, the hip joints are deployed, the lower abdomen is released. In the process of execution, soft and calm breathing is observed. It is necessary to remain in this position for one to two minutes.

The exercises for the uterine muscles in yoga are designed in such a way that they can be performed one after the other. After the first asana, Upavista Konasana is done. To do this, you need to sit on a rug that lies on the floor, and spread your legs wide apart. Ideally, the feet and pelvis should be in line, the heels pointing to the floor, and the legs extended.

Hands are placed on the edge of the pelvis, the spine is pulled to the top, and hands are pushed off the floor. You need to sit straight, not shifting, while doing so so that it seems that the legs are pushed out of the pelvis to the sides, and the spine up. Next, you need to bend a little at the hip joints and grab your big toes with your hands. In this position, one or two minutes remain.

How to do Upavista Konasana correctly. Source: figuradoma.ru

Exercises against uterine prolapse in women should be continued with Upavishta Konasana. They take a pillow, sit on it and spread their legs wide apart. A brick or blaster is placed across the right side, hands on fingers are placed on both sides of it. Next, you need to push off with your fingers from the floor, and as you exhale, turn the body towards the right leg, while the left buttock should remain pressed to the floor.

Performing a sliding movement of the hands along the leg, it is necessary to stretch forward, exhaling. Then they clasp the foot with their palms, and lower their foreheads onto the brick. Remain in this position for one minute, then rise and return to the center, inhaling. Then they change the position of the bloster, and do the same, but to the other leg.

Yoga for the reproductive system of women is very useful. It is not necessary to do a lot of different exercises, but you need to know the 5 basic asanas. The fourth of the above complex is Supta Baddha Konasana. To perform it, you will also need a blaster or a blanket, which is folded into a rectangle and placed on the floor.

Next, you need to spread your toes to the sides and rest them against the wall. A blister or blanket is placed along the spine from the sacral region. From a sitting position, you need to slowly lower your back onto the roller, stretch your arms along the body and relax. Stay in this position for 5-8 minutes.

How to do Viparita Karani asanas.

Omission (prolapse) of the pelvic organs (bladder, rectum, uterus) ”is one of the most frequently diagnosed diagnoses in antenatal clinics and gynecological hospitals. In Russia, prolapse and prolapse of the internal genital organs are observed in 15-30% of women, and over the age of 50, the frequency of prolapse increases to 40%. Among women of elderly and senile age, the frequency of genital prolapse reaches 50-60%. In the structure of planned indications for surgical treatment, uterine prolapse and prolapse of the vaginal walls take third place after benign tumors (uterine fibroids) and endometriosis!

Patients suffering from prolapse of the pelvic organs most often complain of a noticeable anatomical defect, as well as aching pains / a feeling of heaviness in the lower abdomen, a feeling of a foreign body in the vagina, urination disorders (urinary incontinence, difficulty emptying the bladder) and defecation (constipation, gas incontinence), sexual dysfunction, vaginal discharge.

Classification of prolapse of the pelvic organs (according to K.F. Slavyansky):

I degree. Omission of the anterior and / or posterior walls of the vagina (the walls do not extend beyond the entrance to the vagina);

II degree. Prolapse of the anterior and / or posterior walls of the vagina (the walls are outside the entrance to the vagina);

III degree. Complete prolapse of the vagina, which is accompanied by prolapse of the uterus.

Among the factors contributing to the development of prolapse of the pelvic organs are traditionally distinguished:

traumatic birth,

Estrogen deficiency (decrease in general and local levels of female sex hormones),

Chronic diseases accompanied by an increase in intra-abdominal pressure (bronchitis, asthma, constipation, etc.),

Violation of the processes of microcirculation of blood and lymph in the pelvis,

Obesity,

Sedentary lifestyle.

In recent years, increasing importance has been attached to the systemic "connective tissue dysplasia" of patients suffering from prolapse.

Prolapse of the uterus after childbirth is diagnosed in a large number of young mothers. The reason may be the following:

1. Injuries received during childbirth. The muscles and ligaments of the pelvic floor during pregnancy are subjected to strong pressure and stress, the birth process several times exacerbates an already difficult condition. Weakening and ruptures occur regardless of the woman's physical fitness and are individual in nature.

2. Prolonged difficult labor during which forceps are used. Such an obstetric instrument can damage the muscles, due to which they will lose their elasticity in the future.

3. Lifting weights. If, after pregnancy, a woman does not follow the recommendations of a doctor,

the risk of prolapse increases several times. In addition, lifting heavy objects the first month after childbirth threatens to bleed.

4. Neglect of proper nutrition. A healthy lifestyle and a balanced diet help a young mother recover faster after childbirth. The diet should contain all possible vitamins and nutrients. In violation of normal nutrition, there is a risk of constipation, which contributes to the prolapse of the uterus and vagina.

5. Heredity. A factor that cannot be influenced in any way. If women in the family after childbirth suffered from uterine prolapse, then the risk of developing prolapse increases to eighty percent. Such women in labor are treated with great attention, they are assigned special gymnastics.

6. pregnancy. Due to the simultaneous development of two or more fetuses, the load on organs, including the uterus, increases several times. Polyhydramnios also threatens prolapse of the uterus and vagina.

7. Age. Most often, prolapse is diagnosed in women who gave birth to their first child at a late age according to obstetric standards. After all, the older the woman, the weaker her organs.

Normally, all organs of the small pelvis (uterus, vagina, bladder, urethra, rectum) are fixed to the bone walls of the small pelvis with the help of a strong ligamentous-fascial and muscular apparatus (see Fig.). It is conditionally possible to distinguish three levels of support for the pelvic organs. Each level is responsible for maintaining certain organs or their parts and has a characteristic shape. Level I supports the dome of the vagina and uterus. It looks like a funnel, the upper wide part of which is fixed to the bone structures, and the narrow lower one to the cervix. Level II looks like a hammock. It is responsible for the walls of the vagina, bladder, urethra and rectum. Level III is a muscular “plate” on which the pelvic organs “lie”. It also captures the orifices of the vagina, urethra, and rectum, which most time must be closed.

Organ ptosis leads to spasm of ligaments and blood vessels, disrupts normal blood flow, causing congestion, which can manifest itself, for example, in the form of hemorrhoids, varicose veins of the lower extremities. Suspicions of ptosis or "overshoot", as the omission of an organ was called in the old days, can also occur with infertility, uterine fibroids, irregular and painful periods, frequent urination, prostatitis, prostate adenoma, persistent bad breath, discomfort in the abdomen when lifting hands up or tilting the head back, bloating and chronic constipation.

There are also purely individual signs. People of the Mucus type (phlegmatic) often have swelling on the face, "bags" under the eyes, swelling of the ankles, lacrimation, periodic runny nose, heaviness in the epigastrium after eating, constipation.

People of the Bile type (choleric) are characterized by increased irritability, stiffness in the cervical and thoracic spine, heartburn, high blood pressure, and unstable stools.

People-Winds (sanguine) suffer from hemorrhoids and varicose veins of the lower extremities, "gastritis" pains of nervous origin, chronic constipation, belching, weak stress resistance.

A common cause of ptosis is congenital weakness of the supporting muscles and ligaments (more often in people of the Wind type - lean, thin-boned, asthenic type). It is harmful for them to carry weights, overeat, get carried away with diets and laxatives, choose “standing” or “sitting” professions. For many people, especially women, work associated with physical exertion and frequent raising of hands is unsafe - sports, construction, repairs, carrying children and grocery bags in their arms, moving, country work, etc.

Causes of ptosis also include osteochondrosis, kyphosis (excessively bringing the diaphragm closer to the pubic area), multiple or very rapid labor, certain hormonal disorders, obesity, or significant and dramatic weight loss.

With age, the tone of muscle fibers and ligaments decreases, and the internal organs acquire a tendency to voluntarily slide down. Downward movement, even within a few centimeters, is sufficient to impair the function of the organs of the gastrointestinal tract, as well as the organs of the small pelvis.

With moderate fat deposits, the liver, spleen, stomach and their neighbors in the abdominal cavity receive good passive support and reliable support. If an excess of adipose tissue has formed in the body, the internal organs are compressed, their function is impaired. But the worst thing is when not a single fat cell remains under the skin: the entire weight of the internal organs is a heavy burden on the active part of the abdominal press - the muscles and ligamentous apparatus. With a sharp decrease in weight, muscle tone weakens, local muscles are unable to compensate for intra-abdominal pressure, and then the lower abdomen protrudes, and the abdominal organs descend.

Intermittent aching and pulling pain in the abdomen may indicate a prolapse of the stomach and intestines. Unpleasant sensations usually occur in vertical position and subside when you lie down. When the kidneys are lowered, pain in the lumbar region worries. If it was joined by a pulling pain in the lower abdomen and sacrum, episodes of urinary incontinence appeared when coughing, sneezing, laughing, physical effort, prolapse of the uterus and vagina, which sometimes ends with their prolapse, is not excluded.

SPECIAL EXERCISES HELP

A large number of people have successfully avoided pelvic floor surgery by undergoing several sessions of abdominal muscle therapy. In general, the task is to increase the tone of the muscles of the pelvic floor, abdominal wall, lumbar region, and improve the functional state of the digestive organs against the background of a general strengthening of the body and its psycho-emotional state. To strengthen the muscles of the pelvic floor, abdominals, lumbar region and diaphragm, increase the motor function of the gastrointestinal tract, tone the ligamentous apparatus of internal organs, and activate redox processes in the body, special exercises are performed.

1. Lying on your back, perform static breathing exercises (diaphragmatic, full breathing). Perform movements rhythmically, at an average pace, the amplitude is full, breathing is rhythmic. One-two - they inflated the stomach, one-two-three-four - the stomach was pulled in. Inhalation is twice as long as exhalation. On the exhale, press the lower back to the floor, pull the socks towards you.

2. Exercises for the lower extremities - free and with tension. - Lying on the right side. Diaphragmatic breathing, limb movements. The same on the left side.

3. Knee-carpal, knee-elbow position. Exercises for the muscles of the limbs and torso.

4. Lying on your stomach. Exercises to strengthen the back muscles (movements of the lower limbs and lower body). The duration of all exercises is 15 - 20 minutes.

5. Inverted poses - Sarvangasana with a chair, variants of viparita-karani with a bolster and a brick. You can stay in these poses for 5 to 15 minutes or more according to your well-being. Exercises should be simple, when they are performed, the abdominal organs should move towards the diaphragm. In the course of treatment, it is advisable to use no more than three individualized sets of exercises, changing them no earlier than after 1-2 months of training. The duration of classes during the 1st week is 15-20 minutes once a day; 2-3rd week - 20-30 minutes twice a day; within 4-8 weeks and beyond - 30-40 minutes twice a day. When the position of the lowered organ approaches normal, classes are held once a day. Pick up things from the floor, after crouching; getting out of bed, you must first turn on your side, then simultaneously lower your legs and raise your torso. For one year, I do not recommend jumping, jumping, running. To activate the motor function of the gastrointestinal tract, massage of the lumbosacral region, colon massage, self-massage of the abdomen are shown.

SOME MORE USEFUL EXERCISES

Sitting on the mat, keep your back straight, bend your arms at the elbows, as when running. In this case, it is necessary to exhale and draw in the stomach and small pelvis (muscles of the pelvic floor). Exhale - "ha-ah-ah-ah-ah-ah." And, moving only with straight legs, move on the buttocks. First forward, then back.

The next exercise is related to the anti-gravity action. Lie on your back, put your hands behind your head, bend your legs at the knees and lean on your feet (legs slightly apart). On the count of “one”, lift the pelvis up, draw in the stomach “ha-ah-ah-ah”, and touch your knees. So: inhale - spread your knees, exhale - bring your knees together. Perform such inhalation-exhalation at least three times. Rest and repeat again.

