{"id":5880,"date":"2025-09-04T17:12:43","date_gmt":"2025-09-04T15:12:43","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=5880"},"modified":"2025-10-20T22:03:59","modified_gmt":"2025-10-20T20:03:59","slug":"reeducation-perineale","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=5880","title":{"rendered":"R\u00e9\u00e9ducation p\u00e9rin\u00e9ale"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Le pelvis f\u00e9minin<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<h3 class=\"wp-block-heading\">Ceinture osseuse<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ceinture osseuse <\/strong>: os coxaux, sacrum, coccys<\/li>\n\n\n\n<li><strong>Pelvis major <\/strong>: promontoire sacrum, bord ant\u00e9rieur aile iliaque-&gt;pubis<\/li>\n\n\n\n<li><strong>Pelvis minor<\/strong> : bord inf\u00e9rieur symphyse pubienne, tub\u00e9rosit\u00e9s ischiatique, sommet coccyx, forme entonnoir<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"666\" height=\"515\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image.avif\" alt=\"\" class=\"wp-image-5882\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image.avif 666w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-300x232.avif 300w\" sizes=\"auto, (max-width: 666px) 100vw, 666px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Anatomie du petit bassin<\/h3>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"526\" height=\"377\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-1.avif\" alt=\"\" class=\"wp-image-5884\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-1.avif 526w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-1-300x215.avif 300w\" sizes=\"auto, (max-width: 526px) 100vw, 526px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Disposition des visc\u00e8res dans l&rsquo;enceinte pelvienne<\/h3>\n\n\n\n<p>Vagin, ut\u00e9rus et rectum forment un triple coudure qui \u00e9vite le glissement des organes dans l&rsquo;axe vaginal aux cours des efforts de pouss\u00e9e.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"333\" height=\"306\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-2.avif\" alt=\"\" class=\"wp-image-5885\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-2.avif 333w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-2-300x276.avif 300w\" sizes=\"auto, (max-width: 333px) 100vw, 333px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Limites du pelvis<\/h3>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"534\" height=\"301\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-3.avif\" alt=\"\" class=\"wp-image-5886\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-3.avif 534w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-3-300x169.avif 300w\" sizes=\"auto, (max-width: 534px) 100vw, 534px\" \/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Le p\u00e9rin\u00e9e<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<p>Ensemble musculo-fibreux : ferme le pelvis, supporte les visc\u00e8res en position debout. Limit\u00e9 par le cadre ost\u00e9o-fibreux en avant : symphyse pubienne et branche ischio-pubiennes ; en arri\u00e8re : sacrum, coccyx et grand ligament sacro-sciatique<\/p>\n\n\n\n<p>Ensemble des parties molles en dessous du diaphragme pelvien comprenant les organes g\u00e9nitaux externes. La solidit\u00e9 est assur\u00e9e par le plancher musculaire p\u00e9rin\u00e9al. Il ferme le d\u00e9troit inf\u00e9rieur.<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<h3 class=\"wp-block-heading\">Topographie p\u00e9rin\u00e9ale<\/h3>\n\n\n\n<p>Forme losangique : p\u00e9rin\u00e9e ant\u00e9rieur urog\u00e9nital, p\u00e9rin\u00e9e post\u00e9rieur anal<\/p>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"434\" height=\"329\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-4.avif\" alt=\"\" class=\"wp-image-5891\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-4.avif 434w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-4-300x227.avif 300w\" sizes=\"auto, (max-width: 434px) 100vw, 434px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"661\" height=\"515\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-5.avif\" alt=\"\" class=\"wp-image-5892\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-5.avif 661w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-5-300x234.avif 300w\" sizes=\"auto, (max-width: 661px) 100vw, 661px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"459\" height=\"361\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-6.avif\" alt=\"\" class=\"wp-image-5893\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-6.avif 459w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-6-300x236.avif 300w\" sizes=\"auto, (max-width: 459px) 100vw, 459px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Les 3 plans musculaires<\/h3>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"680\" height=\"475\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-7.avif\" alt=\"\" class=\"wp-image-5896\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-7.avif 