PROGRESSIVE RESISTANCE EXERCISE IN THE FUNCTIONAL
RESTORATION OF THE PERINEAL MUSCLES
Anxow H. Knom., MD., FACS, Los Anerues, Cau
Moliywoud Preshyterion Hospital, Otmatead Memoria)
Grom,
NTENSIVE investigations and experiences of World War II, the necent studies
of physiologists, and reseavel in infantile paralysis have greatly changed the
methods of conserving and restoring skeletal masele Zunetion, This knowledge
ltas not been applied to genital relaxation to appreciable extent,
A. restudly of the problems of the Lax perineum in relation to modem eon-
cepts of musclecell regeneration and function veveals that birth-eanal m
eulature is especially responsive to an improved method of conserving and
restoring funetion,
‘The process of childbearing, although ovdinarily eonsidered 2 normal phys-
iologie function, is invariably attended by certain amount of injury to the
tismes of the uterus, cexvis, vagina, and perineum, In the majority of women,
healing takes place rapidly aud the structures ave quiekly restored to a state
Which makes a repetition of the process possible. Never, however, do the organs
original integrity of form and funetion,
Modern advances in obstetries have led to a great reduetion in the loss of
life associated with childbearing. Infection, hemorrhage, and toxemia, the three
principal eauses of death in the partusient woman, claim fewer lives every
year, and toward the accomplishment of this end obstetrie xeseareh has been,
largely directed.
It is not enough, however, merely to keep a woman alive; it is important
to preserve for her the funetion of her reproductive system and to prevent injury
80 far as possille, in order that the involved organs may again eppre
normal state. Althongh some in,juay is inevitable, the manney in whieh labor
and delivery are eondueted and the way in which the patient is eared for in the
postpartum state will in large measure de the extent and permaneney
of that injury
‘Mechanism of Injury
‘The Aelivery of a child is possibile hecause the uterine and abdominal rauseles
ean éxert a. Toree great euongh tu overcome the resistance of the birth eanol.
An object approximately 10 exo, in diameter is gradually pushed through the
cervis, which has an initial opening of only a few millimeters, and through the
vagina, with its lumen of only a fow eeutimeters. Changes take place during
tho cotirse of prognaiiey whielt propare these struetures for the dilatation whieh
is necessary hefore the elild ean he delivered, ‘The tissues heeome progressively
softer and more olastie, and, by the end of prognaney, the cervis i usually 0
altered that it becomes completely effaced and dilated ‘and permits the passaye
Of the infin withont undue strain,
‘The muscles of the porngum aro Joss adequately prepared, and when the
presenting part of iho infant is oreed into the vagina and against the perineal
28
mngel
in din
Tie near
lateral
ane ote
Wh
ing, the
are aah}
pening
heum d
peripher
AS
the Fixe
the vay
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inal pla
apart a
Tongitna
To
diameter
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rubber }
inner he
peninit
the rabh
atlached
the conte
outward
injury b
often’ pe
prevent
Var
munseles
vaginal
sending
of one |
‘opposite
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of the p
of the i
and lis
for supp
museulat
the peri
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to Hill a
ana agenv.
and
phys:
o the
state
rgans
rss of
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every
Deen
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aseles
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wing
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sively
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issue
oes |
I eg ge
EXDROISE IN RESTORATION OF PERINEUIE 238
nningeles, Jess dilatation aceurs, Instead, as the humen of the vagina jnexeases
in diameter, the eells in those portions of the radially inserted! museles whiel:
lie nearest. the vaginal orifiee Decome separated from each other as 9 yesult, of
lateral stzetehing, while the interdigitating museles whieh survound the vagina
ave offen tom as a result of everslongation.