Uddiyana bandha - abdominal muscle lock. Imagine that you are standing (or sitting in a chair) leaning forward with your hands on your knees. Take a deep breath, then exhale with your head tilted, after exhaling, hold your breath. Try to make several breathing movements with a full chest, but without air, while holding your breath, while relaxing the abdominal muscles. There should be an active retraction of the abdominal organs into the chest, the stomach seems to stick to the spine. For one breath hold (after exhalation), you need to make several such supposedly respiratory movements. Each time the abdominal organs will rise and fall (5-10 times). It should be done on an empty stomach, best in the morning on an empty stomach or 3-4 hours after a meal. In total, such “retractions” need to be done 30-40 times for several breath holdings, but reach this amount gradually, waiting for all the pain in the abdomen to pass.

TIGHTEN THE PELVIC ORGANS

This is done with a strong contraction of the pelvic muscles. Mula bandha is a root muscle lock, it is very important to perform it in this pathology. You can practice lying on your back, legs bent at the knees. We take a breath - the stomach is inflated and as we exhale, we mentally tie both ischial bones together and pull them up to the head, inhale - relax. The next breath - the stomach was inflated and on the exhale, as it were, we tie the coccyx and pubis together in one line. Let go of everything and relax as you inhale. Again, inhale and exhale, we connect the two previous movements in the pelvis, that is, we connect both ischial bones and at the same time pull the sacrum to the pubis, it turns out like a bow with a knot in the middle of the perineum, and we keep this knot retracted. This is mula bandha. It can be held only on exhalation, or you can hold it and slowly breathe voluntarily. You can also do mula bandha while inhaling.

The task is to normalize the balance of the muscular corset that holds the internal organ, and normalize the location of the organ, as well as correct posture, get rid of pelvic pain, excess weight, back pain, feel healthier, stronger, younger.

Another complex with the omission of the pelvic organs

1. Starting position (I.p.) lying on the back, under the lumbar spine, a roller 20-30 cm high, a small pillow under the head, one hand on the chest, the other on the stomach. Diaphragmatic breathing. The exhalation is somewhat lengthened with the retraction of the abdomen. Repeat 4 times.

2. I.p. - the same, hand along the body. Alternately lifting straight legs. Breathing is arbitrary. Repeat 4 times with each leg.

3. I.p. - the same, arms along the body, legs bent at the knees. Raise the pelvis, leaning on the feet, elbows, back of the head, forming a "semi-bridge". The pace is slow. Follow your breath. Repeat 4 times.

4. I.p. the same, arms along the body. Inhale. Bend the right leg at the knee and pull it to the stomach with your hands as you exhale. The same with the left foot. Do it rhythmically at an average pace. Repeat 4 times.

5. I.p. - lying on the right side, the right hand under the head, the left along the body. Raise your left arm and left leg at the same time. The same on the left side. The pace is average. Repeat 3-4 times with each leg.

6. I.p. - emphasis, kneeling. Without moving your arms and legs together, sit on your heels, lower your chest, moving forward, return to the starting position. Repeat 4 times.

7. I.p. Same. Inhale. Raise the left leg and right arm up, bending at the waist, exhale. The same with the other hand and foot. Breathing is arbitrary. Repeat 4 times.

8. I.p. - lying on your back, arms along the body. As you exhale, raise both legs. Breathing is arbitrary. Repeat 4 times.

9. I.p. - too. Imitation of the movements of a cyclist, Make movements on the exhale. Repeat 4 times.

10. I.p. - too. Raising and lowering hands. The pace is average. Repeat 4 times.

11. I.p. - too. As you exhale, raise your bent legs towards you and to the right. Same with turning left. The pace is average. Repeat 4 times on each side.

12. I.p. - too. As you exhale, pull both legs to your stomach with your hands. The pace is slow. Repeat 6-8 times.

13. I.p. - lying with support on the elbows. Spread your legs apart, connect. Don't hold your breath. Repeat 8-10 times.

14. I.p. Same. Imitation of walking. Don't hold your breath. Take 10 steps.

15. I.p. Same. Two-foot rotation left and right. Don't hold your breath. Make 4 circles in each direction.

16. I.p. - standing. Walking in place with high hips. Don't hold your breath. Walk from 30 seconds to 1 minute.

17. I.p. - standing. Raise your arms while moving your legs back. Raising your hands - inhale, lowering - exhale. Repeat 4 times with each leg

18. I.p. - standing. Swing your arms to the sides with the legs abducted to the sides to a horizontal position. Raising your hands - inhale, lowering - exhale. Repeat 4 times with each leg.

19. I.p. - standing, holding on to the back of a chair. Take your arms up, leg back, then, raising your arm and swinging your leg, touch your fingers with it. Raising your hands - inhale, lowering - exhale. Repeat 4 times with each leg.

20. I.p. - sitting on a chair with hands resting on a chair. Inhale. On the exhale, lifting the body, bend in an arc. The pace is average. Repeat 4 times.

21. I.p. Same. Inhale. As you exhale, move your leg over the back of the chair in front of you. The pace is average. Repeat 4 times with each leg.

22. I.p. - too. Inhale. As you exhale, raise your bent legs to your stomach. The pace is average. Repeat 4-8 times.

23. I.p. - emphasis, kneeling. Bend your arms, touch the floor with your chest, at the same time lift your leg up, straightening it. The same with the other leg. Don't hold your breath. Repeat 4-8 times.

24. I.p. - lying on your back, one hand on the chest, the other on the stomach. Diaphragmatic breathing. The exhalation is somewhat lengthened with the retraction of the abdomen. Repeat 4 times.

The following Kegel exercises are popular: Lift, Bag, Blink, All Muscles, SOS and others.

"Lift" - mentally divide your vagina into "floors" and, starting from the bottom, strain your muscles from floor to floor until you reach the peak - maximum tension. It must be held for 7-10 seconds, and then begin the "descent" in the opposite direction, gradually relaxing the muscles.

A very effective exercise for prolapse of the uterus is "Blinking". Take a supine position and slightly bend your knees. Concentrating on your feelings, you need to squeeze the muscles of the vagina for 5 seconds and relax for 4. You set the pace of the exercise yourself. Such “blinks” can be adjusted to your own pulse by performing compressions and relaxations to the beating of the heart.

Exercise "All Muscles" provides for a strong and confident compression of all intimate muscles, from the anal sphincter to the upper muscles of the vaginal canal. This contraction must be held for up to 60 seconds, and then relaxed for the same time. The first few times you won’t be able to hold the muscles that long, so you can start with 30 seconds, gradually increasing the time.

Exercises for prolapse of the internal genital organs and urinary incontinence

• I. p. - standing, hands on the belt: hands back to the "castle", slowly raise them above the head with palms outward, at the same time tilting the head and torso back, retracting the anus - inhale, and. p. - exhale. Alternately moving the arms to the side with the simultaneous maximum possible rotation of the body - inhale, and. p. - exhale. Walking 1.5-2 min. holding a stuffed ball or gymnastic stick between the knees.
• I. p. - lying on your back at the gymnastic wall, the feet rest on the rail as high as possible: breeding and adduction of the legs (6-8 times), rotational movements in the hip joints (8-10 times), lifting the pelvis with support on the feet and shoulder blades (3-4 times).
• I. p. - lying on your back, legs apart: alternately raising the legs to a right angle, circular movements in the hip joint (up to 1 minute); "Bicycle" 1 - 1.5 min.; "Scissors" (legs apart - legs crossed).
• I. p: - lying on the stomach: crawling in a plastunsky way - 1-2 minutes.
• I. p. - lying on your back in pairs, feet to each other: the legs of one patient are on the legs of the other, the second tries to raise her legs, overcoming the resistance of the legs of the first. Then the roles are reversed; the legs of one patient between the legs of the other, the first tries to spread her legs, overcoming the resistance of the second. Then the roles change.
• I. p. - standing, arms to the sides: turn to the right, get the right hand with your left hand; turn to the left, get the left hand with the right hand.

Techniques that exacerbate venous congestion and limit normal venous return mechanisms should be avoided. These include standing asanas with long-term fixations, because. they turn off the muscular pump of the lower extremities. By itself, the practice of standing asanas will be very useful, but without long-term fixations. It is possible to perform Surya Namaskar using any standing asanas in dynamic mode with short fixations. This approach will activate the muscular pump of the lower extremities and will not block it.

It should be excluded from the practice of fixation in asanas that significantly increase pressure in the abdominal cavity - primarily ardha navasana and the like.

To unload the veins of the small pelvis, it is recommended to perform inverted asanas. In addition, twisting variations of inverted asanas, such as Parshva Sarvangasana and the like, have a beneficial effect on the venous system of the small pelvis.

It is important to use breathing techniques in a specific regimen aimed at improving venous return. To enhance the suction action of inhalation, one should put into practice

8.1. THERAPEUTIC PHYSICAL CULTURE IN OBSTETRICS

8.1.1. Therapeutic exercise during pregnancy

The positive effect of physical exercise on the course of pregnancy, childbirth and the postpartum period is a generally recognized fact. Through the use of physical exercises, it is possible to counteract a number of undesirable complications of pregnancy (varicose veins, flat feet, weakness of the abdominal muscles and pelvic floor, pain syndromes of various localization, etc.).

General tasks of physiotherapy exercises during pregnancy are the following:

Strengthening the abdominal muscles, back, pelvic floor, lower extremities;

Increasing the elasticity of the muscles of the perineum, maintaining the mobility of the hip and other joints of the body;

Teaching a pregnant woman proper breathing and voluntary muscle relaxation;

Improving the work of the cardiovascular system, lungs, intestines;

Activation of blood circulation and elimination of congestion in the pelvis and lower extremities;

Ensuring sufficient oxygen saturation of the arterial blood of the mother and fetus;

Psychomotor preparation for childbirth.

These general tasks are supplemented and modified by narrower tasks related to the peculiarities of the course of pregnancy in certain periods of pregnancy.

Means of exercise therapy.When exercising with pregnant women, almost all means of exercise therapy can be used: physical exercises (gymnastic, sports and applied exercises, games), autogenic training and massage; hardening elements using natural factors (light, air, water); regulation of the day.

Forms of exercise therapy.UGG, LH procedure, aerobics (including dosed walking), physical exercises in water, fitball, self-study for pregnant women.

Selection of pregnant women for classes. All pregnant women are involved in the classes, starting from the first days of visiting the antenatal clinic and registering them until the moment of delivery, but after a mandatory consultation with a doctor to identify possible contraindications and individualize the exercise therapy program. Pregnant women with diseases of the cardiovascular system in the stage of compensation are also involved in the classes.

In the normal course of pregnancy, preference is given to group classes, as more emotional. A group of no more than 6-8 people, approximately the same period of pregnancy and a similar level of physical fitness. Musical accompaniment is desirable, not loud and not setting a certain pace. Since at least 10-15 sessions are needed to obtain a sufficiently high effect from LH, it is advisable to start LH no later than 32-34 weeks. In the presence of certain complicating factors that are not a contraindication for exercise therapy (chronic somatic diseases, initial forms of toxicosis, metabolic diseases, pain in the back and lower extremities due to postural disorders, etc.), individual classes are held.

When performing, a variety of starting positions are used - standing, sitting, standing on all fours, lying on your back or on your side.

Contraindications to the appointment of exercise therapy:

Conditions requiring emergency surgical or obstetric care.

Conditions, the clinic of which is mainly determined by inflammatory processes: acute infectious and inflammatory diseases in any organs and tissues; prolonged subfebrile temperature of unknown etiology; rheumatism in the active phase; acute and subacute thrombophlebitis; acute kidney disease and

bladder (nephritis, nephrosis, cystitis); residual effects after suffering inflammation in the pelvis.

