Sunday, March 1, 2015

ការលេចទឹកមូត្រ/លាមក/ដើរខ្យល់ដោយអចេតនា/ចៃដន្យ (Incontinence - Urine/Faeces/Wind)

ដកស្រង់ពីអត្ថបទ Pelvic Floor First

តើអ្នកធ្លាប់មានអារម្មណ៏ ឬ ធា្លប់មានបទពិសោធន៏ថា
  • លេចទឹកមូត្រដោយចៃដន្យពេលកំពុងប្រាណ សើច ក្អក ឬ កណ្តាស់
  • ត្រូវទៅបង្គន់យ៉ងប្រញាប់ប្រយាល់តែទៅមិនទាន់ពេលវេលា
  • ត្រូវទៅបង្គន់ជាញឹកញាប់
  • មានការពិបាកក្នុងការបញ្ចេញទឹកមូត្រ ឬ បត់ជើងធំអោយអស់ក្នុងពេលតែមួយ
  • បាត់បង់ការត្រួតត្រាលើប្លោកទឹកមូត្រឬការបន្ទោរបង់លាមក
  • បញ្ចញខ្យល់ (ផោម) ដោយចៃដន្យ
  • ចំពោះស្ត្រី ខ្មែរយើងតែតតែហៅថា "ធ្លាក់ស្បូន" (Uterus Prolapse: កើតមានឡើងនៅពេលដែលសាច់ដុំ និង សរសៃពួរឆ្អឹងធ្លាក់ចុះខ្សោយ ឬ ខូចខាត ហើយធ្វើឱ្យស្បូនធ្លាក់ចូលទៅក្នុងទ្វារមាស។ មូលហេតុដែលបណ្តាលអោយមានបញ្ហានេះរួមមានការប្រសូតកូន ធាត់ជ្រុល ហួសហេតុ ក្អករ៉ាំរ៉ៃ សំពាធរ៉ាំរ៉ៃ និង ការផ្លាស់ប្តូរអ័រម៉ូនបន្ទាប់ពីការអស់រដូវខែ។ 
  • ចំពោះបុរសពួកគេមានអារម្មណ៍ថា ដូចជាប៉ោងនៅក្នុងរន្ធគូថ ឬ អារម្មណ៍ថា គេត្រូវតែបន្ទោរបង់ ប៉ុន្តែវាគ្រាន់តែជាអារម្មណ៏មួយប៉ុណ្ណោះ។
  • ការឈឺចាប់នៅក្នុងតំបន់អាងត្រគៀក ឬ
  • នៅពេលរួមភេទ។


The Pelvic Floorសាច់ដុំទ្រនាប់នៃអាងត្រគាក គឺ ជាមូលដ្ឋាននៃក្រុមសាច់ដុំដែលហៅថា "ស្នូល" របស់អ្នក។ សាច់ ដុំទាំងនេះស្ថិតនៅក្នុងឆ្អឹងអាងត្រគាករបស់អ្នកវាអាចលាតសន្ធឹងពីឆ្អឹងត្រគាតទៅទល់នឹងឆ្អឹងគូថ និង ពីឆ្អឹងត្រគាតម្ខាងទៅម្ខាងទៀត (រូបភាពទី ១) ។

សាច់ដុំជាន់អាងត្រគាក ជាមួយនឹងសាច់ដុំដ៏ទៃទៀត ដែលស្ថឹតនៅផ្នែកខាងក្នុងនៃសាច់ដុំពោះ សាច់ដុំខ្នង និងសាច់ដុំបន្លាប់ពោះសហការគ្នាដើម្បីរក្សានូវស្ថេរភាព និង គាំទ្រដល់ឆ្អឹងខ្នងរបស់អ្នក។ ពួកគេក៏បានជួយសម្រួលដល់ការគ្រប់គ្រងសម្ពាធនៅផ្នែកខាងក្នុងពោះ ដើម្បីទប់ ទល់ជា មួយនឹងកម្លាំងជំរុញទៅផ្នែកខាងក្រោមនៃពោះ ពេលដែលអ្នកលើករបស់របណាមួយ ឬ សំពាធណាមួយពេលកំពុងហាត់ប្រាណ។

The pelvic floor

The pelvic floor is the base of the group of muscles referred to as your ‘core'. These muscles are located in your pelvis, and stretch like a trampoline or hammock from the pubic bone (at the front) to the coccyx or tail-bone (at the back) and from side to side (diagram 1). 
The pelvic floor muscles work with your deep abdominal (tummy) and deep back muscles and diaphragm to stabilise and support your spine. They also help control the pressure inside your abdomen to deal with the pushing down force when you lift or strain - such as during exercise.
The Pelvic FloorPelvic floor muscles support the bladder and bowel in men, and the bladder, bowel and uterus in women. They also help maintain bladder and bowel control and play an important role in sexual sensation and function.