‘When any large abject jn foreed awainst a diayphraem with a sn
ing, the greatest stress is at the margin of the orifice, ‘The more peripheral wrens
fire subject to much less strain, and it is the aren immediately adjacent to the
opening which becomes exeesively alvetehed or tort. This ix true of the perk
eum during ehildbitth,. Te 8 in elese presimity 10 the vagina that Ue most
Aevere injuries occur, Only after the medial tissues have given way dy the
periplieral zones become involved
vAs the perimeter of the hivt canal expands daring delivery and approuches
the fixed 1in of the pelvis, the musculofaseial tissues situated radially between
the vagina. and the 3m of the pelvis would hoeome shorteuerd and velaxed if the
expaiiding movement were entively linoar, T7 the tissues remained! in. the ori:
nal plane, the medial hers of the radially inserted muscles would he pulled
apart and separated, Int the muscles would never be subjected to exeessive
longitudinal tension,
‘To illustrate this process, ane may picture the pelvis ay a hoop 12: em. in
diameters attached to it hy means of rubber hands 5 em, long is a small centrally
paged hoop 2 em, im diameter, whieh represents the undilated vogina. |The
rubber bands hold the two hoons in one pane, If, now, the diameter of the
inner hoop is increased to. 10 em, to carrespand to the dilatation necessary to
permit passage of the ebild's head and the two are still held on the same plane,
the rubber lands are each 4 em. Jonger than necessary to Keep the two hoops
attached. Tt is thus evident that the inner hoop may move trom the plane o|
the outer hoop 4.89 em. without sension, Only when the perineum is foreed.
‘ontward more than the amount permitted by the elasticity of the tigsnes will
ingury be inficted, aiid it is ab approximately this pobri that an episiotomy is
often. pezformed in order to inerease the diameter o7 the vaginol outlet and
prevent Zorther downward pull on the museulofaseial tissves
Variations in anatomic zelations way he responsible for differences im the
tension to which the muscles in any qnadeayt are exposed. Short anterior
nngeles may he subjected to excessive tension, Jeading to mjury of the anteriur
inal wall, Pasievioy miiseles are move coutmonly averextended by the de-
sending head ond axe more commonly injured. Excessive tension in o yuadvant
‘of one diameter will cause relaxation of muscles in both quadrants of the
‘opposite diameter. For this reason Intexal museles are rarely injured
Other museles and fascias which ave intimately eoneerned with the support
of the pelvie struetares and which must become dilated io permit the passige
fof the infant are the sphincters whieh surround the ams aud vagina. | Curtis
fd his assoeiatest have showa that strands of umsrles whieh are predominantly
for support blend with end insert themselves hy interdigilation into the intvinsie
mmiseulatare of the Jower thitd of the vagina sw well as that of the urethra amd
ants. Gorseh* hay emphiagized that “the deep muscular strata, whieh eonsist of
the Tevator ani together with its fascia, re oF Jess elosely interrelated witit
the perineal sphineters. By supporting and fising the pelvie dinpnragm the
evators synterize oud cooretinate the etivity of the sphincters.” | According
to Hill end yon Del “the k i aupelo aels as a powerful sphineter, since
4 surtornds the vagina like a Joop," amd Bureh* has made the statement that
‘laxation o? the vaginal oulet is caused hy lack of tone of the levator ant
muse,”
Th
muscle tisse in the iumediate proximity of the vaginal canal is in the
igtentest (ension stress during labor, ‘This sphineterie zone is most clastio240 KER
and resilient anid is capable of undermoing a greater cha other part
fof the perineum, Muscles in this area are injured ty yome extent in every
pregnaney Init in most instamiees shave amazing: reeperative pa
When museles and fascias are subjected to excessive t duuvinge chile
birth, twa typos of injuy may result: (1) actunl Inceration and separation of
fhe sieles and Faseian and (2) sepuation of individual mele cells frum the
motor nerves hy whiel they are innervated, The latter injury i proebly wnt
versal, awing to the grunt clasticity of amwele cells and the relatively lesser
tensions whieh nerve flhens ean withstand,
With the hivth of the hey, the forve whieh has hen applied fo the yerineurn
suddenly ecases. ‘The museles and faseias of the peripheral ame, whiel have
jeeted to proportionately’ Joss tension stress than these of the medi
zane, contract, t0 cause reduetion in; the eirewnference, shape, and form of the
vauina. In tlie position they serve ay snp pwrtive aplinis for the medial muscles
and faseias, whieh were the site of The most eyneentrated Cension xfrews. Come
drvetion occurs gray, fov.n sate of fami fs nover eanlueve to rapid
healing, amd only after some time does the vagina approximate ite former si
and the perineum anproaeh its original eompreteney.