Conditions associated with current or previous pregnancies: severe toxicosis of pregnancy (uncontrollable vomiting, nephropathy, pre-eclamptic state and eclampsia); bleeding from the genitals of various origins (placenta previa, premature detachment of a normally located placenta, etc.); threatening abortion; damage to the amniotic membrane; ectopic pregnancy; habitual abortions; pronounced polyhydramnios; a history of stillbirths in mothers with an Rh-negative factor; divergence of the pubic joint; cramping pains in the abdomen.

Conditions associated with somatic burden of a pregnant woman: acute and progressive chronic cardiovascular insufficiency; decompensated diseases of the cardiovascular system, especially in the stage of progression of the process; abdominal aortic aneurysm; actively ongoing diseases of the liver and kidneys; pronounced omission of internal organs with the presence of pain during physical effort; blood diseases; epilepsy; threat of retinal detachment.

Physiotherapy exercises are not contraindicated, but strict individualization of classes is required under the following conditions: past operations in the abdomen and pelvis, including obstetric and gynecological (caesarean section, removal of benign neoplasms, etc.); delayed pregnancy; multiple pregnancy and fetal growth retardation; history of eclampsia; pain syndromes of the musculoskeletal system accompanying pregnancy; syndrome of blocking blood circulation in the wrist; dysfunction of the pubic fusion; toxicosis of pregnancy of mild severity; neurosis of pregnant women; compensated heart defects; initial stages of hypertension, bronchial asthma; mild forms of chronic nonspecific lung diseases; compensated forms of pulmonary tuberculosis in the absence of functional disorders; obesity; diabetes; constipation (atonic or spastic); reflux esophagitis (heartburn); urinary incontinence; expansion of the veins of the lower extremities or hemorrhoidal plexus.

Physiotherapy

When compiling a complex of therapeutic gymnastics procedures, one should take into account both the period of pregnancy in which the woman is, and her functional capabilities, the nature of concomitant disorders. As a rule, the LH complex during pregnancy includes general strengthening dynamic exercises for the arms, trunk, legs, which improve metabolism, as well as breathing exercises and special ones to strengthen the abdominal muscles, long back muscles and the musculoskeletal apparatus of the lower extremities, increase the elasticity of the muscles of the perineum. Special relaxation exercises are also required.

First trimester (from 1 to 16 weeks). The greatest changes in this period occur in the uterus. The connection of the uterus with the fetal egg in this period is very fragile, its increased excitability is noted, and it is especially sensitive to any physical stress. Therefore, pregnancy can easily be interrupted due to overwork during heavy physical work, body shaking during falls and jumps, exercises that sharply increase intra-abdominal pressure (including during bowel movements). This requires caution and individualization when practicing LH. Intense physical exercise is especially not recommended on days that should have accounted for the first three menstrual cycles.

In the first trimester, with the help of LH, the following tasks are solved:

Activation of the cardiovascular and respiratory systems to improve the overall metabolism and their adaptive capabilities;

Improvement of the psycho-emotional state of the pregnant woman;

Improving blood circulation in the pelvis and lower extremities to prevent venous congestion;

Strengthening the muscles of the back, abdominals and lower extremities for the prevention of pain syndromes of the musculoskeletal system;

Teaching skills of volitional tension and relaxation of muscles and proper breathing;

Preservation and development of mobility of the spine and other joints.

Features of the body of a pregnant woman, characteristic of the first trimester, require the development of individual sets of exercises. It includes dynamic exercises for training the muscles of the arms, legs, muscle corset, relaxation exercises.

Exercises should be simple and cover large muscle groups. Movements are performed in full. Classes in therapeutic exercises during this period also provide for training in the skills of abdominal and chest breathing.

When performing exercises, all the basic starting positions are used. LH procedures are carried out at a moderate, calm pace, avoiding excessive excitation of the nervous system. Breathing should be calm and rhythmic.

The coordinating ease of the exercises performed, their low intensity, gradually adapting the cardiovascular and respiratory systems to physical activity, make it possible to recommend them to all pregnant women, regardless of their general condition.

Second trimester (from 17 to 32 weeks). The increased activity of the placenta in the body of a pregnant woman provides hormonal balance, which is manifested by a decrease in autonomic disorders, an increase in mental stability. Increased tolerance to physical activity. Due to good fixation of the fetus (a placenta has formed) and a decrease in the increased contractility of the uterine muscle, the likelihood of miscarriage is reduced.

In this period of pregnancy, there are significant changes in the musculoskeletal system, creating favorable conditions for childbirth. Ligaments of the pubic and sacroiliac joints, intervertebral cartilages of the lumbar spine are softened. However, due to loosening of the ligaments of the pelvis, their ability to maintain a normal body posture is reduced. This role of the ligaments is taken over by the muscles, which leads to their constant tension and rapid fatigue.

There are changes in the statics of the pregnant woman's body. Body weight increases, and the center of gravity moves forward, which is compensated by the backward deviation of the upper body. This increases the lumbar lordosis of the spine and the angle of the pelvis. At the same time, the muscles of the back and abdomen, being in an ever-increasing static tension, carry a large load. A pregnant woman who does not perform appropriate exercises and does not correct her posture may experience pain in the sacrum and back. Incorrectly selected shoes further worsen posture and increase pain.

The bottom of the uterus at the end of the 2nd trimester is located between the navel and the xiphoid process of the sternum. Compression of the pelvic vessels makes it difficult for the outflow of blood and lymph from the lower half of the body, which is accompanied by

congestion in the legs. There are pastosity of the lower extremities, their edema, vein expansion begins. This limits the use of the initial standing position during the LH. The limited mobility of the diaphragm makes it difficult to breathe. However, some of its increase compensates for the oxygen deficiency.

The volume of the abdominal cavity increases, the lower part of the chest expands. The center of gravity moves forward significantly. As a result, the tension of the muscles of the back and lower extremities increases even more, there is pain in the lower back, spasm of the muscles of the legs. The latter is also promoted by a low content of calcium in the blood of pregnant women. The loosening effect of hormones on the ligamentous apparatus, an increase in body weight lead to the development of flat feet, which intensifies the pain syndromes of the musculoskeletal system. Motor functions, including walking, are difficult. Hence the increased fatigue.

In the 2nd trimester, the following tasks are solved:

Improving the adaptation of the cardiovascular and respiratory systems to physical activity;

Improving blood circulation in the pelvis and lower extremities;

Activation of the muscles of the pelvic floor, thighs, buttocks and lower leg;

Strengthening the muscles of the back and abdominals, which carry an increased load due to a shift in the center of gravity, as well as the muscles of the foot due to its possible flattening;

Increased elasticity of the pelvic floor muscles and adductor muscles of the thigh;

Improving the ability to volitional tension and relaxation of the abdominal muscles in combination with chest breathing;

Preservation and development of mobility of the spine and pelvic joints, hip joints.

Procedures are carried out at the usual moderate pace. Assign simple general developmental exercises for all muscle groups. Relaxation and stretching exercises are prescribed in larger quantities than in the first period. Movements for the lower extremities are performed with the greatest possible amplitude in the form of static stretch marks, which increase the mobility of the hip joints and sacroiliac joints of the pelvis and improve the outflow of blood from the lower extremities. Assign relaxation exercises, breathing exercises.

During the period of maximum load on the heart (28-32 weeks), reduce the overall physical load by reducing the repetition

exercises and the introduction of more breathing exercises that improve volitional muscle relaxation. The duration of exercise therapy classes is somewhat reduced to 30 minutes, mainly due to the main part of the LH procedure.

In the final section of the LH classes, with a gradual decrease in the load, walking, dynamic breathing exercises, and relaxation exercises are used.

Third trimester (from 33 to 40 weeks). In this period, there is a significant increase in the size of the uterus, the bottom of which by the end of 35-36 weeks reaches the xiphoid process. Because of this, the mobility of the diaphragm is even more significantly limited, and the heart takes a horizontal position. The displacement of the stomach and intestines contributes to the appearance of reflux esophagitis, heartburn, constipation. The compression of large vessels is accompanied by congestion in the pelvis and further expansion of the venous vessels of the lower extremities, rectum and external genital organs of a woman.

The center of gravity shifts forward even more, increasing the tilt of the pelvis, accompanied by an increase in lordosis and an increase in pain in the muscles of the back and calf muscles. There are restrictions in the movement of the hip joint. This leads to typical changes in gait in pregnant women. It becomes unstable, the stride length is shortened. The hormonal background again causes an increase in the tone and contractility of the muscles of the uterus, accompanied by separate contractions, which requires attention from the instructor during classes.

After the 36th week, the bottom of the uterus begins to descend to the level of the costal arches, which somewhat facilitates breathing and heart function. However, the outflow of blood from the abdominal cavity and lower extremities is difficult, which supports stagnation there. The pressure on the intestines and bladder explains the frequent constipation and dysuric phenomena during this period. Due to hormonal influences, the pubic and sacroiliac joints are weakened, the pelvic bone ring loses its stability, making the pregnant woman's gait even more unstable. The consequence of this is also the appearance of pain syndromes of this localization. Minor physical activity leads to rapid fatigue.

In the third trimester, the following tasks are solved:

Increased elasticity, extensibility of the muscles of the perineum;

Maintaining the tone of the muscles of the back and abdomen;

Increased mobility of the sacroiliac joints, hip joint, spine;

Activation of the activity of the intestine;

Reducing congestion in the lower half of the body;

Increased coordination of relaxation-tension of the muscles involved in attempts, in combination with breathing; activation of the circulatory system.

The above changes in the body, characteristic of this period, require changes in the nature of the exercises. Since this is the most difficult period of pregnancy, the volume and intensity of physical activity is reduced. Procedures are carried out

Rice. 8.1.Sample exercises used in the third trimester

at a slow pace from a position lying on your side or sitting. Light and simple general developmental exercises are used to maintain the skill of correct breathing and, as far as possible, the tone of the abdominal and back muscles. The number of exercises for stretching the muscles of the perineum and the adductor muscles of the legs increases. Continue exercises that increase the range of motion of the spine and hip joints. It is recommended to train relaxation, as well as adjust walking. Walking is recommended.

In the future, against the background of reduced overall physical activity, more attention is paid to the development and consolidation of skills that are important for the normal course of the birth act: arbitrary tension and relaxation of the muscles of the pelvic floor and abdomen, continuous breathing training with simultaneous tension of the trunk muscles and their subsequent complete relaxation. Breathing exercises are changes in the rhythm of breathing, consisting in a gradual increase in the frequency of breathing for 10-20 seconds, followed by a breath hold, which will be used during attempts. Diaphragmatic breathing should be used.

Exercises that imitate postures and actions during attempts are also used, for example, muscle relaxation after the last exhalation (during rapid breathing exercise) or, in cases where uterine contractions are felt, combine them with breathing.

Procedures should be carried out carefully due to the increased excitability of the uterus. Avoid exercises that increase intra-abdominal pressure.

When solving some more local or narrowly focused problems, you can use some of the exercises below.

For back and pelvic pain.

1. I.P. sitting on the edge of a chair. Bend your back at the waist. Then bend it in an arc, pressing it against the back of the chair. After several repetitions, stay in a neutral position for 10-20 seconds.

2. I.P. sitting on the floor, buttocks between the feet, knees apart as wide as possible. Tilt the body forward to the floor. The back is kept straight. Hands lie freely on the floor. Raise the buttocks as high as possible, holding them in this position for several seconds. Repeat 5-6 times. Then slowly return to I.P.

Rice. 8.2.Starting positions of exercises for back pain

3. I.P. On knees. The arms are at right angles to the floor, and the body and head are parallel to the floor. While inhaling, slowly bend your back down, at the same time raise your head and buttocks up. As you exhale, arch your spine (like an angry cat) and lower your head. Repeat the movement several times. This posture increases the flexibility of the spine, strengthens it, and also reduces the pressure of the fetus on the nerves and blood vessels of the pelvis.