Signs of a pelvic floor problem

Common signs that can indicate a pelvic floor problem include:
  • accidentally leaking urine when you exercise, laugh, cough or sneeze
  • needing to get to the toilet in a hurry or not making it there in time
  • constantly needing to go to the  toilet
  • finding it difficult to empty your bladder or bowel
  • accidentally losing control of your bladder or bowel
  • accidentally passing wind
  • a prolapse
    • in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
    • in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
  • pain in your pelvic area, or
  • painful sex .

How do pelvic floor problems occur? 

Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight. 
Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain life stages such as pregnancy, childbirth or menopause.
Some people have pelvic floor muscles that are too tight and cannot relax. This can be made worse by doing squeezing exercises and overworking the muscles without learning how to relax .
Pelvic floor muscle fitness is affected by a number of things. These include:
  • not keeping them active or over working them 
  • being pregnant and having babies
  • a history of back pain
  • ongoing constipation and straining to empty the bowels
  • being overweight, obese or having a body mass index (BMI) over 25
  • heavy lifting (e.g. at work or the gym)
  • a chronic cough or sneeze, including those linked to asthma, smoking or hayfever
  • previous injury to the pelvic region (e.g. a fall, surgery or pelvic radiotherapy), and
  • growing older.
If you experience pelvic floor (or bladder or bowel control) problems it is advisable to see a continence professional to determine the cause of your symptoms and discuss the best treatment and management options to suit your needs. This may include an individually tailored pelvic floor muscle training program to help get you back in control.

Working your pelvic floor

Although it is hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg or abdominal (tummy) muscles. Strengthening your pelvic floor muscles will help you to actively support your bladder and bowel. This improves bladder and bowel control and reduce the likelihood of accidentally leaking from your bladder or bowel   Like other muscles in your body, your pelvic floor muscles will become stronger with a regular exercise program. This is important for both men and women.
Speak to a continence professional who can assess your pelvic floor and develop an individualised pelvic floor muscle training  program for you.

The benefits of pelvic floor muscle exercises

Pelvic floor muscle exercises can help:
  • improve bladder and bowel control
  • reduce the risk of prolapse 
    • in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
    • in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
  • improve recovery from childbirth and gynaecological surgery (in women)
  • improve recovery after prostate surgery (in men)
  • increase sexual sensation and orgasmic potential, and
  • increase social confidence and quality of life.
Before starting a pelvic floor muscle training program it is important that you can identify your pelvic floor muscles correctly. Speak to a continence professional if you have difficulty identifying your pelvic floor  muscles, are unsure if you are performing the exercises correctly or are continuing to experience bladder or bowel control symptoms.
It is best to have a continence professional assess your pelvic floor and develop an individualised pelvic floor muscle training program for you.

Exercising your pelvic floor

To learn more about how to correctly exercise your pelvic floor muscles follow the links below: 