‘The forces what Wad to the dilatation of the birth cana and the consequent
stretching amd fearing of muscle and nee Shey vary in their noruve avd in
their effect on the pevines! structures, The relotive size of te fetal head and
the bong pelvis, the pasition the head assumes in the pelvis, tle character of
the nterine contractions, the length of tine during whieh foree is exertod and
ihe state of the perineal inuseles, all phiy a part in determining the extent to
whiel the perinenm will ho injured. Tan young woman with resilient, elastic
muscles if the head is in an accipstoanterior position, the mtorine contractions
are normal, and an episiotomy: hais een dono lo prevent overdistention of the
perineum, permanent injury is minimized.
In any region where tisiues ecome averstretehed, even, though lacerations:
of mnselus o fascias are nob visible, nerve ingury is inovitable, Every muscle
cell ig supplied with a motor end-plate, attached to one of the many Alaments
making up the terminal portion af a motor nave. Sineo musele eells are capable
of greater extension than nerve Abory, they may stretel to steht on extent that
the motor end-piates are torn fram the newer oF which ther were a part. Never
ave all such eomections sevored, Sou muscle eells will netuin tholy innervation
and be eapeble of acting as splints or evitelios for Their injaved neighbors. The
amount of permanent musele relaxation will depend in large measure on the
proportionate nusibers of intuet and diseupted novwemuscle unity and the
umber which are reconstructed
‘Mechanism of Reconstruction
Tr iq nit enongh, there/are, 10 approximate the margins of laeerated mn
and fasrias and suruve then in place, Stel a procedure will ordinarily lead to
fh restoration of the gress form of te perineal structures hut will not in ftsel!
Then about a veturn io normal function, Ti some way, re-innervation of maxele
cells mast he aceonplished smd the injured muscle celle rmusi sain be educated
to fimetion,
The si
Pisehox* stated thy
nation most favorable fur n xeturn af fanetion is a demand for use
jit gener] an inactive injured muscle Will lose almost 80
per cent of is weight, while sn aetive injured musele will lose only 20 yer cent
Injured perinen) nnustle eclls are iit an ideal sitmation for niaintenaner of size
through activity, ‘The inferspeisod intaet mnsele cells are andinarily sitfieienthy
exercised
incentivs
tion of th
mn
cain th
with aan
lost ite 3
Van Har
striated
ov vests
anda
fh xrenter
ithe hq
applica
The
developed
and salve
Titeratung
have felt
indicated
their oft
histor
on all
the. uter
ahdonnina
nd fori
Th
restoratia
hase beer
Wyek"
of Foees |
cians ind
in the per
Onc
firm peti
the duty
thst the
hy: eontr
alter hiv
est
Past
tion af 2
seh req
Prive ta
nd pass
expert
Ce paila
inthe
jeme
sauont
nd in
Tend
ter oF
Vand
ations
imsele
rents
able
{that
Ney
vation
Th
mn the
a the
aiseles
rad (0
itself
nue
rented
ost 80
Peon
sxe
jently
plo BNEMOIN IN HERTORATION OF PEIN on
aomerons fo permit some contraction, and when dese muyeles aue netively
exereised, the injured usele cells are put to work at the sune tine, The
ineontive foy veirinervation, regeneration, and re-edueation is the need for fune=
tion of the nnasele as w whote
Th the cause of embryologie develupment, contractile muscle tissue is formed
eavlicn tian the nerves which supply it, and consequently nine cells heeone
seondavily Synexvated.? This ability of a nerve fher to establish a eonneetion
With a nele eell 18 earvied over into adlult life, amd a muselo cell whieh has
Tost its innervation way heeome yeinnervated under favorable cirenmstances.