4. I.P. lying on your back. Put your legs bent at right angles at the hip and knee joints on a stool or couch. Stay in this position for several minutes.

The pace of movement in these exercises is slow. The number of repetitions is 3-5 times (with good preparedness, 10 times or more until slight fatigue). In the final phases of movements, it is desirable to fix the posture for 5-10 seconds.

Pain in the calf muscles.

Passive stretching of the calf muscles is used. I.P. - standing, facing the wall or Swedish wall at a distance of a step. Rest your hands on it at shoulder level. Bend your arms and lean forward, as if pressing your chest against the wall. Heels do not come off the floor. Feel the tension in the muscles, without bringing it to a feeling of pain. Stay in this position for 10-20 seconds. Return to I.P. Repeat 3 times.

Varicose veins of the lower extremities, edema.

An exercise is used - legs up with support on the wall. I.P. lying on your side, buttocks pressed against the wall. Roll onto your back, lifting your legs up and pressing them against the wall. Straight arms, palms up, spread apart. After several minutes of this position, spread your legs as wide as possible, until you feel a slight tension in the adductor muscles. Maintain this posture for a few minutes as well. bend

knees, roll onto your side and rest. Repeat 2-3 times. This exercise is also effective for strengthening the muscles of the perineum, which is important in preparation for childbirth.

The procedure of physiotherapy exercises during pregnancy should be stopped in the event of the appearance during classes:

unusual symptoms or phenomena;

Vaginal bleeding, painful uterine contractions;

Feelings of nausea, fainting, shortness of breath, irregular or rapid heartbeat;

Pain in the back and pelvis;

Physically unreasonable, abrupt, frequent fetal movements.

8.1.2. Therapeutic exercise in the postpartum period

The normal course of the postpartum period is very important, since the possibility of the appearance of many diseases in women depends on it. Therapeutic gymnastics allows the body to quickly get out of the postpartum period and cope with the presence of disorders. The role of physical exercises in the prevention of functional inferiority of the muscles and organs of the pelvic floor, abdomen, and posture disorders is especially important. In addition, regular LH classes help to improve lactation.

Physiotherapy exercises in the postpartum period should solve the following tasks:

Improving blood circulation in the small pelvis, abdominal and thoracic cavity and lower extremities, thereby eliminating congestion and the formation of blood clots in these areas;

To promote active contractions of the uterus, ensuring its correct involution;

Contribute to the regulation of bowel and bladder functions;

Improving the function of the cardiovascular, respiratory and digestive systems;

Strengthening the muscles and ligaments of the abdominal wall and pelvic floor, helping to maintain the correct anatomical position of the internal organs, including the genitals;

Strengthening the muscles of the musculoskeletal system, ensuring the restoration of the normal posture of a woman and the prevention of flat feet;

Improving the emotional state, sleep and appetite;

Activation of metabolism and thereby an increase in the general tone of the puerperal, an increase in lactation capacity;

Restoration of the working capacity of the puerperal in the shortest possible time.

Contraindications to the appointment of exercise therapy after childbirth may be the following conditions:

Body temperature over 37.5?;

Complications of the postpartum period (endometritis, thrombophlebitis, mastitis);

Severe anemia due to large blood loss during childbirth;

Bleeding after childbirth;

Difficult, prolonged, exhausting labor;

Preeclampsia or eclampsia in childbirth;

Severe forms of transferred gestosis;

Progressive insufficiency of blood circulation, kidneys, liver;

Severe subcutaneous emphysema;

Tears of the perineum III degree;

postpartum psychosis.

Means of exercise therapy- exercise and massage.

Forms of exercise therapy.The therapy uses: UGG, LH, self-study of puerperas.

Selection of mothers. Before starting therapeutic exercises, a careful examination of the lower extremities is necessary. The presence of varicose veins, pain, fever require a doctor's consultation for thrombophlebitis. If inflammatory diseases are detected, exercises are prescribed after the condition normalizes (temperature decreases to normal and there is no pain).

With stitches on the perineum after perineotomy or its ruptures, exercises with leg abduction are excluded for 5-6 days. Perineal ruptures of the III degree require therapeutic exercises according to the methods developed for postoperative patients.

In the normal course of the postpartum period, classes are conducted by the group method. The presence of certain complications of the postpartum period involves the use of individual lessons.

Physiotherapy

Physiotherapy exercises should be started as early as possible, since it is in the first days after childbirth, when the restructuring of the body is most active, that physical exercises accelerate and optimize them. With a relatively mild course of childbirth, LT classes can be started from the first day. In severe cases, when the body of the puerperal requires a longer rest, from the 2nd day after childbirth.

Remedial gymnastics classes begin with general developmental exercises in combination with breathing exercises. Basically, elementary exercises for the upper and lower extremities, pelvic muscles are used. Later, exercises are prescribed to strengthen the muscles of the abdomen and pelvic floor. The load is increased gradually. Exercises are performed at a calm, slow, and then at an average pace. The duration of classes in the first days is 15-20 minutes, in the next days up to 30-35 minutes.

In the first two days, therapeutic exercises are carried out in bed, in the next 2 days - in a sitting position.

On the 1st dayafter childbirth, all physical exercises are performed from the starting position lying on your back:

1. Wiggling fingers and toes.

2. Sipping. Raise your arms above your head and pull your toes - inhale. I.p. - exhale.

3. Bending the fingers into a fist.

4. Pronation and supination of the hands and at the same time rotation of the feet outwards and inwards.

5. Bending of the legs at the knee and hip joints with support on the feet.

6. Lifting the pelvis with support on the feet and shoulder blades.

7. Deep differentiated breathing (thoracic, abdominal, mixed) with self-control.

The whole procedure of postpartum LH consists of 8-10 exercises, performed 3-6 times, and lasts an average of 20 minutes.

On the 2-3rd dayafter childbirth, the exercise therapy complex includes exercises that enhance peripheral circulation, diaphragmatic breathing, reduce congestion in the abdominal cavity and pelvic cavity, muscle relaxation exercises, exercises for the abdominal muscles. Activation of blood circulation in the pelvic organs helps to reduce the sphincters of the rectum and urethra.

On the 4th-5th dayafter childbirth, the load gradually increases, mainly due to the introduction of new exercises for the abdominal and pelvic floor muscles and an increase in the number of repetitions of previous exercises. Starting positions are added lying on the stomach, on all fours.

In the following days when the uterus decreases in size, most physical exercises are performed from the initial standing position: turns and tilts of the torso to the sides, circular movements of the pelvis, half-squats, movements of the straight leg forward, to the side and back, standing on toes, etc. Postpartum gymnastics procedures are usually carried out through half an hour after feeding the baby.

Restoration of a sufficiently full-fledged working capacity of the muscles of the back and abdomen requires daily systematic training for 2-3 months.

8.1.3. Massage during pregnancy

Massage tasks:

Activation of blood and lymph circulation, eliminating congestion in the pelvis and lower extremities;

Reducing pain, especially in the muscles of the back and lower extremities; strengthening the muscles of the body, increasing the elasticity of the muscular-ligamentous apparatus and maintaining joint mobility;

Improvement of the general metabolism;

Improvement of psycho-emotional status; acceleration of recovery after childbirth.

Indications for massage: pain syndromes in the back, neck, lumbosacral region, sacroiliac joints, lower extremities, calf muscle cramps; mental stress, general fatigue, dizziness, insomnia, headache; signs of toxicosis of mild severity (nausea, increased salivation, swelling of the lower extremities, a slight increase in blood pressure); prevention of the appearance of stretch marks (stretch marks) in the area of ​​the mammary glands, abdomen and thighs; delayed labor activity; psycho-emotional and physical stress during childbirth; dysfunction of lactation.

Contraindications: common to massage and the same as for physiotherapy exercises. However, in some cases, even if they are available, acupressure methods can be used.

Disorders of the venous network (varicose veins, phlebitis and thrombophlebitis), acute back pain radiating to the arms or legs require special attention.

Massage position. The position of the pregnant woman during massage should be given great attention. The most important condition for this is relaxation.

Massage can be performed both lying down (usually on the side) and in a sitting position. In the supine position, large vessels and nerve trunks are compressed in the abdominal and pelvic cavity, which is difficult for some pregnant women to tolerate.

At the beginning of pregnancy, with an uncomplicated history, massage can be performed with the woman lying on her stomach. If there is soreness in the mammary glands, it is advisable to place small pillows in the subclavian region.

At later stages of pregnancy, massage is carried out in the supine position on the side. In this case, the leg, which is located below, is almost completely straightened, and the upper one is bent at the knee and hip joints. To stabilize the body and its uniform (calm) position, a pillow is placed under the bent knee. Sometimes you need another pillow under the stomach for more relaxation. In this position, you can work on the neck, back, lower back and buttocks, as well as on the upper and lower extremities.

Massage technique.

In the first trimester, massage is aimed more at general strengthening of the body of a pregnant woman. In the second trimester of pregnancy, massage can be more targeted (eliminating back pain, reducing swelling, etc.).

General massage traditionally begins from the back. In the first 3 months of pregnancy, significant pressure in the lumbar region is not recommended. Muscle tension during pregnancy is often concentrated in the collar zone, the area of ​​​​the shoulder blades, which causes soreness, stiffness of the neck and headache. Therefore, they are worked out more carefully.

The procedure continues with a foot massage. With pain in the legs, their fatigue and swelling, massage is especially effective. When massaging the legs, strong pressure is avoided on the inner surfaces of the thigh, as well as on the inner surfaces of the lower leg in its lower third. Here is concentrated a large number of important biologically active points.

Then, in the prone or half-sitting position, the hands are massaged according to the suction technique.

After that, the front surface of the body is massaged. In the first three to four months of pregnancy, abdominal massage can be done lying on your back. As it increases, it becomes difficult to lie on your back, so they move to a semi-sitting position. The abdomen is massaged with very light circular movements in a clockwise direction, with an increasing radius. It is necessary to work on the stomach very softly and rhythmically, mainly with flat stroking techniques.

Massage during pregnancy can be carried out in the form of general and private massage, self-massage.

In the normal course of pregnancy, general massage is possible, with a frequency of about 1-2 times a week and a duration of up to 1 hour. With self-massage, the duration of the procedure usually does not exceed 15-20 minutes and can be performed daily.

Private massage usually includes a local impact on the collar, lumbosacral region, joints and soft tissues of the extremities, especially the lower ones. Such a massage lasting 15-20 minutes can be carried out every other day and even daily.

In the presence of segmental zones, elements of segmental massage are included in a small or moderate dose. The appearance of signs of early and late toxicosis of pregnancy is the basis for the inclusion of acupressure methods.

The course of treatment - 5-10 procedures.

8.2. THERAPEUTIC PHYSICAL CULTURE FOR GYNECOLOGICAL DISEASES

8.2.1. Tasks, indications and contraindications, means and forms of exercise therapy

The use of physiotherapy exercises for organic and functional disorders in the female body has a long history as one of the effective methods of treatment.

