골반저 근육(pelvic floor muscle)

[문형철]

1. 골반저근육은 복횡근과 동시수축

2. 팔을 뻗을때 복횡근과 골반저근육은 대뇌반응보다 빠르게 먼저 수축

3. 허리디스크, 골반통증, 고관절 통증이 있으면 골반저 근육의 기능부전(dysfunction)이 발생

4. It is important in providing support for pelvic viscera (organs), e.g. the bladder, intestines, the uterus (in females), and in maintenance of continence as part of the urinary and anal sphincters. 

5. 케겔운동법의 주인공 - 바이오피드백으로 정확하게 하지 않으면 소변실금에 그렇게 효과적이지 않음. 

6. 내생각 - 코어강화운동이 효과적!!

7. Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia(외음부통증). 

골반저 근육이 정상적으로 기능을 하도록 하기 위해서 우리는 무엇을 해야할까?

이 생각을 하면서 아래 글을 보자

panic bird..

The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects. The pelvic floor separates the pelvic cavity above from the perineal region (including perineum) below.

- 골반저 근육은 levator ani, coccygeus근육과 결합조직으로 구성됨. 

골반저 근육의 기능

The right and left levator ani lie almost horizontally in the floor of the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal. The levator ani is usually considered in three parts:pubococcygeus, puborectalis, and iliococcygeus. The pubococcygeus, the main part of the levator, runs backward from the body of the pubis toward the coccyx and may be damaged during parturition. Some fibers are inserted into the prostate, urethra, and vagina. The right and left puborectalis unite behind the anorectal junction to form a muscular sling. Some regard them as a part of the sphincter ani externus. The iliococcygeus, the most posterior part of the levator ani, is often poorly developed.

- levator ani 근육은 양측으로 존재하고, 세부분으로 나뉨 pubococcygeus, puborectalis, iliococcygeus

The coccygeus, situated behind the levator ani and frequently tendinous as much as muscular, extends from the ischial spine to the lateral margin of the sacrum and coccyx. 

The pelvic cavity of the true pelvis has the pelvic floor as its inferior border (and the pelvic brim as its superior border). The perineum has the pelvic floor as its superior border.

Some sources do not consider "pelvic floor" and "pelvic diaphragm" to be identical, with the "diaphragm" consisting of only the levator ani and coccygeus, while the "floor" also includes the perineal membrane anddeep perineal pouch.^[2] However, other sources include the fascia as part of the diaphragm.^[3] In practice, the two terms are often used interchangeably. Posteriorly, the pelvic floor extends into the anal triangle. The pelvic floor has two hiatuses (gaps): Anteriorly urogenital hiatus through which urethra and vagina pass through and posteriorly rectal hiatus through which anal canal passes.^[4]

It is important in providing support for pelvic viscera (organs), e.g. the bladder, intestines, the uterus (in females), and in maintenance of continence as part of the urinary and anal sphincters. It facilitates birth by resisting the descent of the presenting part, causing the fetus to rotate forwards to navigate through the pelvic girdle. It helps maintain optimal intra-abdominal pressure.^[4]

골반저 근육의 중요성

In women, the levator muscles or their supplying nerves can be damaged in pregnancy or childbirth. There is some evidence that these muscles may also be damaged during a hysterectomy. Pelvic surgery using the "perineal approach" (between the anus and coccyx) is an established cause of damage to the pelvic floor. This surgery includes coccygectomy.

In female high-level athletes, perineal trauma is rare and is associated with certain sports (each with a distinct type of trauma): water-skiing, bicycle racing, and equestrian sports.^[5]

Damage to the pelvic floor not only contributes to urinary incontinence but can lead to pelvic organ prolapse. Pelvic organ prolapse occurs in women when pelvic organs (e.g. the vagina, bladder, rectum, or uterus) protrude into or outside of the vagina. The causes of pelvic organ prolapse are not unlike those that also contribute to urinary incontinence. These include inappropriate (asymmetrical, excessive, insufficient) muscle tone and asymmetries caused by trauma to the pelvis. Age, pregnancy, family history, and hormonal status all contribute to the development of pelvic organ prolapse. The vagina is suspended by attachments to the perineum, pelvic side wall and sacrum via attachments that include collagen, elastin, and smooth muscle. Surgery can be performed to repair pelvic floor muscles. The pelvic floor muscles can be strengthened with Kegel exercises.

Disorders of the posterior pelvic floor include rectal prolapse, rectocele, perineal hernia, and a number of functional disorders including anismus.Constipation due to any of these disorders is called "functional constipation" and is identifiable by clinical diagnostic criteria.^[6]

Pelvic floor exercise (PFE), also known as Kegel exercises, may improve the tone and function of the pelvic floor muscles, which is of particular benefit for women (and less commonly men) who experience stress urinary incontinence.^[7][8] 

However, compliance with PFE programs often is poor,^[7] PFE generally is ineffective for urinary incontinence unless performed with biofeedback and trained supervision,^[8] and in severe cases it may have no benefit. Pelvic floor muscle tone may be estimated using a perineometer, which measures the pressure within the vagina. Medication may also be used to improve continence. In severe cases, surgery may be used to repair or even to reconstruct the pelvic floor. It has been reported that patients who have overly-toned musculature may suffer from inability to relax the pelvic floor muscles - in effect, Kegel exercises would only exacerbate the problem.http://www.massagetoday.com/mpacms/mt/article.php?id=13515

Perineology or pelviperineology is a speciality dealing with the functional troubles of the three axis (urological, gynaecological and coloproctological) of the pelvic floor.

골반저 근육 기능부전

Pelvic floor dysfunction refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, lower back, coccyx, or hip joints. Tissues surrounding the pelvic organs may have increased or decreased sensitivity or irritation resulting in pelvic pain. Many times, the underlying cause of pelvic pain is difficult to determine.^[1]

Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.

The major known causes include obesity, menopause, pregnancy and childbirth.^[2] Some women may be more likely to developing pelvic floor dysfunction because of an inherited deficiency in their collagen type.^[3] Keane et al. in their study suggest some women may have congenitally weak connective tissue and fascia and are therefore at risk of stress urinary incontinence and pelvic organ prolapse.

By definition, postpartum pelvic floor dysfunction only affects women who have given birth, though pregnancy rather than birth or birth method is thought to be the cause. A study of 184 first-time mothers who delivered by Caesarean section and 100 who delivered vaginally^[4] found that there was no significant difference in the preval‎ence of symptoms 10 months following delivery, suggesting that pregnancy is the cause of incontinence for many women irrespective of their mode of delivery. The study also suggested that the changes which occur to the properties of collagen and other connective tissues during pregnancy may affect pelvic floor function.

It is estimated that at least one-third of adult women are affected by at least one of these conditions. Furthermore, statistics show that 30 to 40 percent of women suffer from some degree of incontinence in their lifetime, and that almost 10 percent of women will undergo surgery for urinary incontinence or pelvic organ prolapse. 30 percent of those undergoing surgery will have at least two surgeries in trying to correct the problem.^{[citation needed]}

Some conditions are reversible, with pelvic floor exercises, or Kegel exercises recommended to strengthen the area muscles. Devices and probes are also available over the counter which purport to increase pelvic floor tone by stimulating muscle contractions with electrical impulses.

골반저 근육의 Trp

PIR로 스트레칭 하는 방법

기능적 수축-이완을 통해 Trp를 치료하는 방법 등이 있음.