Yan Harveveld? Billig anit yim Tiarveveld Arey" and others have shown that
striated nmele fibers afrophy wien they Inge hele nezve soppy but are expalle
fof esturation when reitnervated, A xingle nerve filer is eapable of growing
tnd of multiplying fis bnmelies way tines so thot it way eventually supply
fer neither of musele cells tham id originally. Tu no grogp of muscles
in the. homsr. bady are the yencral prineiples of wuxelecell rexeneration more
fo than ta those injured in ehildbirth,
weil for some method by whieh perinen! muscles way be preserved and
a. Hipniacrates tried il Injections, hut douches
fant salves, and Simmntty (a,b. 110) attempted styiport with the hand. Medical
Titeratave of the past centway reveals that many obstettielsns ond gynecologists
ave fel! that exervise or xonie other conservative meas of reeonstetction ix
findieated and should he of value during the ehildhearing age, hut. reeords of
their efforts have beer mone ar less relegated to the footnotes of gynecolouie
Listny. "Exercises sel as the assamption of the knee-chost yosition, walling
on all fous, lew maising and early postpartum getivity are valuable in aiding
the uteris fo resume its normal postion and in fauproving the tone of the
ahdaninal maseles, Phey do little, however, tw affect the state of the perineum,
‘and Zor its museles spectal exercises mre neeesiary
Specific Exercise
In the eurrent literiture there ji little mention pf exereises to promote the
vostoration of perineal function, end would seem that no satisfactory exercise
has heent found. One of the {evr velevenees to exercise és that of Seoti and Van
Wye who deseribed a procedure in whieh the patient eontraeiy the gluteal
neta, at the same time drawing in the reetim as though ro cheels the passage
ff fees Through the lower bowel, Personal cansmunieations frum many’ phys
iis indicate that it is 9 fairly common practice to instruct the patient so draw
§n the perineal region repeatedly
One repnrt of interest is thet, oF
an Skolleviki:* who ofwerved upnsnally
firm perinen among a the of natives in Soil Africa, He found that if wax
tho duty of the midivife, who was usually the mother oe iotlier-iustang, to sve
thae the young muther reeaverrd perineal strength after childbirth, Hsereise
by eontirdetion of vayival muscles on distended Buxgors way begun several dag
alter birth aud seas emitinned periodieally for several werkss, woitil the desived
result wa olifaines)
Past olxorvations of abstetvicians and gynecolagists in relation ton
fon of mnsely Fonction are inv acegril with te earielusiing Fearhed concerning
suelt regeneration thvopedh investigations conducted during World War TL
Prior to the war, the accepted treatment af injuned muscles was prolonged rest
and passive exereise, “Tt has heen forbid, however, that lent, whisling w
expert mizassyce, cleetvien! stination and -[litgard general aetivity. Dave
Their phiee, shot Cliey have rele rnacle an fatten ta 1 on preventedBry KEGEL fm Jog 8 oy
, atrophy, or loss of fimetion, With exeessively long periods of passive
shabibine
jan, mmvsele reflexes become sa impaived that actual paralysis is often
immobiliza
siurulated,
ing the recent war, according to a wer summany,” it was found that
Fomination is ensiey fo prevents than th restore.”” “In the preservation
ov restoration of musewlar function, nothing is more fundamental than the
Frequent repetition of correctly quided exercises” instituted by the patients
own offoris, “*Fxereise must he carried out against progressively inereasing
hrin direet proportion to the demands,
rrosistamen, ginee museles inerease in stren
placed upon then.”
Tt would seein rom the aeenmulated evidence that perineal exercises are
capeeinlly important for two purposes: (1) to promote a retam of normal muscle
Sunetion jn the immediate yortpartuia period a mmugele fanetion
in wornen will in the ebildhearing age who, heeause of musele-cell injury ineurred
fat a more distant time, suffer relaxation of the pelvie musenlatare.
For the past fifteen years I have experimented with various means of oxcr
ising the perineal museles, Any active exereise must he ditected primarily
foward drawing in the periueam, Only the exceptional woman, however, will
continue the oxereise long enough 10 prodaee results on mere instruction to da
this. Many wonten, in addition, have no “awareness of Sunetion” and, unless
provided with some way. of knowing whether or not they are being suceessfu
foo hoeome dizeomaged or are unwilling to make even an initial attempt
Tt seemed advisable, eonsermently, ta dovixe some method by whieh the
pationt might soe the results of her nelivity and be encouraged to eontinne her
offurts—io give her an actual inecntive to, inerease the eontraetile power a” her
perineal museles snd vaginel sphinciers.