Indications for exercise therapy for gynecological diseases:

Residual effects of the inflammatory process;

Salpingo-oophoritis chronic;

Incorrect position of the uterus, ovarian dysfunction due to pelvic peritoneal adhesions after an inflammatory process or surgery on the uterus and appendages;

Genital infantilism, uterine hypoplasia;

Weakness of the pelvic floor muscles;

Stress incontinence;

Concomitant disorders of the function of the large intestine and bladder, pain syndromes;

climacteric disorders;

Decreased physical performance due to physical inactivity;

Reactive neurosis-like states. Contraindications:

Acute and subacute diseases of the female genital organs;

Exacerbation of chronic inflammation with fever, increased ESR, signs of peritoneal irritation;

Malignant neoplasms of the pelvic organs and abdominal cavity;

Encapsulated purulent processes until the opening of the purulent focus and the creation of a good outflow;

Sactosalpinx;

Uterine bleeding;

Vesico-intestinal fistulas. Tasks of exercise therapy with gynecological diseases:

Improvement of blood and lymph circulation in the pelvic organs;

Strengthening the ligamentous apparatus of the uterus, abdominal muscles, lower back, hip joint and pelvic floor;

Contribute to the restoration of mobility and normal ratios of the pelvic organs;

Elimination of residual effects of the inflammatory process;

Optimization of the endocrine system and metabolic processes;

Improving the motor-evacuation function of the intestines and bladder;

Improving the function of the cardiovascular and respiratory systems, increasing physical performance;

Improvement of the psycho-emotional state. The following forms of exercise therapy are used - therapeutic exercises,

morning hygienic gymnastics, hydrocolonotherapy, classes

on simulators, aerobics (dosed walking, step aerobics, etc.). The LH complex includes: general developmental exercises for the muscles of the trunk, upper and lower limbs and special (dynamic and isometric exercises) for the muscles that provide movement in the hip joint, for the muscles of the lower back, abdomen and pelvic floor; breathing exercises - static and dynamic nature, diaphragmatic breathing.

In order to improve blood and lymph circulation in the pelvic organs, dynamic exercises are used that include the muscle groups surrounding the pelvis. They are functionally and reflexively connected with the organs of the female reproductive system. The active work of these muscles improves metabolic and reparative processes in this area, promotes stretching and rupture of adhesions resulting from an inflammatory process of an infectious origin or after surgical interventions.

Considerable attention is required to train the abdominal muscles, which strengthens the ligamentous apparatus of the uterus, activating the function of the intestines. In addition, strengthening the abdominal muscles together with the muscles of the lumbar spine reduces the manifestations of pain in the lumbosacral region, which is so common in patients of this group due to muscle hypertonicity, which reflexively occurs in gynecological diseases.

Isometric exercises are usually used to ensure good functional condition of the pelvic floor muscles. With weakness of the pelvic floor muscles, the internal genital organs of a woman fail to maintain their normal position, which disrupts their functions. Strengthening the pelvic diaphragm is an urgent task in almost all pathological conditions in the pelvic area.

The LH complex necessarily includes diaphragmatic breathing, which contributes to the regulation of intra-abdominal pressure and activation of blood circulation in the organs of the abdominal cavity and small pelvis.

When prescribing exercise therapy funds, the following are taken into account:

The nature of the pathological condition;

The presence of adhesive process, its localization;

The period of the disease (acute, chronic, subacute);

The age of the patient;

The state of the cardiovascular system;

The severity of hypodynamic manifestations.

Menstruation without heavy bleeding is not a contraindication for LH, however, the emphasis in the load should be shifted to exercises for the muscles of the upper and lower extremities, stretching, and relaxation. LH is carried out by group (8-10 people), small-group (3-4 people) methods, 2 times a day - once in the exercise therapy room under the guidance of an instructor, then at home or in the ward on their own. With an incorrect position of the uterus, pain syndrome, concomitant pathology of the cardiovascular system, classes are carried out in an individual form.

The choice of the starting position when performing therapeutic exercises is the most important component of successful treatment for gynecological diseases, which depends on the nature of the exercises performed, the relative position of the pelvic organs in a particular patient. In the absence of uterine displacement, LH is performed in any IP: standing, sitting, lying (on the back, on the side, on the stomach), standing on all fours, etc. However, uterine displacements require a differentiated approach to choosing the starting position, which should facilitate the transition uterus in a normal physiological position. With retroflexion (backward bending of the uterus), such a starting position during CG exercises will be: knee-elbow, lying on the stomach, etc.

8.2.2. Therapeutic exercise in chronic inflammatory diseases of the female genital organs

The most common causes of inflammatory diseases of the female reproductive system are sexually transmitted infections, surgical interventions (including abortions), poor personal hygiene, and weakened immunity. Often they occur at a young age and quickly take a chronic course. At the same time, the whole organism is involved in the process, metabolism is disturbed, significant deviations occur in the endocrine, nervous, and cardiovascular systems. However, due to the close anatomical location, the unity of innervation, blood supply and lymph circulation with the internal genital organs, the inflammatory process often affects the urinary and digestive systems.

The most common complaint that makes a woman see a doctor is pain of a different nature and intensity, which radiates to the lower abdomen, lower back, leg, rectum, and bladder. Pain, significant during exacerbation of the process,

they force a woman to spare herself, try to exclude stress on the abdominal muscles, pelvic floor and diaphragm, and ultimately lead a sedentary lifestyle. This circumstance, in turn, leads to further deterioration of blood and lymph flow in the pelvic organs and congestion, which contributes to the development of deeper functional and organic disorders in them.

Almost all women are concerned about menstrual irregularities, accompanied by headache syndrome, neurotic manifestations, asthenia and sleep disorders.

The most serious consequences of chronic inflammation are infertility, the risk of ectopic pregnancy.

Tasks of LG:

Reducing the residual effects of the inflammatory process;

Improvement of blood and lymph circulation in the pelvic organs and lower extremities;

Restoration of mobility and normal ratios of the pelvic organs;

Strengthening the ligamentous apparatus of the uterus;

Prevention of adhesion formation;

Stimulation of metabolic processes in the body as a whole, including in the organs and tissues of the small pelvis;

Improving the motor-evacuation function of the intestine;

Prevention of hypotrophy of the abdominal muscles and pelvic floor;

Increasing the body's resistance to infection;

General strengthening of the body, improving the function of the cardiovascular system and increasing physical and mental performance.

Simple gymnastic and respiratory, general strengthening and special exercises are used that correspond to the tasks of exercise therapy for this pathology (Fig. 8.3). Classes include exercises that improve blood circulation in the pelvic region. The acceleration of blood flow leads to a decrease in congestion in the pelvic organs, which, in turn, contributes to the resorption of exudate, the evacuation of decay products from the focus of inflammation. Increased blood circulation during exercise in parallel with increased gas exchange improves trophic processes in tissues, which to a certain extent prevents the occurrence of cicatricial adhesions in the pelvic peritoneum and fiber.

Rice. 8.3.Exercise Options for Women with Chronic Inflammatory Diseases

Exercises to increase the mobility of the spine should be performed with the maximum range of motion in I.P. standing, kneeling, sitting, lying on your back and on your stomach. Exercises to strengthen the thigh muscles include active movements of the lower limbs in the I.P. lying on your back - bending the legs at the knee and hip joints, sliding the feet along the plane of the couch; abduction and adduction of the legs; circular movements with straight legs;

Rice. 8.4.Exercise options to increase blood circulation in the pelvis

imitation of cycling; leg extension (breaststroke swimming); in i.p. sitting - abduction and adduction of the legs; torso to the right and left foot; rotational movements of the legs; movements with straight legs ("scissors"). These exercises are carried out actively, with dosed resistance, weights; exercises at the gymnastic wall are recommended.

In order to improve blood circulation in the pelvic area, classes include dosed complicated walking: with high hips, lifting on toes, with a swing of a straight leg forward, to the side, with a forward lunge in a semi-squat, in a squat, with overcoming obstacles of various heights.

To prevent hypotrophy of the abdominal muscles and pelvic floor, exercises are used for the oblique and rectus abdominal muscles, as well as the muscles of the perineum, which increase blood and lymph circulation in the pelvic organs (Fig. 8.4).

Strengthening of peripheral blood circulation is achieved by exercises for the distal extremities. These exercises are introduced into the LH classes when significant physical activity has not yet been shown, but the general condition of the patient allows her to expand her motor regimen.

During the period of compaction and delimitation of the infiltrate, rhythmic chest breathing is recommended with its gradual deepening and the transition to mixed and diaphragmatic; exercises for the upper limbs; rotational movements in the hip joints; raising the pelvis with support on the feet and shoulder blades; flexion of the legs at the knee and hip joints (Table 8.1).

Classes can be started when the inflammatory process subsides and the general condition of the woman improves: body temperature is normal or subfebrile; leukocytosis is not higher than 9000; ESR no more than 20-25 mm/h; there is no local increase in temperature; there is no pulsation and sharp pain in the area of ​​the infiltrate.

Exercises are performed from the starting positions while standing, lying on your back, standing on all fours, etc. LH classes should be carried out daily, first individually (for 10-15 minutes), then in a group method (for 20-25 minutes). All exercises are done at a calm pace, combined with deep breathing. If pain occurs, the session must be stopped. With a good functional state of the patient, the session can last up to 40-45 minutes at a submaximal load level.

Table 8.1.LH for patients with chronic inflammatory diseases of the female genital organs (recovery period)

The end of the table. 8.1

8.2.3. Therapeutic exercise in operative gynecology

Modern operative gynecology has good anesthetic support, perfect surgical technique, new technologies (microsurgery, surgical laparoscopy, seamless tissue connection). However, in today's unfavorable environmental and socio-psychological environment, a negative premorbid background (a sharp increase in extragenital diseases, especially cardiovascular diseases, diseases of the central and peripheral nervous system, and diseases associated with metabolic disorders) can adversely affect the course of the postoperative period. For a complete recovery of the patient, special rehabilitation treatment is necessary, including exercise therapy, aimed at preventing postoperative complications, preventing recurrence of the disease and eliminating functional disorders caused by the pathological process.

Indications:

Extensive adhesive process in the pelvis and abdominal cavity;

Concomitant pathology of the cardiovascular, urinary, digestive and endocrine systems;

Obesity;

The presence of foci of chronic infection;

Large volume and invasiveness of surgical intervention. In malignant neoplasms, exercise therapy is prescribed only

after surgical treatment.

The tasks of restorative treatment are largely determined by the volume of the operation. Depending on the volume, gynecological operations are divided into radical (extirpation of the uterus, removal of uterine appendages, etc.) and reconstructive-plastic - organ-preserving - (conservative myomectomy, resection of the ovaries, etc.) with the removal of only the pathologically altered part of the organ.

Tasks, means and methods of exercise therapy during operations on the pelvic organs depend on the period of treatment, the age of the patient, comorbidities and the volume of surgical intervention.

There are periods:

Preoperative;

Early postoperative;

late postoperative.

Preoperative period.

Means of exercise therapy are prescribed in the preoperative period to prepare the patient for planned operations. Tasks of exercise therapy:

Restorative, general tonic effect, increased immunity as part of general preparation for surgery;

Improving the functions of the most important systems of the body (cardiovascular and respiratory);

Preparation of the surgical field for surgical intervention: increasing the elasticity of the skin and muscles; improvement of blood and lymph circulation in the pelvic organs, reduction of congestion in the pelvis;

Improvement of peripheral blood circulation, mainly in the vessels of the lower extremities (prevention of thrombophlebitis);

Teaching exercises for the early postoperative period and self-care, emptying the bladder and intestines in the supine position (subject to bed rest);

Training in controlled localized breathing, painless coughing, relaxation;

Prevention of constipation and urinary retention;

Normalization of the psycho-emotional state. Contraindications to the appointment of exercise therapy:

Severe condition of the patient;

Acute purulent inflammatory process;

Increased body temperature, pronounced symptoms of intoxication;

Severe pain syndrome;

Bleeding or risk of bleeding;

Mobile cyst on a leg;

Ectopic pregnancy;

Malignant neoplasms;

Thrombophlebitis.

Normal menstruation is not a contraindication to therapeutic exercises.