680w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-7-300x210.avif 300w\" sizes=\"auto, (max-width: 680px) 100vw, 680px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Plan superficiel<\/h3>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"727\" height=\"512\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-9.avif\" alt=\"\" class=\"wp-image-5900\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-9.avif 727w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-9-300x211.avif 300w\" sizes=\"auto, (max-width: 727px) 100vw, 727px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"784\" height=\"521\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-8.avif\" alt=\"\" class=\"wp-image-5899\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-8.avif 784w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-8-300x199.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-8-768x510.avif 768w\" sizes=\"auto, (max-width: 784px) 100vw, 784px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00f4le des muscles p\u00e9rin\u00e9aux superficiels et moyens<\/h3>\n\n\n\n<p>Muscles bulbo-spongieux et ischio-caverneux jouent un r\u00f4le dans l&rsquo;\u00e9rection du clitoris et son d\u00e9capuchonnage, compression des glandes vestibulaires, fermeture de l&rsquo;orifice vaginal.<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Les muscles \u00e9l\u00e9vateurs de l&rsquo;anus<\/h3>\n\n\n\n<p><strong>Lat\u00e9rale : c&rsquo;est la portion sphinct\u00e9rienne.<\/strong> Lame mince formant un appentis oblique.<\/p>\n\n\n\n<p>3 faisceaux : pubococcygien, iliococcygien, ischiococcygien<\/p>\n\n\n\n<p>Les fibres convergent vers la r\u00e9gion r\u00e9tro-anale (anal sling), s&rsquo;entrecroisent avec celles du c\u00f4t\u00e9 oppos\u00e9 et participent \u00e0 la constitution du raph\u00e9 ano-coccygien.<\/p>\n\n\n\n<p><strong>Param\u00e9diane : c&rsquo;est la portion \u00e9l\u00e9vatrice.<\/strong> Plus \u00e9paisse et solide, moins large.<\/p>\n\n\n\n<p>Origine pubienne, 2 faisceaux : puborectal (rectal sling) qui se termine dans la paroi du canal anal, pubovaginal qui pr\u00e9sente des rapports intimes avec le vagin et se termine dans la r\u00e9gion rectovaginale. Il constitue la sangle musculaire \u00e0 concavit\u00e9 ant\u00e9rieure qui d\u00e9limite le hiatus uro-g\u00e9nito-digestif.<\/p>\n\n\n\n<p><strong>Portion sphinct\u00e9rienne<\/strong> : mince et peu puissante, peu mobile. Origine : ligne pubis-\u00e9pine sciatique, terminaison : raph\u00e9 ano-coccygien et aux bords lat\u00e9raux du coccys.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"415\" height=\"312\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-10.avif\" alt=\"\" class=\"wp-image-5902\" style=\"width:349px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-10.avif 415w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-10-300x226.avif 300w\" sizes=\"auto, (max-width: 415px) 100vw, 415px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"414\" height=\"270\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-11.avif\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-11.avif 414w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-11-300x196.avif 300w\" sizes=\"auto, (max-width: 414px) 100vw, 414px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"460\" height=\"340\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-12.avif\" alt=\"\" class=\"wp-image-5905\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-12.avif 460w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-12-300x222.avif 300w\" sizes=\"auto, (max-width: 460px) 100vw, 460px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00f4le des muscles p\u00e9rin\u00e9aux profond<\/h3>\n\n\n\n<p>Muscles \u00e9l\u00e9vateurs de l&rsquo;anus cr\u00e9ent un d\u00f4me vaginal permettant l&rsquo;aspiration p\u00e9nienne, la fermeture de l&rsquo;orifice vaginal par une augmentation maximale de leur tension.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Structure musculaire<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Fibres I tonique (slow twitch)<\/td><td>Fibres II phasiques (fast twitch)<\/td><\/tr><tr><td>Contraction lente, peu fatigables<br>75% du potentien p\u00e9rin\u00e9al<br>Donne le tonus (sphincter&#8230;)<\/td><td>Contraction rapide, fatigables<br>25% du potentiel p\u00e9rin\u00e9al<br>Donne le mouvement (\u00e9l\u00e9vateur&#8230;)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Composition des fascias<\/h3>\n\n\n\n<p>Fascias : form\u00e9 de tissu conjonctif. Fibres musculaires lisses, collag\u00e8ne, \u00e9lastine, vaisseaux sanguins et nerfs. Diff\u00e9rents niveaux de suspension ant\u00e9rieurs, lat\u00e9raux et post\u00e9rieurs du vagin. Soumis au vieillissement.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Fascia pelvien<\/h3>\n\n\n\n<p>Entre plancher pelvien et p\u00e9ritoine, form\u00e9 de tissu conjonctif. <\/p>\n\n\n\n<p>2 feuillets : pari\u00e9tal recouvre les muscles pelviens, visc\u00e9ral recouvre les visc\u00e8res pelviens. Continuit\u00e9 entre les 2 fascias par un septum.