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8/16/2019 Latihan Otot Dasar Panggul
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REHABILITASI MEDIK UTK
GANGGUAN MIKSI LANSIA
dr. NURUL ULYANI, SpKFR(kuliah geriatri FK UNIZAR)
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GANGGUAN MIKSI LANSIA
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Anat!i tt da"ar panggul
!. le#atr ani
o Mrpkn $tt pen%angga
uta!a rgan& pel#i" 'rdiri dari tt
pu***%geu",
pure*tali",
ili***%geu",
***%geu".
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!. ul*a#ern"u"
o Lapi"an pel#i* /lr %g paling di"tal, er/0
"ek"ual, tidak !en%kng rgan pel#i"
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Neuranat!i kandung ke!ih
kandung ke!ih 4 3ar di"ekitarn%a pd -anita
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Iner#a"i peri/er Kandung Ke!ih
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Iner#a"i peri/er KK..
1. A//erent" /r! detru"r "tret*h re*eptr","phin*ter,perineu!, genitalia
&. 6//erent"
a. 2ara"%!patheti* S& 8 S7
Re*eptr" 9hlinergi* 8 !u"*arini* ( at d% / the ladder )
. S%!patheti* '11 8 L&Re*eptr" Alpha adrenergi* ( at "phin*ter)
:etha adrenergi* ( at d% / theladder
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RECEPTORS INSIDE
THE BLADDER :
Cholinergic-
muscarinic
Betha - arenergic
Al!ha - arenergic
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INERVASI SENTRAL KK :
Lp 1 (nuklei *rtikpntin!e"en"e/alik) A"al Lu" /rntali"Si/at inhii"i thd Sa*ral Mi*turitin 9enter(SM9)2engi"ian KK
Kalau ru"ak ( Strke, 2arkin"n ) hipere/lek"ia
detru"r, tanpa di"inergia "pingter Inkntinen"ia Urin Lp & (Nuklei 2ntin!e"en"e/alik"akral) ;
2ntine Mi*turitin 9enter ( 2M9 )Fung"ikrdina"i detru"r dengan "pingter
Kalau ru"ak dia-ah 2M9 dan diata" SM9 ( S9I ) hipere/lek"ia detru"r < =etru"r Spingter =i"inergia (=S=) KK tn!ik IU
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INERVASI SENTRAL KK…..
Lp ( Nuklei 2el#i*2udendal) ; SM9+
Sa*ral Mi*turitin 9enter
Fung"i 1. Mengintegra"ikan "ti!uli dari Lp 1
&. Meneru"kan 2ara"i!pati" S& S7 Sa*ral
Mi*turitin Re/le0Kalau ru"ak KK Are/lek"ik + Atnia Reten"i Urin
IU #er/l-
Lp 7 ( Krtek" !tri" N. 2udendu"Spingter ek"terna
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Iner#a"i
"entral KK
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Fi"ilgi pr"e" !ik"i
'erdiri dari & /a"e
/illing ("trage) pha"e (pengi"ian KK) tekanan intra #e"ika !eningkat perlahan
"ti!ula"i re"eptr "i!pati" (eta adrenergi*)di d% KK relak"a"i detru"r, dan"ti!ula"i al/a adrenergi* di a"i"#e"ika4uretra kntrak"i inhii"i "i"te!
para"i!pati" (!angha!at kntrak"iladder+#e"ika)
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Fi"ilgi pr"e" !ik"i..
#iding + e!pt%ing pha"e (peng"ngan
KK)
KK penuh ingin !ik"ipenurunan
akti#ita" tt "pin*ther 4 penurunan
tekanan di uretra !enghilangn%a re/lek
inhii"i dr "pin*ther !e*hani"! ke SM9
kntrak"i tt detru"r
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2eruahan /i"ilgi pr"e" !ik"i
pada lan"ia
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2eruahan /i"ilgi pr"e" !ik"i
pada lan"ia.....
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2eruahan /i"ilgi pr"e" !ik"i
pada lan"ia.....
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=IAGN$SIS
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Kla"i/ika"i /ung"inal inkntinen"ia urin
Type offail!e
Bla""e! fac#o! $#le# fac#o!
Failuret "tre
>ipera*ti#it%=e*re"ed
*!plian*e
=ener#ated pel#i* /lr :ladder ne*k de"*ent
Intrin"i* ladder ne*k"pin*ther /ailure
Failure
t e!pt%
Are/le0i*
>%p*ntra*tilit%
=etru"r "pin*ther
di""inerg%Nn rela0ing #luntar%"pin*ther Me*hani*al
"tru*tin(!i" :2>)
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company name
=IAGN$SIS ..
26M6RIKSAAN FISIK
2e!erik"aan u!u!
