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Jak fizjoterapia wpływa na rekonwalescencję kobiety po porodzie?

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Zarówno kobiety po cesarskim cięciu, jak i porodzie naturalnym, powinny rozważyć podjęcie rehabilitacji w okresie połogowym. Odpowiednio wcześnie rozpoczęte zabiegi fizjoterapeutyczne mogą pomóc kobietom w zapobiegniu niekorzystnym zmianom, jakie wywołał poród, a także cały okres ciąży. Fizjoterapia po porodzie pozytywnie wpływa m.in. na gojenie się ran i proces kształtowania się blizn poporodowych.

Fizjoterapia połogowa zajmuje się powikłaniami i dolegliwościami, które powstają w czasie ciąży i podczas porodu, m.in. terapią dna miednicy, tkanek miękkich (blizny po cięciu cesarskim), a także wspiera pacjentki w stopniowym wdrażaniu aktywności fizycznej.

Jakich dolegliwości mogą doświadczać kobiety po porodzie?

Po ciąży i porodzie kobiety mogą doświadczać m.in. wysiłkowego nietrzymania moczu, opadania narządów wewnętrznych, rozejścia mięśni brzucha, rozstępów skórnych czy problemów laktacyjnych, a także dolegliwości bólowych, szczególnie w obrębie kręgosłupa lędźwiowego i szyjnego.

Pacjentki niejednokrotnie doświadczają także dyskomfortu z powodu kształtowania się blizny po cesarskim cięciu lub nacięciu krocza. Nacięcie krocza może wywołać problemy w funkcjonowaniu układu płciowo-moczowego, a także uczucie ciągnięcia, kłucia i bólu przy współżyciu. Z kolei blizna po cesarskim cięciu powstaje nie tylko na skutek przerwania ciągłości tkanek skórnych, ale także mięśni i na macicy. Jeżeli pomiędzy bliznami utworzą się dodatkowe zrosty, może to prowadzić do ograniczenia ruchomości.

Kiedy rozpocząć rehabilitację po porodzie?

Okres połogu trwa 6 tygodni od porodu naturalnego i 12 tygodni od cesarskiego cięcia. W tym czasie narządy wewnętrzne wracają do pierwotnego położenia i goją się rany poporodowe. Zwiększa się również napięcie powłok brzusznych i zmniejsza ukrwienie macicy. Rehabilitacja w połogu powinna zostać wdrożona już w pierwszych godzinach od narodzin dziecka, by zapobiec ewentualnym powikłaniom. Jeżeli nie istnieją przeciwwskazania do ćwiczeń (m.in. wysoka temperatura ciała, choroby układu krążenia, ból, krwiaki poporodowe, znaczny ubytek krwi podczas porodu), a samopoczucie pacjentki jest wystarczająco dobre, rehabilitację można rozpocząć po 6-8 godzinach od porodu naturalnego i 10-12 godzin po cesarskim cięciu.

Rozpoczęcie ćwiczeń w okresie połogu niesie za sobą wiele korzyści. Przede wszystkim wpływa na odnowę tkanek, pozwala na przywrócenie prawidłowej postawy ciała, zapobiega nietrzymaniu moczu czy zmniejsza ryzyko zakrzepów. Ponadto fizjoterapia wdrożona w krótkim czasie po porodzie pozytywnie wpływa na proces gojenia się ran, zmniejsza ryzyko zrostów i ogranicza ewentualne dolegliwości bólowe związane z kształtowaniem się blizny. 

Jakie ćwiczenia zalecane są podczas rehabilitacji po porodzie?

Plan ćwiczeń i zabiegów opracowywany jest przez fizjoterapeutę po ocenie stanu pacjentki. Intensywność ćwiczeń dostosowywana jest do możliwości kobiety i zwiększa się wraz z upływem czasu od porodu. Przykładowe ćwiczenia i zabiegi zalecane przez fizjoterapeutę to:

  1. Ćwiczenia przeciwzakrzepowe – polegają na ruchach dystalnych części ciała. Są one szczególnie wskazane kobietom po cesarskim cięciu i trwale unieruchomionym po porodzie (np. w wyniku powikłań). Wdrożenie ćwiczeń w ciągu pierwszych 12-48 godzin pozwala na zminimalizowanie powikłań zakrzepowych.
  2. Ćwiczenia na mięśnie dna miednicy – zapobiegają wysiłkowemu nietrzymaniu moczu oraz zmniejszają ryzyko obniżenia lub wypadania narządów. Pacjentkom w pierwszych dniach od porodu zaleca się kontrolę postawy ciała, włączenie napięć mięśnia poprzecznego brzucha oraz koncentrację na oddychaniu przeponą. Można również wdrożyć ćwiczenia hipopresyjne, które m.in. zmniejszają nacisk narządów na dno miednicy powodując wyraźne ich podciąganie, a także ćwiczenia na mięśnie Kegla.
  3. Ćwiczenia oddechowe – w czasie ciąży przepona oddechowa była ściśnięta i nie pracowała w pełnym zakresie. W czasie połogu pacjentkom zaleca się więc oddychanie przeponowe (w czasie oddechu unosi się brzuch, a nie klatka piersiowa).
  4. Mobilizacja blizn po nacięciu krocza i cesarskim cięciu – terapia blizny obejmuje manualne mobilizacje, czyli techniki masażu i rozluźnianie mięśniowo-powięziowe, a także kinesiology taping. Pacjentki są również instruowane przez fizjoterapeutów, by wykonywać mobilizację blizny samodzielnie. Manualna mobilizacja blizny może być również wspierana zabiegami fizykalnymi, takimi jaj laser biostymulacyjny, ultra dźwięki czy jonoforeza.
  5. Rozstępy – na tę dolegliwość skórną fizjoterapeuci mogą zalecić zabiegi z wykorzystaniem lasera biostymulacyjnego, ultra dźwięków, jonoforezy, lampy sollux.
  6. Ćwiczenia na zaburzenia laktacji – matki karmiące często spotykają się z nadmierną produkcją pokarmu, której towarzyszą dolegliwości bólowe oraz zatykanie się kanalików mlecznych. Zabiegi fizjoterapeutyczne mają na celu wspomaganie udrażniania kanalików. Specjaliści proponują m.in. masaż, kinseiology taping, zimne i ciepłe okłady.

Źródła: praktycznafizjoterapia.pl, znana-polozna.pl, fizjomama.pl, fizjoplaner.pl

 

Przeczytaj także: Rana po cesarskim cięciu – pielęgnacja i możliwe powikłania

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Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

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