The pelvic floor and core

The pelvic floor muscles form the base of the group of muscles commonly called the ‘core’.  These muscles work with the deep abdominal (tummy) and back muscles and the diaphragm (breathing muscle) to support the spine and control the pressure inside the abdomen. 
During exercise, the internal pressure in the abdomen changes. For example; when lifting a weight - the internal pressure increases, when the weight is put down – the internal pressure returns to normal
In the ideal situation the regulation of pressure within the abdomen happens automatically. For example, when lifting a weight, the muscles of the ‘core’ work together well- the pelvic floor muscles lift, the abdominal and back muscles draw in to support the spine, and breathing is easy (Diagram 1). In this scenario, the pelvic floor muscles respond appropriately to the increase in abdominal pressure.
If any of the muscles of the ‘core’, including the pelvic floor, are weakened or damaged, this coordinated automatic action may be altered.  In this situation, during exercises that increase the internal abdominal pressure, there is potential to overload the pelvic floor causing depression (Diagram 2). When this happens many times during each exercise session, over time this may place strain down on the pelvic organs and this may result in loss of bladder or bowel control, or pelvic organ prolapse.  If a problem already exists, then pelvic floor symptoms can potentially be worsened.
Correct action and incorrect action
 Diagram 1. Correct action             Diagram 2. Incorrect action
Pelvic floor muscles need to be flexible to work as part of the ‘core’, which means that they need to be able to relax as well as lift and hold. It is common for people to brace their ‘core’ muscles constantly during exercise in the belief they are supporting the spine, but constant bracing can lead to the muscles becoming excessively tight and stiff. 
Pelvic floor muscle stiffness commonly coexists with muscle weakness and can contribute to problems such as urinary urgency and leakage.  Other problems often associated with the pelvic floor muscles being too tight include pelvic pain, pain with intercourse and difficulty emptying the bladder. 

Common myths

There are many myths about pelvic floor muscle exercises. Here we explore the most common myths and misconceptions and reveal the truth between fact and fiction. 

Pelvic floor muscle exercises are easy to do

Pelvic floor muscle exercises are not always easy to do. The pelvic floor muscles are complicated muscles which are hard to isolate.

You learn pelvic floor muscle exercises from a pamphlet

Pelvic floor muscle exercises can be learned from a pamphlet by some people, but research shows that up to 50% of women trying to do pelvic floor muscle exercises from a pamphlet get the technique wrong. For both men and women, practicing the wrong technique will not help and could even make the problem worse.

Pelvic floor muscle exercises don't work

Research shows that pelvic floor muscle exercises are effective for some types of incontinence such as stress incontinence and/or an overactive bladder causing urge incontinence. They can also help faecal incontinence when the cause of the problem is a weak pelvic floor. However, they will not work if there are other causes of urine or bowel motion leakage (for example, infection, inflammation or underlying bowel disease).
There is ample evidence to show that pelvic floor muscle exercises are effective when the exercises are done correctly and when taught and supervised by a physiotherapist who specialises in continence and women's health or a Continence Nurse Advisor. If your 'do-it-yourself' pelvic floor muscle exercise program did not work, then chances are they were not done the right way. Get help from a health professional to confirm that your technique is correct and have an individualised training program specifically developed for your problem and the condition of your pelvic floor muscles.

Pelvic floor muscle exercises are done by stopping the flow of urine over the toilet

This is a common misconception. Stopping the flow of urine on the toilet is not an exercise but is one way of identifying the pelvic floor muscles.

I'm too old for pelvic floor muscle exercises

Some people say "Pelvic floor muscle exercises won't work for me, I'm too old". This is not true. Age is no barrier to the benefits of pelvic floor muscle exercises. There is evidence to suggest that older people are just as likely to benefit from pelvic floor muscle exercises for incontinence as younger people.

I've had a baby, the damage is done

Just because you've had a baby doesn't mean pelvic floor muscle exercises won't help. Postnatal pelvic floor muscle exercises have been shown to assist in the recovery of pelvic floor muscle function and to reduce or cure the likelihood of urinary incontinence in women who have had instrumental births or big babies.

I don't need to do pelvic floor muscle exercises

Everyone (including women who haven't had a baby, and men) can benefit from doing pelvic floor muscle exercises. For women, pelvic floor muscle training is important to control incontinence which may start during pregnancy. Pelvic floor muscle exercises done during pregnancy will help the recovery of pelvic floor muscle function and bladder control after the birth of the child. New research shows that strong pelvic floor muscles will not make birthing more difficult.
For men, pelvic floor muscles not only help to control the bladder and bowel but they also assist in sexual function.

I can't sit on the floor therefore I can't do them

Some people think that pelvic floor muscle exercises are done on the floor. In reality however, these exercises can be done in any position. The word 'floor' merely refers to their position at the bottom (or floor) of the pelvis. In fact, they should especially be done standing up as control of urine leakage is usually most necessary when upright.

Men don't have a pelvic floor

Men do have pelvic floor muscles. These muscles can even be trained to improve bladder control after prostate surgery.

How to learn more

To learn more about pelvic floor exercises, including how and where to get professional help, contact the National Continence Helpline on 1800 33 00 66.

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