The prineiple of restoring the fumetion of a segregated group of rnscles
with a sheeife. aid, method, ar jroxzam of ve-cditeation is well established
Tnyough constant use in the fields of orthopedies, nenromuserdar and plastic
ety, phywiea! medicine and zohabilitation. Lnsportant speeifieations eommon
to aceented methads of restoring Zametion of injured skeiotal museles are means
of segrezation, gaidmee, and progression,
‘An eavly theta wfuedied was Friinkel's'* (1805) re-education program for
Jocomatar ataxia, Methods recently dexcloped for rehabilitation of the war
injured and for eatablishment of awareness of fimetion in patients with infantile
paralysis gave valuable help iu this study. The most veeent developments in
this highly impovtant field are by Tuddelston and Colseth’* and by Billig,” who
re devised & method of registering nusele aetion patentials on a, Toxdspeaker
ao that the patient hexs inezeased sound when, he is pulling move acearately
with the musele heing, trainer! For Improved Sanetion,
The special sense which ordinarily activates the genital museles is the
inetilo ‘whielt obviously eannot he utilized in tyainiug, em neeount of its
iypersensitivity and eshaustibility, Sight is the most highs developed special
serse for the wiidanee of skeletal inagele artion, sad in the restoration of pexineal
tmisele, ftmetion the respnise to siglt sense’ guidance ig instantaneous, with
immediate anderstanding of the modus operand hy the patient,
‘The Perincometer
A. ymeumatic anparatas (Pig. 1) has heen devised specifically for the e
vise at birth canal muscles, with measurement of each tmuseular contraction
Wisille to the patient. A earl. (Fig. 2) is provided to kecp a recortl of the
“ilishisent-of cach exercise pevind and #erve ag & progress quide Zor both
‘sivian. ‘The apparagis eansists of « simple, halaniecd-resistaniee
patient and
aw
Dy mea
mereurs
cot of |
flange 2
with th
and pen
of the v
with me
pert
patient |
50 that 1
to conte
Pasi
especial
even afvtien
that:
ation
+ the
ent’s
vands
rasele
tion
axred
exer
vavily
5 will
todo
mules
ss
nt ab
h the
of hee
aseles
lished
plastic
means
atile
alg In
"who
realeer,
rately
is the
at its
special
evineal
a sith
of the
an Doth
dstanee
ginal chamber gperating at atmuspberie prosure and conreeted
hy means af Fabher tubing with a nemoueter ealilnated from 0 to 100 mm, of
nievemy. In construetion, tle vaginal ebanher is an, asiode-progessed rubber
cot of Specified consistency, lightly strotehod over a rigid slender eore wit
Aange at cach end. An ait vent, tn the eove conncets the emmatie ela}
with the tubing and wmanometer. The hese of the ehambor is fitted with a x
rar, tad nae ems ec aera Me
Bios PR SR, of PSM tee Seat, nas aie gy ee
and yermits pivoting into position. ‘Dhe length (8 em.) and diamoter (2 er.)
of the vaginal chamber are in conformity with anatomnie structures, especially
with regard to the anterior and posterior musculature of the vaginal wall. Th
operation, any prossure from 0 to 100 min, of mereitry exerted on the pueainatie
vaginal chamber is immediniely registered hy the dial of the manametor, Tho
patient i¢ instructed to insert the pneumatie chamber into the vaginal eavity
0 that the rubber disk resis auainst tho perineum. Sho is then told ta attempt
to contunct the muscles of the vagina while watelsmag the dial on the gage.