LH includes simple general strengthening and special physical exercises for small and medium muscle groups in combination with breathing exercises. Starting positions depend on the nature of the disease: with prolapse and prolapse of the genital organs in the initial position lying on the back and standing on all fours;

with tumors - in the supine position. It is necessary to avoid starting positions and exercises that increase intra-abdominal pressure, especially when preparing for operations for oncological diseases. Sharp movements and quick change of starting position are excluded.

Special attention give exercises that patients will perform in the early postoperative period:

Painless coughing with small cough shocks with fixation of the area of ​​the postoperative wound;

Correct rise from bed with the exclusion of the muscles of the anterior abdominal wall.

The first classes are held in the antenatal clinic. The LH procedure is carried out at a moderate pace, it is possible to use gymnastic items, the duration is 15-20 minutes. The duration of the course is determined by the duration of the preoperative period.

Early postoperative period.

It starts from the moment the patient wakes up after anesthesia and lasts 1-3 days, depending on the severity of the operation.

Tasks of exercise therapy:

Prevention of early postoperative complications (hypostatic pneumonia, thrombosis, atelectasis, intestinal and bladder atony);

Improvement of peripheral circulation;

Improvement of blood and lymph circulation in the area of ​​the postoperative wound, which contributes to epithelialization and scarring;

Prevention of orthostatic disorders;

Accelerating the elimination of drugs from the body.

Increase in psycho-emotional tone. Contraindications to the appointment of exercise therapy:

Threat of bleeding (when ligating large vessels);

Violations of the blood coagulation system, the threat of thrombosis;

Severe anemia, hypovolemia due to the loss of a large amount of blood during surgery;

Increase in the phenomena of cardiovascular and respiratory insufficiency;

Diffuse peritonitis, septicopyemia;

Acute thrombophlebitis.

LH is prescribed on the 1st day after surgery, already 2-3 hours after waking up, it is advisable for the patient to perform static breathing exercises and repeat them every hour, dynamic exercises for the distal extremities in light conditions (Fig. 8.5.) For the prevention of congestive phenomena in the lungs and improve expectoration, you can apply a vibration massage of the chest: vigorous rubbing of the intercostal spaces and tapping (duration of the procedure 3-5 minutes). The same techniques can be used to activate the actual respiratory muscles (diaphragm and intercostal muscles).

Subsequently, the LH procedure includes: dynamic breathing exercises, breathing exercises with prolonged exhalation, resistance; simple dynamic general strengthening exercises for small and medium muscle groups (multiple rhythmic movements of the feet, bending the legs at the knee joints, etc.); simple exercises for coordination and exercises for

Rice. 8.5.Exercise options in the early postoperative period

vestibular training. To prevent thrombosis, it is recommended to bandage the lower extremities with an elastic bandage, which accelerates blood flow through the deep vein system and prevents blood stasis in them. LH is carried out in I.P. lying on your back, at a slow pace, lasting 10-15 minutes, with pauses for rest and relaxation exercises, by an individual method 1-3 times a day.

In acute thrombophlebitis, physical exercises are allowed only for the muscles of the upper shoulder girdle in combination with breathing exercises.

Rice. 8.6.Variants of exercises in free motor mode

In the future, the motor regimen is expanded, in the absence of contraindications, patients can get up and walk around the ward the next day after the operation. In laparoscopic operations, the general motor mode is assigned by the end of the day of the operation. Gradually complicate the LH technique, increase physical activity, add special exercises for the hip joints, large muscle groups, include exercises for the abdominal muscles, pelvic floor, increase the complexity of the exercises, the range of motion, increase the pace of training, add isometric exercises for the muscles of the perineum and abdominal wall (Fig. 8.6)

Late postoperative period.

Tasks of exercise therapy:

Prevention of adhesions;

Strengthening the muscles of the anterior abdominal wall, pelvic floor;

Prevention of recurrence of the disease;

Restoration of organ function (with organ-preserving operations);

Restorative effect, increased physical performance, adaptation to social conditions.

After removing the stitches, patients can exercise in the gym. They use a variety of starting positions, dosed walking at an average pace is recommended, gymnastic objects, medicine balls, expanders can be used. The LH technique with the use of special inflatable gymnastic balls (fit-ball) has proven itself well (Fig. 8.7).

The LH procedure is carried out by small-group and group methods, the duration of the lesson is 30-40 minutes.

After discharge from the hospital, it is desirable to continue exercise therapy in a clinic (antenatal clinic) or at home to achieve a stable clinical and functional effect for at least 4-6 months.

8.2.4. Therapeutic exercises with incorrect positions of the uterus

Normally, the uterus is in the midline of the body and is slightly tilted forward. It is mobile and easily moved. Incorrect positions of the uterus:

Posterior displacement (retroposition), most often due to pathological shortening of the sacro-uterine ligaments under the influence of a long forced supine position, with a complicated course of the postpartum period, as a result of inflammatory processes in the parameter, with anomalies in the development of internal genital organs, etc .;

Rice. 8.7.Exercises to strengthen the abdominal muscles, pelvic muscles, adductor and abductor muscles of the thigh using the "fit-ball"

Lateral displacements (to the right - dextroposition, to the left - sinistroposition) due to inflammatory processes in the genital organs or in the adjacent loops of the intestines, followed by the formation of adhesions in the peritoneum and scars in the pelvic tissue, pulling the uterus to the side;

"tilts", in which the body of the uterus is pulled by scars and adhesions in one direction, and the cervix - in the opposite direction (tilt of the body of the uterus backwards - retroversion);

Bends - a change in the angle between the cervix and the body of the uterus; normally, this angle is open anteriorly (anteflexio), in pathological cases it is open backwards (retroflexo); often at the same time there is also a posterior tilt of the uterus (retroversio-flexio).

The changed position of the uterus can be the result of injuries, surgical interventions, perineal ruptures, multiple pregnancies and childbirth, postpartum infection, various neoplasms, prolonged bed rest after childbirth, and many chronic diseases. In addition to the above reasons, irrational physical exercises associated with sharp shaking of the body, especially during puberty, can negatively affect the position of the uterus. It should be noted that long-term unilateral exercises, such as high jumps, always performed with one leg (jogging), can also affect the position of the uterus.

Incorrect positions of the uterus can cause menstrual irregularities, female infertility, and pain syndromes.

Indications.

For PH exercises, cases of mobile acquired uterine deviations are shown, as well as position anomalies complicated by non-rough post-inflammatory adhesions of the genital organs with surrounding tissues. Treatment of anomalies in the position of the uterus, the formation of which is determined by congenital defects in the development of the reproductive apparatus (infantilism, etc.), is less favorable prognostically.

When burdening the incorrect position of the uterus with inflammation, neoplasms, etc., therapeutic exercises are prescribed after the elimination of these complications.

Tasks of LH in the wrong position of the uterus:

Strengthening the whole body;

Training of the abdominal muscles, diaphragm and pelvic floor;

Strengthening the muscular-ligamentous apparatus of the uterus;

Bringing the uterus to its normal position and fixing this position.

The most common form of exercise for abnormalities in the position of the uterus is the LH procedure. At the initial stages, to ensure that the features of the anatomical and topographic relationships of the pelvic organs of a particular patient are taken into account, individual lessons are held, lasting 15-25 minutes. Mandatory morning hygienic gymnastics. Practically healthy women can do water aerobics, swimming, with the exception of all types of jumps.

Types of anomalies in the positions of the uterus determine the nature of special physical exercises LH. The main role in their selection is played by the initial positions, which, by changing the direction of the forces of intra-abdominal pressure and the gravity of the body of the uterus itself, as well as causing the movement of the intestinal loops, create conditions for the transition of the uterus to its normal position.

When the uterus is tilted back, the optimal starting positions include: knee-elbow, knee-wrist, on all fours and lying face down. With this position of the body, the pressure on the uterus from the abdominal organs weakens due to the movement of the intestinal loops to the diaphragm, and the high position of the pelvis is a favorable moment for the return of the uterus, due to its severity, to its normal position. In these initial positions, for example, standing on all fours, the corresponding movements are performed (alternately raising the legs, etc.) (Fig. 8.8).

On the contrary, with hyperanteflexia (excessive bending of the uterus forward), the best starting position is lying on your back, in which the force of abdominal pressure and the heaviness of neighboring organs (bladder, intestinal loops) falls on the anterior surface of the uterus, thereby contributing to its deviation back.

When the uterus deviates to the side, exercises are introduced mainly in the I.P. lying on the side opposite to the deviation, which contributes to the stretching of the round ligaments of the uterus due to its movement under its own weight.

Along with special corrective physical exercises, it is necessary to use exercises to activate intestinal motility and eliminate constipation.

When doing most exercises, you need to monitor proper breathing. First of all, it is necessary to achieve

there was no breath holding, straining, so that the movement was always accompanied by an inhalation or exhalation phase.

Special physical exercises that correct the position of the uterus are often performed from uncomfortable positions, such as the knee-chest position, etc. To master them, you need to prepare for several weeks in the form of a variety of general strengthening gymnastic exercises.

Special physical exercises are complemented by gynecological massage.

Rice. 8.8.Special exercises for retrodivations of the uterus

In most cases, the so-called retroflexion of the uterus occurs, so we present special exercises that help position and fix the uterus in the correct position. These exercises should be included in the LH complex, compiled taking into account age, fitness and the functional state of the body. Women who have too much tilt of the uterus back are recommended not only to perform exercises in the I.P. lying on his stomach, but also to rest during the day and even sleep only in this position. Most favorably I.p. standing on all fours, when the uterus, shifting due to gravity, leans forward. I.p. is also useful. sitting on the floor with straight legs, since the center of gravity is transferred forward, the internal organs press on the abdominal wall and contribute to the tilt of the uterus forward.

Active exercises are combined with weight-bearing exercises, with dosed resistance and muscle tension (isometric exercises). The classes use breathing exercises (static and dynamic), pauses for passive rest, walking, elements of sports games, swimming.

Special exercises for tilting the uterus back (according to Vasilyeva E.V., 1970)

I.p. lying on the stomach.

1. Alternately bend your legs at the knee joints.

2. Alternately raise the straight leg back.

3. Simultaneously raise straight legs.

4. Turn on your back, return to I.p. I.p. standing on all fours.

5. Raise the straight leg up, then return to the I.P. The same with the other leg.

6. Simultaneously raise the right arm and left leg and vice versa.

7. Raise your leg, then bend it, trying to touch your knee with your hand. I.p. standing on your knees with support on your elbows.

8. Touch the elbow of the left hand with the knee of the right leg, return to the SP, then with the elbow of the right hand touch the knee of the left leg.

9. Straighten the legs at the knee joints, lifting the pelvis up without lifting the elbows off the floor.

10. Crawling forward and backward (15-30 seconds).

I.p. legs wide apart, palms of hands resting on the floor.

11. Walking in this position for 15-30 seconds. I.p. sitting on the floor.

12. Spread and bring straight legs.

13. Spread your legs as wide as possible to the sides, lean forward to the left and touch your left foot with your hands. The same on the other side.

14. Turns of the torso in one direction or the other, while touching the floor near the pelvis with both hands.

The incorrect position of the uterus also includes its omission, which may be the result of malformations and anatomical changes in the pelvic organs, weakness of the muscles of the pelvic floor, weakening and stretching of the ligamentous apparatus of the uterus.

In women who did not strengthen the abdominal muscles during pregnancy and did not engage in health-improving physical culture after childbirth, in the future they often have a “big stomach”, since the abdominal muscles overstretched during pregnancy and not strengthened after childbirth do not hold the pressure of the viscera. This entails the omission of all internal organs, which, of course, can impede their function. Weakening of the pelvic floor muscles can be associated with general muscle weakness and result from trauma and overstretching during childbirth. The pelvic floor serves as a support for the genital organs, therefore, with weakness of the muscles of the pelvic floor and the ligamentous apparatus of the uterus, prolapse of the uterus and vagina can occur, up to the complete prolapse of these organs.