<\/p>\n\n\n\n<p>Ligaments visc\u00e9raux ant\u00e9rieurs, lat\u00e9raux, post\u00e9rieurs difff\u00e9renci\u00e9s. Arcade fascia pelvien en lien avec l&rsquo;arcade tendineuse levatores ani qui s&rsquo;ins\u00e8re sur l&rsquo;obturateur interne.<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"344\" height=\"315\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-14.avif\" alt=\"\" class=\"wp-image-5909\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-14.avif 344w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-14-300x275.avif 300w\" sizes=\"auto, (max-width: 344px) 100vw, 344px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"410\" height=\"308\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-15.avif\" alt=\"\" class=\"wp-image-5910\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-15.avif 410w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-15-300x225.avif 300w\" sizes=\"auto, (max-width: 410px) 100vw, 410px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"409\" height=\"313\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-16.avif\" alt=\"\" class=\"wp-image-5911\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-16.avif 409w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-16-300x230.avif 300w\" sizes=\"auto, (max-width: 409px) 100vw, 409px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">La vessie<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"312\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-17.avif\" alt=\"\" class=\"wp-image-5914\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-17.avif 400w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-17-300x234.avif 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"655\" height=\"536\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-18.avif\" alt=\"\" class=\"wp-image-5915\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-18.avif 655w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-18-300x245.avif 300w\" sizes=\"auto, (max-width: 655px) 100vw, 655px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"727\" height=\"544\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-19.avif\" alt=\"\" class=\"wp-image-5916\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-19.avif 727w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-19-300x224.avif 300w\" sizes=\"auto, (max-width: 727px) 100vw, 727px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"409\" height=\"407\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20.avif\" alt=\"\" class=\"wp-image-5917\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20.avif 409w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20-300x300.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20-150x150.avif 150w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20-144x144.avif 144w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-20-80x80.avif 80w\" sizes=\"auto, (max-width: 409px) 100vw, 409px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Structure de la vessie<\/h3>\n\n\n\n<p>La vessie est constitu\u00e9e de 3 couches :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Couche interne muqueuse<\/li>\n\n\n\n<li>Couche moyenne musculaire (d\u00e9trusor) avec m\u00e9cano-r\u00e9cepteurs pour besoin mictionnel normal et nocicepteur pour besoin imp\u00e9rieux<\/li>\n\n\n\n<li>Couche externe s\u00e9reuse en lien avec le fascia<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"553\" height=\"411\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-21.avif\" alt=\"\" class=\"wp-image-5918\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-21.avif 553w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-21-300x223.avif 300w\" sizes=\"auto, (max-width: 553px) 100vw, 553px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">L&rsquo;ut\u00e9rus<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Un organe unique<\/h3>\n\n\n\n<p>Position centrale dans l&rsquo;excavation pelvienne, trait d&rsquo;union entre 2 syst\u00e8mes fonctionnement ind\u00e9pendants mais \u00e9troitement li\u00e9s<\/p>\n\n\n\n<p>Fonction d&rsquo;organe de gestation, soumis \u00e0 des contraintes de volume et de poids in\u00e9gal\u00e9es (station debout, sport), contraintes fonctionnelles impos\u00e9es par la vessie et le rectum (r\u00e9pl\u00e9tion-vidange)<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"546\" height=\"411\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-22.avif\" alt=\"\" class=\"wp-image-5922\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-22.avif 546w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-22-300x226.avif 300w\" sizes=\"auto, (max-width: 546px) 100vw, 546px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"399\" height=\"390\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-23.avif\" alt=\"\" class=\"wp-image-5923\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-23.avif 399w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-23-300x293.avif 300w\" sizes=\"auto, (max-width: 399px) 100vw, 399px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">La sph\u00e8re digestive terminale<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-24.