Pationts vary greatly in their ability fo contract the vaginel muyeles, Many,
‘specially those with marked reloxation of the pelvie floor, are unabie to rewister
even a few millimeters of pressure on their initiel attempts. (Gradually, after¥
dun
withROUSH IN RESVORTION OF PRRINEUM
rnd as the museles Decome stronger throvzh exercise, the pressure
prneli¢
Wehieh ean tie exerted inervasee amd Sveqptenily reaches 61 to 80 ov more milli-
meters of mererry
Since the instrument measmres the degree of contraction of the perinenl
mavelos, it hax been called’ the “Perineoreter.”” Tt iv a simple pmeumatie
apparatny waieh Tanetions auly to show that museular contraction is taking
place snd th uicasure the eontreetion, Tis only aetion iy to provide » medina
Retween mitisele action and silt, ‘There is no ymovision to stimubste muscle
ceontraction, no dacs it provide Zor passive exereise in any way, ‘The apparutus
Aris constmeted with the view tint any juibitting or wasging action wut
feat its puepose and would prove detrimental, huomful, and wseless, wd that,
in the preservation or mestoration if perineal! mnseular function, nothing is
hore fanlamental shan exeresae instituted by the patient's awn efforts,
Clinical Application
1e initial test with the) apparatus requires Fess than five minates and i
nade in the eowse of physieal eSnmination, The watient iy instructed to exercise
twenty minutes tinve dimes daily amd fe. record Toth tie periady and the omise
sions oF exercike on her chart. ‘The perio over w is my to eaery
tut this procelure varies Wheipally in yelation fo the state of the perineum
ni the finte exereises are commented and to the diligence of the patient. Initial
presence aie ahyenee af awraveniess of fanetion and euordinatiun also is.on. inapor
Lint factor, An vceasional pintient may experience reat diffeclty hn gaining
awareness of funetion
Restoration of tone and Souetion to lax or atrophied perinenl muscles re-
quives fram twenty to forty houes of proueessive resistance exeveise, spread over
twenty ta sisty days, AS a Teale, yong patients promess move ta
colder antes, Init ane Wonian of 5S biezvawd her eontractile strength from 10 to
$00 inn. of meremy without undue effort in thirty days, ‘The period reawized
for masini results varies als according. to the purpose fax which Perineome
exercise is preseribed, whether to rstore tone and tanetion in the immediate
posipattan periud, to imprave early exstocele or veclucele during: tie. child:
hearing yours, to iiipruve fhe vaginal wgseles xo that a contraceptive diaphragm
nay: he setained" oF fo relieve winary sizes incontinence, When satisfactory
Tsults are not nebieved in a reasonable period, the patient may he exereisine
ahdottinal aiuteal, or other extuaneous muscles fo affeet dial readings, Backache
Or ahdominal distvess also suggest that the Weoag nnuseles axe heing used. ‘The
Patient who complains of fatigme prohwhly is exexting greater effort than is
For these reasons the patient shonld he seen. at least ones 2 week,
yy be property direeted.
arly, she iy enemraged to atternpt to
nevease the pvsware T to 2 mm, of mercury daily and to Keep a veeund oF the
nnsinuis eontraetiin af whieh she is eapable at eel esereise period, For this
Prose the graphie chart jas heen prepared, ty enable her to record the pres
Rares register Oi the dial, ‘The aettal reeord kent dy one patient is shown in
gD With minor variations any woman with reasonable diligence may
duplivate the record shown,
‘The types of ewatenctions of whieh this patient was eapable x
While the patie
with her exereies and evideneed progressive restoration of tnetion
In Pigg fed, Brand 6. While Ike period neeessane Tar masiinum restoration of
finetion by exereise may vary, i is posible te diseerm shires or fae phases of
Aecclojment. The reser eliose: for ilust ation shuns four phases rather event
Aidtihnted iver four weeks, The fist phase, the period required to establish246 KEGEL Se hOB ore
awareness of Zunetion and coordination, may be absent or brief or veqnire as
long ag eight days, ‘The sceand phase is a transitional phase, The third phase,
‘evio« of regeneration, is aveoanized grossly by the gradual inovease of resist
noice registered, Tt is daring this phage thot a ehange in symptams, such as
lief of uniamy fueontinenee, seems, The phawe of restoration is recognized by
a leveling ont of the resistzmee whieh the msenlar contractions are able to over
fore, usally hove 60 mm. of mneveury pressure, A leveling out at less than 40
nnn. is sa indiention that the lower vaginal muscles have been aetive and that
with eantinnation of exervise the muscles in a. higher plane will show evidenee of
regmieration, Tu meet the lutte euntingeney, ane speeifeation of the pneumatic
vautinal ehnmnbor is that Tt shall he eompressible but uot expansible, TE eompres.
