A wide variety of pathologies are encountered in male pelviperineal rehabilitation at the urinary, anorectal and sexual levels: urinary incontinence, anal incontinence, chronic pain, erectile dysfunction (ED), etc. It could be of value for a physiotherapist to use INDIBA at 448 kHz as an adjuvant for conventional rehabilitation. It should be remembered that access to the pelvic floor is relatively difficult, whose rehabilitation route in men is primarily by rectal touch, alternatively via the central fibrous nucleus. The traversing effect of Indiba® provided by the energy path between the resistive electrode and the neutral electrode (return plate) results in action on deep structures without the necessity of this type of invasive manipulations. In addition, the pelvic diaphragm of men contains striated muscles controlling active urinary and anal continence (Kegel exercises) and it is also a structure of support, provided by aponeuroses, fascias and ligaments. We also find the ground substance of the male reproductive system. The RF at 448 kHz has been shown to be highly effective towards all these structures, with anti-inflammatory, analgesic and regenerating effects.
Treating erectile dysfunctions
The causes of erectile dysfunction may be psycho¬logical, hormonal, drug-related, vascular, neurological or structural. When considering erection physiology, the RF would complement rehabilitation by increasing the blood supply and by regulating connective tissue quality and thus the tunica albuginea, guaranteeing a satis¬fying erection by an antifibrotic action on connective tissue in the presence of adhesions, e.g. Peyronie’s disease, and by regulating cell action of neurological tissue. It would also be of value for retaining penis elasticity that decreases with age, sclerosis being more frequent in the absence of voluntary or induced erections, e.g. after prostate surgery.
Treating urinary incontinence
Pelvic floor muscle training is proposed as first-line treatment. It is important to manage the respiratory system (among other things), in particular the diaphragm that vitalises and stabilises the abdominal cavity. By considering the entire lumbar- abdominal-pelvic cavity, har-monising becomes easier as a result of tra¬versing currents, and of muscle, tendon and ligament structures. In this case, Indiba® is used to increase the rapidity of diaphragm relaxation work.
Concerning the overactive bladder syndrome, the approach is more difficult because of the origins occasionally unknown of UI or that are difficult to diagnose. The RF at 448 kHz combined with usual treatments, however, often provides patients with an improved quality of life by regulating neurological information, by targeting the innervations and structures involved in this type of pathology.
Treating faecal incontinence
In the treatment of faecal incontinence (resulting from faecal urgency, either passive or obstructive), the draining effect of RF in the context of haemorrhoids, the acceleration of healing of fistulas and fissures, as well as work on the viscera to facilitate transit for chronic constipation, may result in improvement being rapidly observed. This is especially true if faecal incontinence is linked to insufficient function of the anal sphincter.
This valuable tool will add to usual rehabilitation work to restructure tissues, to normali¬se vascularisation and to assist proprioception for this zone that is sometimes difficult to visualize and to sense and thus difficult to control.
Frédérique Fitoussi-Soussen
Masseur-Physiotherapist specialised in pelvi-perineology in Perreux-sur-Marne (Val-de-Marne Department, Paris region).
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