Exercise therapy for the prolapse of internal organs becomes the main means of treatment, involving the gradual training of weakened muscles with the establishment of internal organs (in particular, the uterus) in the correct anatomical position.

Here is a list of special exercises for the muscles of the pelvic floor and abdominals, which should be included in the exercises of CG (according to Vasilyeva E.V., 1970).

I.p. lying on your back.

1. Alternately move one leg over the straightened other.

2. Alternately bend the legs at the knee joints, sliding the feet along the plane of the couch.

3. Alternately bend your legs, trying to touch your chest with your knee.

4. At the same time, bend your legs at the knee joints, trying to press them to your chest.

5. Alternately raise one or the other straight leg up.

6. Perform leg movements, as when riding a bicycle.

7. Raise straight legs up, hold them (exposure 5-7 sec).

8. Cross and spread straight legs to the sides, raised at an angle of 50-90?.

9. Perform leg movements, as in breaststroke swimming.

10. Legs bent, feet connected. Spread your knees to the sides, bring your knees together, stretch your legs.

11. Move to a sitting position with the help of the hands (without the help of the hands).

12. Legs are fixed, arms along the body. Sit down, bend forward, touching the feet with your hands.

I.p. lying on the stomach.

13. Hands behind the head. Alternately raise the straight leg (right, left) while simultaneously tensing the muscles of the perineum.

14. Arms along the body, legs apart. Raise both straight legs up at the same time and then slowly lower them.

16. Hands under the head, legs apart. Raise the right half of the body up, tensing the muscles of the thigh, buttocks and contracting the muscles of the perineum. The same on the other side.

I.p. sitting on the floor.

17. Emphasis on the back. Spread and bring straight legs without lifting them from the floor.

18. Raise the pelvis off the floor.

19. Tilt the torso to the right, lean with the hands of both hands on the right near the pelvis, moving the hands along the floor, tilt the torso to the left. The same on the other side.

Methodical instructions.

Classes with patients with an incorrect position of the uterus are carried out, as a rule, in the conditions of physiotherapy exercises for women's clinics and in sanatorium-and-spa institutions. It is desirable to have an isolated gym, inaccessible to outsiders. Patients should wear clothing that does not restrict movement. Belts, tight shorts, etc. are not allowed. Before class, the bladder and intestines must be emptied.

It is necessary to focus on the following:

During menstruation, classes do not stop, but the load in general strengthening exercises decreases;

In all exercises, special attention should be paid to breathing, combining it with a rhythm, position and movements favorable for inhalation and exhalation;

The supine position, as well as running and light jumping, for uterine retroflexions can be introduced at the end of the course of treatment in patients with a properly established uterus and dosed carefully.

8.2.5. Massage in gynecology

Massage is an important and effective means of non-drug therapy for various pathological conditions of the female genital area. However, such treatment should be supervised by a gynecologist.

Indications for massage:

Chronic inflammatory diseases of the genital organs;

Adhesive changes in the pelvis;

Menstrual disorders (dysmenorrhea, amenorrhea, etc.);

Hypoplasia of the genital organs;

Hypofunction of the ovaries;

Incorrect position of the uterus, its prolapse;

Infertility without anatomical changes in the internal genital organs;

With weakness, insufficient contractility of the muscles of the uterus and bleeding on this basis;

Urinary incontinence due to physical exertion;

Climacteric phenomena;

Concomitant disorders (pain syndromes, including headaches and lumbosacral pains, neurotic disorders, diseases of the urinary system and intestinal tract);

Surgical interventions. Contraindications:

General contraindications, including tumors of the pelvic and abdominal organs, conditions requiring immediate surgical care;

Acute and subacute forms of inflammatory diseases of the external and internal genital organs;

Purulent processes of the pelvic organs;

Exacerbation of chronic inflammation of the pelvic organs;

III-IV degree of purity of the vaginal flora;

Temperature increase (above 37?), ESR acceleration (above 20 mm per hour);

Endocervicitis and erosion of the cervix;

endometriosis;

Bloody issues;

The presence of menstruation (with oligomenorrhea, massage is possible); the presence of pregnancy or suspicion of it;

Postpartum and post-abortion periods within 1-2 months after the restoration of the normal menstrual cycle;

Venereal diseases;

The appearance of sharp pains during and after the massage. Massage tasks:

Improvement of blood and lymph circulation, metabolic processes and regeneration in the pelvic organs;

Reducing congestion in the circulatory and lymphatic system of the pelvis;

Restoration of the normal physiological position of the uterus;

Normalization of motility, tone of the myometrium and fallopian tubes;

Normalization of ovarian-menstrual function of the ovaries;

Restoration of reproductive function;

Elimination (resorption) of infiltrate in periuterine tissue;

Elimination of adhesions of the ligamentous apparatus of the uterus;

Mitigation of pain syndrome of various localization;

Improvement of the psycho-emotional state. Massage area.

In most diseases of the female genital area, the main areas of massage are: the lower thoracic back, lumbosacral and gluteal regions, lower abdomen, thighs (segments D11-12, L1-5 and S1-2). However, reflex changes are often found in the distal parts of the lower extremities and the collar zone (menstrual irregularities are usually accompanied by headache syndrome, sleep disorders), which should also be subjected to therapeutic effects. With concomitant diseases, the zone of influence of massage can expand significantly.

Massage position: sitting, lying on the stomach or on the side.

Massage technique.

In the treatment of female diseases, any type of therapeutic massage is used. The most common are gynecological, vibrational and classical massage. At present, various reflex types of massage are being actively introduced into practice: segmental, connective tissue, acupressure, etc. However, with a particular pathological condition, in order to achieve the greatest therapeutic effect, preference is given to a certain type of massage (Table 8.2)

Table 8.2.The most effective types of massage for various pathological conditions of the female genital area

Gynecological massage has a direct effect on the pelvic organs, their receptor and vascular apparatus. This massage (vaginal) is a medical procedure and is performed only in the conditions of the gynecological department of the hospital or antenatal clinic and is prescribed for violation of the position of the uterus and cicatricial adhesive processes after surgical interventions or inflammatory diseases of the female genital organs.

Vibration massage. Mechanical vibrations cause excitation of receptors located in the skin, mucous membranes, muscles and tendons, walls of blood vessels and internal organs. At the same time, vibration has not only a local, but also a general effect, affecting distant organs and systems, including the central nervous system and the hormonal function of the central structures of the brain. Features of physiological shifts depend primarily on the frequency of vibration, its intensity, duration and localization of exposure, resonant properties of the tissues on which it affects. Massage also has a pronounced analgesic effect. Vibration massage is used to enhance the contractility of the muscles of the uterus, with bleeding due to its weakness, with amenorrhea, to stimulate ovarian function, and thus it is indicated for infertility.

Impact area: sacrum, lower thoracic and upper lumbar vertebrae, lower abdomen, mammary glands, acupuncture points associated with the pelvic organs. The duration of exposure does not exceed 3-10 minutes. Number of procedures 10-12.

Segmental massage uses reflex connections of internal organs with surface tissues - skin, muscles, fascia, periosteum, by influencing which massage techniques can significantly improve the functional state of the corresponding organs. Techniques of stroking, rubbing, vibrations from the arsenal of classical massage and specific ones are used. The most important and obligatory component of the effective use of this type of massage is the identification of segmental zones - areas of the body, usually of constant localization with reflex changes in tissues. These may be areas of hyperalgesia in the skin and muscles, muscle hypertonicity and myogelosis, areas of swelling or retraction in the connective tissue. As tissue changes are eliminated, there is an improvement in the function of internal organs segmentally associated with these zones. The greatest reflex changes in diseases of the female genital organs are observed in the tissues of the lumbosacral region, pelvis, lower abdomen and thighs. However, attention should also be paid to the zones of the lower cervical and upper thoracic segments, since reflex changes in this area are most often detected in the presence of menopausal disorders.

Segmental massage is highly effective in a wide range of female diseases: menstrual disorders, dysmenorrhea, genital hypoplasia, pain syndromes of various localization, residual effects after surgery and inflammatory diseases of the genital organs. Massage is carried out in a sitting position, lying on the stomach or on the side. The duration of the massage is usually no more than 20 minutes. The duration of the course of treatment is determined by the rate of disappearance of reflex changes, usually 6-10 procedures.

Classic intensive massage (Makarova M.R., Kuznetsov O.F., 1998). This method is based on the use of classical massage techniques, but taking into account reflex changes in the muscles, subcutaneous adipose tissue and skin in the lumbosacral region and abdomen, resulting from irritation of visceroreceptors in inflammatory diseases of the pelvic organs.

Massage begins with the abdomen, subsequently affecting the lumbosacral and gluteal regions. Particular emphasis in massage is given to the impact on areas where there is poor tissue displacement, skin hyperalgesia zones, muscle hypertonicity in order to eliminate them.

Massage of the abdomen begins with a planar superficial stroking turning into a deep one, then rubbing and kneading techniques. The most intensive massage techniques are performed in the iliac regions. The direction of movement is clockwise and towards the regional lymph nodes. Additionally, the iliac crests, the area of ​​the inguinal fold, the pubic joint are worked out by rubbing techniques, and the iliac muscle is worked out by pressing (kneading technique) in the direction from the iliac crest into the depths of the pelvis with a brush clenched into a fist. This technique also affects the colon along its course with pressure in the ileocecal and sigmoid angle with vibration for 2-3 seconds. The massage of the abdominal area ends with vibration (pelvic concussion), stroking (planar superficial circular and longitudinal).

Massage of the lumbosacral region: all the techniques of classical massage are used with an emphasis on areas with reflex-changed tissues and exit points of the spinal roots.

Methodical instructions. The construction of an intensive massage technique depends on the course of the underlying disease. In patients with chronic salpingo-oophoritis without exacerbation with rare relapses of the disease, lasting up to 5 years, in the presence of adhesions of the small pelvis of the I-II degree, the massage procedure begins with an intense impact on both areas until a feeling of mild soreness appears. The duration of the procedure is up to 25-30 minutes. The course consists of 4-6 procedures with an interval of 2-3 days.

In patients with a disease duration of more than 5 years, in the presence of frequent recurrences of the development of sactosalpinxes or an extensive cicatricial adhesive process of III-IV degree in the small pelvis, abdominal massage is carried out according to an intensive technique from the first procedures and is combined with a more “sparing” effect on the lumbar sacral area. As you get used to, the effect on the lumbar zone is increased, using all the techniques in the massage procedure, increasing the duration of the procedures up to 25-30 minutes. The course consists of 5-6 procedures with an interval of 2-3 days.

Gymnastics to strengthen the pubococcygeus muscle, once developed by the gynecologist Kegel (USA), is actively used in the treatment of various medical problems in women and men of any age. Effectively solving the problems of preventing ruptures and prolapses, as well as urinary incontinence, hemorrhoids, impotence, these exercises improve the quality of life and increase libido.

Determining where the pelvic floor muscles are located is the first step to starting the exercises. To detect them, you should suspend the jet during urination, and then relax, restoring it. The muscles that were involved during this manipulation are precisely the muscles of the pelvic floor.

Its fibers, depending on the location, can be called:

• pubovaginal (LV);
• pubic-urethral (LU);
• pubic-prostatic (LP);
• pubic-rectal (LR).