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"535\" height=\"385\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-24.avif\" alt=\"\" class=\"wp-image-5925\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-24.avif 535w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-24-300x216.avif 300w\" sizes=\"auto, (max-width: 535px) 100vw, 535px\" \/><\/a><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-25.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"547\" height=\"367\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-25.avif\" alt=\"\" class=\"wp-image-5926\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-25.avif 547w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-25-300x201.avif 300w\" sizes=\"auto, (max-width: 547px) 100vw, 547px\" \/><\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Vascularisation et innervation<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Les p\u00e9dicules neuro-vasculaires du p\u00e9rin\u00e9e<\/p>\n\n\n\n<p>Art\u00e8re pudentale interne, branche du tronc ant\u00e9rieur de l&rsquo;art\u00e8re iliaque interne<\/p>\n\n\n\n<p>Veine pudentale interne issue du plexus de Santorini se termine dans la veine iliaque interne<\/p>\n\n\n\n<p>Nerf pudental issue des racines sacr\u00e9es S2-S3-S4 se termine au niveau p\u00e9rin\u00e9al profond et superficiel<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-26.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"461\" height=\"412\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-26.avif\" alt=\"\" class=\"wp-image-5927\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-26.avif 461w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-26-300x268.avif 300w\" sizes=\"auto, (max-width: 461px) 100vw, 461px\" \/><\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Innervation p\u00e9rin\u00e9ale<\/h3>\n\n\n\n<p>Nerf pudental (S2-S3-S4) : tous les muscles du p\u00e9rin\u00e9e<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Maintien du tonus ur\u00e9tral pendant la phase de remplissage<\/li>\n\n\n\n<li>Inhibition de la contraction d\u00e9trusorienne<\/li>\n\n\n\n<li>Rel\u00e2chement sphincter stri\u00e9 pour la miction<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"518\" height=\"409\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-27.avif\" alt=\"\" class=\"wp-image-5930\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-27.avif 518w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-27-300x237.avif 300w\" sizes=\"auto, (max-width: 518px) 100vw, 518px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>La sensibilit\u00e9 p\u00e9rin\u00e9ale et sexuelle sont v\u00e9hicul\u00e9es par le nerf pudental depuis les branches terminales jusqu&rsquo;au cerveau<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"543\" height=\"378\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-28.avif\" alt=\"\" class=\"wp-image-5932\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-28.avif 543w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-28-300x209.avif 300w\" sizes=\"auto, (max-width: 543px) 100vw, 543px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Contr\u00f4le neurologique du syst\u00e8me v\u00e9sico-sphinct\u00e9rien<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Syst\u00e8me v\u00e9g\u00e9tatif : sympathique et parasympathique<\/li>\n\n\n\n<li>Syst\u00e8me somatique<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"408\" height=\"387\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-29.avif\" alt=\"\" class=\"wp-image-5934\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-29.avif 408w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-29-300x285.avif 300w\" sizes=\"auto, (max-width: 408px) 100vw, 408px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"551\" height=\"414\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-30.avif\" alt=\"\" class=\"wp-image-5935\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-30.avif 551w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-30-300x225.avif 300w\" sizes=\"auto, (max-width: 551px) 100vw, 551px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Innervation de l&rsquo;ut\u00e9rus<\/h3>\n\n\n\n<p>L&rsquo;innervation de l&rsquo;ut\u00e9rus et de ses annexes est assur\u00e9e par le plexus nerveux hypogastrique compl\u00e9t\u00e9e par les fibres sympathiques qui accompagnent les art\u00e8res ut\u00e9rines.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Innervation sensitive<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Les nerfs pelviens innervent le vagin, le col ut\u00e9rin et la peau p\u00e9rin\u00e9al<\/li>\n\n\n\n<li>Les nerfs hypograstriques innervent le col ut\u00e9rin et les 3\/5 proximaux de l&rsquo;ut\u00e9rus<\/li>\n\n\n\n<li>Les nerfs pudentaux innervent la peau p\u00e9rin\u00e9ale<\/li>\n\n\n\n<li>Il est probable que les nerfs pelviens et pudentaux sont activ\u00e9s pendant la copulation<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Le vagin<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Anatomie du vagin<\/p>\n\n\n\n<p>S&rsquo;\u00e9tend du col ut\u00e9rin \u00e0 la vulve, mesure environ 8cm de long.