sion of cine segment were to enue ballooning of another segment of te chamber,
iL wuld he posible for strung amuseles fo undergo development at the expense
‘of Weaker ratieles,
While progressive resistance exereise with the aid of the Perincometer is
useful whenever it Is dlearable to strengthen pevineal museles, work now being
dono ny relieving, urinary stress ineontinenee Tnrnishes an exeellent exainple of
‘he effeaey af the method, ‘Ty date (May 20, 1948), the condition has lieen
reliever! i 64 cuss, Thatfiefent time lias elapsed to justify a statistical repovt
‘on this sinies, Tint ihe patient longest under observation has remained dry for
‘unsteen months. Same of the women treated had warn pads eoutinuonsly for
as Tong as cloven years; thes had underinie one to three plastie operations,
without relief, There have heen no failures when the condition was dae pri
auvily to relaxation or atrophy of the anteriar vaginal museles and the patient
Tradl wh least jartial eoutied at times.
The mother has heen used alo to improve tone of muscles and texture of
tissues in the presence of anal ineontinenge, and apparently facilitated repaie
A patient with mdimentary vagina and eongenital alsonce of the uterus was
instructed fo use the “Perincameter"” after plastic procedures to enlarge the
vagina, and inereased sphinetey aetfon trom 0 to 40 mm, contractile strength.
Summary,
‘The passage of the fetal head through the vagina during delivery is in-
Vurially sitended by mmscle injury. Bscossive teusion sever motor end-
plutes attached to muscle eclls fvom the terminal nerve ‘laments to which th
deter geld ata eter
TENS ie ab ce ED PFE Bia en aa Bice ne
een a se magn
Ba tanga Oe EPED tls
BHlienee sf dnevad Retion exis
‘Sourar SP Tineke Peved Bens aadeanic polke aetten
2PNERCISH IN RESTORATION OF PHRINBUM a4
|
ee toninde om enpoeite pe)8 Yo he 8 pe
fave normally commeeted ‘This partial Joss af iunercation is in Torge measure
espousihle. for the relaxation of perineal muscles sv commonly: oliservedd ater
ehildbivth
“Bxperience has shown thot a dontand for use is Che most important fetor
in restoring fle funetional eayeity’ of any skeletal anaseie, Active exercise will
aid in the reinnervation of injured nusele cells and will being about a return of
nortal eontratility
‘The shorter the time elipsing hetween muselo
surgieal proceduve and the hegiuting of exereise, the less wll be the amomt
Of tissue afeuphy and the sovier will he the tine necessary to re-establish not
smal funetion,
Bxereise with the Perineometer is useful In restoring frmetion and tone ity
the immediate postpartum pexiod, improving early eystuvele and seetorcle du
ing the childbearing yous, impruving the vauinal museles so that a contricey-
tive diaphragin may he retained, and relieving wrinary stress incontinence
Sunstieal procedures for the correction of vaginal, wrethiral, znd rectal in=
competence may be facilitated iy preoperative and postoperative exereise whieh
Inyproves tle texture, tone, and fumetion of perineal waxsces.
The “Pevineometer,”” im instrament devised to register musele euntraction
of great value as a viene! aid 1 guiding the patient duving the eouve of her
oxeredxes and in encouraging her to coutinite until the desired result is attained
‘The method of exereise descriled suggests « new approach to the studies of
perineal pliysiology as related to physics
\jury due to ebildbinth or a
References
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Darel, latte Soothe 863,472 318-9,
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CB Ee Yer and tan Hatrereldy Az (8 Nav. 21, Toll, 4104, 104
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i Finustaltes, Har Newopath, & Paper
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1, 80010 We Ay and Va Wek, HL
“pniladelfibig WH, tat & eh
Yan Sonkvils, Bors gemnuae
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iin; Daruthy. At Pema communi
TF, Powell, racy O., Peraaal combaneat ion
(200
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