It is designed to support the rectum, internal genital organs, urethra, in addition, it ensures the normal functioning of the prostate, urethral and anus sphincters, participates in the process of delivery, provides pleasure during sex. It must be practiced in everyday life. You should not try to combine training with the process of urination, as this can cause dysfunction of the urethra.
To understand more precisely which muscles need to be used during training, you can insert a clean finger into the vagina and make a squeezing movement of the pelvis, and then relax. Thus, it is best to feel how the pelvic floor rises and falls, which muscles are involved.
Squeezing and unclenching movements of the pelvic floor muscles are the basis of Kegel gymnastics. Performing them, you should concentrate and use only the muscles of the perineum, leaving the abdominal and gluteal muscles inactive. Kegel exercises are done with an empty bladder and intestines. The complete absence of any discomfort or pain indicates the correct performance of the exercises.

To study the basic exercise, it is recommended to lie on your back, pulling up your legs, relax your stomach. If desired, hands can be placed on the stomach. While inhaling, squeeze the pubococcygeal muscle, as if drawing it inward for up to 5 seconds and exhale, relaxing, and as if pushing it out. Repeat the exercise up to 5 times in 1 run, in total it is recommended to perform 3-4 runs during the day.

The Kegel technique is contraindicated in the case of:

• pathologies of the small pelvis or inflammation;
• neoplasms and bleeding;
• hyperthermia;
• venous insufficiency and other vascular diseases;
• recent surgery;
• risks and threats to pregnancy

Before you start exercising, you should consult your doctor for contraindications and restrictions.

Kegel exercises for men

Initially, Kegel gymnastics was developed to solve typical female medical problems:

• stress urinary incontinence;
• weakening of the tissues of the pelvic floor and genital prolapse;
• breaks during delivery.

Over time, medical practice has shown that this complex copes well with some male, as well as common medical problems for both sexes.
The main direction of application of the Kegel technique for men is the prevention and treatment of prostate pathologies, the prevention of hemorrhoids.
The technique for performing Kegel exercises for men is no different from women's. Like women, they can feel where the muscle is being worked out when they urinate, interrupting and then releasing the stream of urine. In addition, they can also determine the necessary muscle during an erection by twitching the penis.

Kegel exercises for pregnant women

The use of the Kegel technique during pregnancy allows you to learn how to control the pubovaginal muscles in order to:

• facilitate the process of childbirth;
• prevent the appearance of tears during attempts;
• accelerate recovery in the postpartum period.

Regular implementation of this complex for several months helps to activate the blood supply to the pelvic tissues, and, accordingly, increase their tone and elasticity, and improve well-being. You can perform it anywhere and anytime.

Since the implementation of the Kegel complex is not recommended if there is a threat of premature birth, miscarriage, or the presence of hemorrhoids, it should be studied only after consulting a gynecologist.

It is recommended to start practicing even in the period of preparation for pregnancy or in its early stages. At the initial stage, it is enough to perform each exercise 5 times. Over time, subject to good health, the load can be increased, bringing up to 20-30 repetitions.

The main thing is to do it daily. Until the 16th week of pregnancy, Kegel exercises are performed in any position - standing upright or on all fours, sitting or lying down, after this period, gymnastics is recommended to be done exclusively standing or sitting.

1. Exercise 1. While sitting or lying down, bend your legs, spread them apart. Contract the pubococcygeal muscle as if urination is stopped. Hold for 5 sec. Relax her.
2. Exercise 2. Being in a sitting or lying position with legs bent and spread apart, alternately squeeze and unclench the pubococcygeal muscle for 10 seconds.
3. Exercise 3. Being in the same starting position, gradually squeeze the muscles of the vagina for 3-5 seconds, going from bottom to top. Having reached the very top, continue moving back to the bottom, also squeezing the vaginal muscles alternately, for 3-5 seconds.
4. Exercise 4. Quickly squeeze and unclench the intimate muscles, as if rolling a wave from the vagina to the anus and back.
5. Exercise 5. Being in a lying position or sitting with legs spread apart, push, simulating a bowel movement.

If you put your hand on the perineum while doing these exercises, you can feel how the PC muscles move.

Kegel exercises for urinary incontinence

This problem is most often encountered by women after childbirth or during menopause.

However, the cause of the pathology may also be a weakening of the pelvic muscles, surgery on the pelvic organs, trauma, or other causes. Not representing a threat to health, however, such a condition significantly affects the quality of a woman, giving her a lot of unpleasant moments.

The treatment regimen for incontinence necessarily includes gymnastics to strengthen the pelvic muscles. The use of the Kegel technique for this purpose is an easy and affordable way to train the pubourethral muscle.
The Kegel complex against urinary incontinence includes exercises for alternate contraction and relaxation of the pubourethral muscle. Exercises can be done on their own or with vaginal trainers - PelvicToner, Kegel balls, vaginal egg. Before starting classes, be sure to empty the bladder. The following video demonstrates how these exercises are performed correctly.

Kegel exercises to strengthen the pelvic floor

The muscles located between the pubic bone and the coccyx are the muscles of the pelvic floor. Their loss of elasticity leads to:

• to the problems of uncontrolled urination caused by an attack of coughing or laughing, sneezing, lifting weights;
• to reduce the brightness of sensations during sex, loss of orgasm;
• to genital prolapse;
• to the appearance of inflammation and pain in the perineal area.

Classes according to the Kegel method strengthen the intimate muscles, allow them to restore their lost elasticity.

Exercises to strengthen them are built on alternately squeezing and relaxing the pubic-coccygeal muscles.

To perform the exercise, you need to lie on your side, pulling up, bent legs, put your hand on the perineum. Slowly strain the intimate muscles, hold them for up to 10 seconds, then relax. Repeat 5-15 times. Having mastered this exercise, it can be performed throughout the day in various poses - standing on all fours or in full growth, sitting in Turkish style, lying on your back and other positions.

Kegel exercises for uterine prolapse

As an effective way to prevent the progression of uterine prolapse, the Kegel training complex is used in medical practice. To increase its effectiveness, it is recommended to perform basic exercises using vaginal simulators - special silicone balls and cones with different weights, muscle stimulators.

For those who have just started to master the exercises, it is recommended to use the lightest balls and cones in weight - they are painted in light shades.

Before inserting the selected simulator into the vagina, it should be treated with an antiseptic. If necessary, a little lubricant or lubricant can also be applied to its surface to facilitate the insertion process.
Kegel exercises can be done in a variety of positions.

It is most convenient for beginners to do them while in the position:

• lying or reclining on the back;
• sitting, placing a roller or leaning back;
• lying on your stomach, pulling your knees and lifting your pelvis.

Having taken a position lying on your back, for convenience, you can put a small roller under your back. Then, spreading your legs to the sides, insert the simulator into the vagina. Holding it with the muscles of the perineum, it is easy to pull on the loop for 10 seconds. For 1 approach, perform from 5 to 15 repetitions. The purpose of the exercise is to strain the pubo-vaginal, try to keep the simulator inside yourself. Thanks to regular training, this simple exercise will quickly bring the muscle tone of the pelvic floor tissues back to normal. Having achieved certain results, the exercise can be complicated by performing it while standing or squatting, after placing a roller under the knees, using exercise machines with different weights for training.

Kegel exercises for prostatitis

Complex therapy used in the treatment of inflammation of the prostate, identified at the initial stage, gives an effective result. Therapeutic gymnastics, carried out according to the Kegel method, is an effective tool that allows you to eliminate congestion in the urinary organs and strengthen the puboprostatic muscle. As a prophylaxis for the prostate, it is recommended to use it for men with a sedentary lifestyle.

Exercise 1. Having taken a convenient IP - lying, sitting or standing, for 10 seconds. simultaneously squeeze the muscles of the anus and urethra, performing movements that mimic the interruption of the process of urination and defecation, relax.
Exercise 2. Being in the same position, alternately strain, as if rolling a wave over the anus and urethra.
Each exercise should be done up to 15 times three times a day. When performing exercises, it is necessary to monitor breathing, breathing in when squeezing and exhaling when relaxing the muscles.

With regular classes, the result from the use of Kegel gymnastics can be observed in a month.

Kegel exercises after childbirth

Pregnancy and childbirth often lead to the fact that the pubovaginal muscles lose their elasticity, stretch, creating the preconditions for the uterus to lower.

In order to prevent the development of such a situation and quickly recover from childbirth, it is recommended to do Kegel exercises daily, starting from 30-40 days after childbirth. You can start classes only after consulting with a gynecologist.
The exercises performed involve the alternation of slow and fast compressive and unclenching movements of the vaginal muscles, performed at different intervals. The frequency of approaches is 3-4 times throughout the day.

Kegel exercises for hemorrhoids

Remedial gymnastics, performed according to the Kegel method, strengthens the puborectal (LR) muscle, activates the blood flow of the inguinal region, preventing the formation of hemorrhoids. Its implementation involves 5 approaches during the day for 10-30 exercises, including slow or fast compression, and then relaxation of the pubococcygeal muscles.
Exercise 1. IP - lying on your back, pulling up your bent legs. While inhaling, tighten the LR muscle, exhaling - relax.
Exercise 2. Without changing the PI, raise the hips and squeeze the muscles of the perineum, maintaining this position for several seconds. Get down on the floor and relax the LR muscle.
Exercise 3. Without changing the PI, raise your legs and tighten the internal muscles. Then spread your legs to the sides, relaxing the muscles of the pelvic floor. Bring the legs together again, tensing the muscles, then spread them again, relaxing the pelvic muscles.
Exercise 4. Without changing the PI, slowly raise your legs, tighten the LR muscle, and then relax it, lowering your legs to the floor.
Exercise 5. IP standing on all fours. Inhale while tensing the LR muscle, exhale - relaxing it.
The implementation of this complex will improve blood circulation, prevent congestion. Exercise 1. IP - lying on your back, with an emphasis on bent legs. While inhaling, raise the pelvis and tighten the pubovaginal muscle. On the exhale, lowering the pelvis, relax it.
Exercise 2. Without changing the PI, connect the feet together, push the knees apart, as if opening up. Inhale and bring your knees together, squeezing the pubovaginal muscle. Then, exhaling, spread your knees to the sides, relaxing it.

Exercise 3 Without changing the PI, inhale, raising one leg and straining the pubovaginal muscle. On the exhale, lowering the leg, relax it. Repeat the same, but with the second leg.
Exercise 4 IP sitting on the floor, spread legs extended in front of you and rest your hands behind you. Take a breath and bring your legs together, without lifting them off the floor, while simultaneously squeezing the pubovaginal muscle. As you exhale, relax it by spreading your legs.

Exercise 5. Standing, stretch your arms in front of you, inhale and perform a semi-squat, squeezing the pubovaginal muscle. Exhaling, rise, relaxing it.

A set of exercises for men

A complex of 4 exercises performed according to Kegel will allow you to tone the pubococcygeal (PC) muscle in men, improving erection. You can perform the exercises standing or being in another position, repeating each exercise 10 times.
Exercise 1. Squeeze the PC muscle as much as possible, straining it while inhaling. As you exhale, relax sharply.
Exercise 2. While inhaling, strain the PC muscle, holding it for a few seconds, then slowly relax, exhaling.
Exercise 3. While inhaling, slowly compress the PC muscle, and then slowly relax it, exhaling the air.
Exercise 4. Inhale and exhale quickly, simultaneously tensing and relaxing the PC muscle, achieving the effect of twitching the penis.

Do Kegel exercises help?

Data presented by the National Institutes of Health (USA) confirm the effectiveness of the Kegel technique. Its positive effect is noted by gynecologists, urologists and even sexologists. The following figures indicate the results of regular Kegel classes for 6 months:

• 100% of women talk about the absence of ruptures during childbirth and problems with the uterus in the postpartum period;
• 85% of women indicate improvement in the presence of problems with urinary incontinence;
• 75% of men note an improvement in the condition of the prostate;
• 75% of men and women indicate an aggravation of sensations during sex.

The Kegel technique is in demand all over the world and, when used correctly, is absolutely safe. This is evidenced by the fact that on its basis a complex of therapeutic exercises for children was created.