<br>Situ\u00e9 en avant du rectum et en arri\u00e8re de la vessie et de l&rsquo;ur\u00e8tre. Plus \u00e9troit au niveau de son 1\/3 inf pr\u00e8s de la vulve, s&rsquo;\u00e9largit au 1\/3 moyen et surtout au 1\/3 sup.<\/p>\n\n\n\n<p>Ses parois reposent l&rsquo;une contre l&rsquo;autre lui donnant un aspect aplati. Ses parois ne sont pas lisses ais rid\u00e9es et tr\u00e8s \u00e9lastiques permettant ainsi la p\u00e9n\u00e9tration d&rsquo;un doigt, d&rsquo;un sp\u00e9culum ou d&rsquo;un p\u00e9nis. Son \u00e9lasticit\u00e9 est maximale lors de l&rsquo;accouchement.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"549\" height=\"395\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-31.avif\" alt=\"\" class=\"wp-image-5938\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-31.avif 549w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-31-300x216.avif 300w\" sizes=\"auto, (max-width: 549px) 100vw, 549px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"601\" height=\"495\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-34.avif\" alt=\"\" class=\"wp-image-5943\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-34.avif 601w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-34-300x247.avif 300w\" sizes=\"auto, (max-width: 601px) 100vw, 601px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"429\" height=\"391\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-32.avif\" alt=\"\" class=\"wp-image-5940\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-32.avif 429w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-32-300x273.avif 300w\" sizes=\"auto, (max-width: 429px) 100vw, 429px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"527\" height=\"338\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-33.avif\" alt=\"\" class=\"wp-image-5941\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-33.avif 527w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-33-300x192.avif 300w\" sizes=\"auto, (max-width: 527px) 100vw, 527px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Physiologie du vagin<\/h3>\n\n\n\n<p>Le vagin est riche en vaisseaux sanguins, art\u00e8res et veines, lymphatiques. Il est pauvre en terminaisons nerveuses sur ses 2\/3 sup\u00e9rieurs, sauf au niveau du 1\/3 inf\u00e9rieurs (\u00e9l\u00e9vateurs de l&rsquo;anus). Pas de r\u00e9cepteur superficiels mais des r\u00e9cepteurs profonds (tensio et baro r\u00e9cepteurs)<\/p>\n\n\n\n<p>Biom\u00e9canique pelvi-p\u00e9rin\u00e9ale<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p><strong>Respiration<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Action de la gravit\u00e9<\/li>\n\n\n\n<li>Enceinte de pression hydroa\u00e9rique<\/li>\n\n\n\n<li>Sout\u00e8nement p\u00e9rin\u00e9al<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Muscle diaphragme inspirateur<\/li>\n\n\n\n<li>Muscles abdominaux toniques<\/li>\n\n\n\n<li>Muscles p\u00e9rni\u00e9aux<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"289\" height=\"376\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-35.avif\" alt=\"\" class=\"wp-image-5946\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-35.avif 289w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-35-231x300.avif 231w\" sizes=\"auto, (max-width: 289px) 100vw, 289px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"248\" height=\"320\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-36.avif\" alt=\"\" class=\"wp-image-5947\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-36.avif 248w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-36-233x300.avif 233w\" sizes=\"auto, (max-width: 248px) 100vw, 248px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p><strong>Action de la pression abdominale<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>DIaphragme<\/li>\n\n\n\n<li>Muscles abdominaux<\/li>\n\n\n\n<li>Suspension visc\u00e9rale<\/li>\n\n\n\n<li>Sout\u00e8nement p\u00e9rin\u00e9al<\/li>\n\n\n\n<li>Cin\u00e9tique visc\u00e9rale<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"290\" height=\"395\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-37.avif\" alt=\"\" class=\"wp-image-5948\" style=\"width:162px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-37.avif 290w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-37-220x300.avif 220w\" sizes=\"auto, (max-width: 290px) 100vw, 290px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Repos<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cavit\u00e9 virtuelle vaginale<\/li>\n\n\n\n<li>Tonicit\u00e9 p\u00e9rin\u00e9ale formant le cap vaginal 140\u00b0 participant au sout\u00e8nement v\u00e9sico-ut\u00e9rin<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"353\" height=\"332\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-38.avif\" alt=\"\" class=\"wp-image-5953\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-38.avif 