RESUMO
A new approach to pelvic floor rehabilitation is presented. The aim was to strengthen the three directional muscle forces observed during effort along with their ligamentous insertions. A new anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. Where relevant, HRT was administered to prevent long-term collagen loss. Electrotherapy, fast and slow twitch exercises strengthened the striated muscles of the pelvic floor and, therefore, their insertions also. Sixty patients aged 15--86 (mean age: 55 years) were independently assessed at the end of the 3 month programme using the same semiquantitative questionnaire and self-assessment. The median improvement rate per symptom was 65%. Symptom improvement was: stress incontinence,78%; urgency, frequency, 61%; nocturia, 75%; pelvic pain of unknown origin, 65%; involuntary leakage, 68% and bowel problems, 78%. Three patients reported significant worsening of their stress symptoms. This method potentially broadens the conditions amenable to nonsurgical therapy. The preliminary results are promising, and appear to sustain the theory on which they are based. More objective and longer term data, and especially, comparative testing of this regime by other investigators is required.