2e!erik"aan neurlgi"( kn"entra"ipada rt S& S7)
2e!erik"aan ad!en, genitalia, #agina
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M%t! Sakral &7
2le#i* /lr !u"*le, e0terna
urethral4 anal "pin*ther, hip
e0ten"r, lateral rtatr Ankle plantar /lek"r,
lu!ri*al, inter""ei
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2e!erik"aan genitalia
In"pek"i
Lihat #ul#a+#agina
tanda& irita"i, pel#i*
rgan prlap"
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2!0 tt da"ar panggul dgn 1
3ari
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2!0 tt da"ar panggul dgn &
3ari
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Ring / *ntinen*e
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=era3at kekuatan
tt da"ar
panggul
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26M6RIKSAAN 26NUN?ANG
La. Urdina!ik. radilgi"
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26NA'ALAKSANAAN
R6'6NSI URIN
KA'6'6RISASI
Ind-elling+kntin%u
:erkala (*lean inter!itten *ath)
Supra puik
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26NA'ALAKSANAAN...
INK$N'IN6NSIA URIN
'erapi perilaku
Latihan tt da"ar panggul
Far!akterapi
$pera"i+:edah
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'6RA2I 26RILAKU
'IM6= @$I=ING + MIKSI '6R?A=AL
nr!al !ik"i B50+&7 3a!
pa"ien di!inta !ik"i "e"uai 3ad-al
"ulit pd p0 dg gangguan kgni"i
:LA==6R =IARY !en*atat intake *airan(3eni",3u!lah), -aktu dan #lu!e !ik"i
ALA' 26NAM2UNG C ppk, knd!kateter, kateter !enetap
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Me!uat Dladder diar%E
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LA'I>AN $'$' =ASAR
2ANGGUL
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2rin"ip u!u! latihan
$#erlad "trength 4 enduran*e tt i"a!eningkat apal tt eker3a leih kera" drpdean %g ia"a
"trengthening high re"i"tan*el- repetitin, 7
"et, 51& repeti"i enduran*e l- re"i"tan*ehigh repetitin, "hrtre"t,!i" 7 detik.
Spe*i/i*it% tt %g dilatih kuat
Maintenan*e Re#er"iilit%
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company name
Latihan tt da"ar panggul
2"i"i eraring+duduk+erdiri
Latihan na/a" in"pira"i dada
!enge!ang, tt perut relak", ek"pira"i
dada ke!pi", tt perut kntrak"i
Ken*angkan tt da"ar panggul ("eperti
"aat !enahan :AK, "aat ek"pira"i)
Latih kntrak"i pan3ang (1 detik) dankntrak"i pendek& dan *epat
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company name Kuliah $A: dr :a%u SpKFRK
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company nameKuliah $A: dr :a%u SpKFRK
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Kuliah $A: dr :a%u SpKFRK
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9nth latihan tt da"ar panggul
(Kegel" e0er*i"e)
Ini#ially 'ighten the pel#i* /lr !u"*le" /r *unt / "i0 and rela0 /r"i0 "e*nd". 6a*h *ntra*tin *%*le "huld la"t 1& "e*nd" r H*ntra*tin" a !inute. Repeat &H ti!e". = thi" ti!e" ea*h da% ttalH *ntra*tin".
%ee& ' 'ighten the pel#i* /lr !u"*le" /r B "e*nd" e#er% 1&"e*nd" (H per !inute) /r 1 !inute", H *ntra*tin". = thi" ti!e"ea*h da% ttal 1H *ntra*tin".%ee& ( 'ighten the pel#i* /lr !u"*le" /r B "e*nd" e#er% 1&"e*nd" (H per !inute) /r 1H !inute", H *ntra*tin". = thi" ti!e"ea*h da% ttal &&H *ntra*tin".%ee&) *+'* 'ighten the pel#i* /lr !u"*le" /r B "e*nd" e#er% 1&"e*nd" (H per !inute) /r & !inute", 1 *ntra*tin". = thi" ti!e"ea*h da% ttal 1 *ntra*tin".Af#e! '* mon#,) 9ntinue !aintainen*e at 1 !inute" three ti!e" ada% r 1H !inute" t-i*e a da%, ttal / 1H *ntra*tin" a da%.
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6le*trtherap%+ "ti!ula"i li"trik
i" the appli*atin / ele*tri*al *urrent tpr#ke ner#e a*ti#it% and t "ti!ulate
/un*tin in di//erent rgan "%"te!".
'he ai! / ele*tri*al "ti!ulatin -ithin thepel#i* /lr regin i" t indu*e "keletal
!u"*le training, re!del "!th !u"*le
and r *nne*ti#e ti""ue" and t !dulateladder, -el, r "e0ual d%"/0
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company name'eri!a ka"ih