353w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-38-300x282.avif 300w\" sizes=\"auto, (max-width: 353px) 100vw, 353px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Relaxation<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Effacement du cap vaginal 180\u00b0<\/li>\n\n\n\n<li>Rectitude vaginale<\/li>\n\n\n\n<li>D\u00e9contraction des muscles p\u00e9rin\u00e9aux<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"372\" height=\"334\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-39.avif\" alt=\"\" class=\"wp-image-5954\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-39.avif 372w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-39-300x269.avif 300w\" sizes=\"auto, (max-width: 372px) 100vw, 372px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Contraction<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fermeture du cap vaginal 110\u00b0<\/li>\n\n\n\n<li>Ascension du CTP<\/li>\n\n\n\n<li>Formation du d\u00f4me p\u00e9rin\u00e9l<\/li>\n\n\n\n<li>Augmentation de 20 \u00e0 40mmHg<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"355\" height=\"297\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-40.avif\" alt=\"\" class=\"wp-image-5955\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-40.avif 355w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-40-300x251.avif 300w\" sizes=\"auto, (max-width: 355px) 100vw, 355px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">La contraction p\u00e9rin\u00e9ale<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"471\" height=\"384\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-41.avif\" alt=\"\" class=\"wp-image-5956\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-41.avif 471w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-41-300x245.avif 300w\" sizes=\"auto, (max-width: 471px) 100vw, 471px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"476\" height=\"376\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-42.avif\" alt=\"\" class=\"wp-image-5957\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-42.avif 476w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-42-300x237.avif 300w\" sizes=\"auto, (max-width: 476px) 100vw, 476px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">La statique pelvienne<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Supension par les ligaments visc\u00e9raux<\/li>\n\n\n\n<li>Coh\u00e9sion par les fascias visc\u00e9raux<\/li>\n\n\n\n<li>Sout\u00e8nement par le plancher pelvien<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"490\" height=\"287\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-43.avif\" alt=\"\" class=\"wp-image-5958\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-43.avif 490w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-43-300x176.avif 300w\" sizes=\"auto, (max-width: 490px) 100vw, 490px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Etiopathog\u00e9nie des troubles de la statique pelvienne<\/h3>\n\n\n\n<p>Les maladies cong\u00e9nitale, l&rsquo;accouchement, la d\u00e9f\u00e9cation, le sport, la chirurgie, le vieillissement peuvent entra\u00eener :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Une modification de la r\u00e9sultante de la pression abdminale<\/li>\n\n\n\n<li>Une d\u00e9gradation neuro-musculo-apon\u00e9vrotique<\/li>\n\n\n\n<li>Une anomalie des visc\u00e8res pelviens<\/li>\n<\/ul>\n\n\n\n<p>-&gt; D\u00e9gradation du plancher pelvi-p\u00e9rin\u00e9al<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Les prolapsus vaginaux<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<p>\u00a0\u00bb Toute saillie permanente ou \u00e0 l&rsquo;effort, dans la lumi\u00e8re vaginale ou \u00e0 l&rsquo;orifice vulvaire ou hors de celui-ci, de tout ou partie des parois vaginales plus ou moins doubl\u00e9es de la vessie, du rectum et des culs-de-sac p\u00e9ritonaux adjacents, ainsi que du fond vaginal solidaire du col ut\u00e9rin.\u00a0\u00bb (Cerbonnet, 1970)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Autres d\u00e9finitions <\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Colpoc\u00e8le : prolapsus de la paroi vaginale<\/li>\n\n\n\n<li>Elytroc\u00e8le : prolapsus du cul-de-sac de Douglas<\/li>\n\n\n\n<li>Rectoc\u00e8le : prolapsus du rectum de la paroi vaginale post\u00e9rieure<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types de prolapsus<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Localisation<\/td><td>Termes utilis\u00e9es<\/td><\/tr><tr><td>\u00c9tage ant\u00e9rieur<\/td><td>Colpoc\u00e8le ant\u00e9rieur : Hernie de la paroi ant\u00e9rieure <br>Ur\u00e9troc\u00e8le : Contenant l&rsquo;ur\u00e8tre<br>Cystoc\u00e8le : contenant la vessie<\/td><\/tr><tr><td>\u00c9tage moyen<\/td><td>Hystroc\u00e8le : Prolapsus ut\u00e9rin<br>Trach\u00e9loc\u00e8le : Prolapsus du col ut\u00e9rin fr\u00e9quemment anormalement allong\u00e9<\/td><\/tr><tr><td>\u00c9tage post\u00e9rieur vaginal<\/td><td>Colpoc\u00e8le post\u00e9rieure : Hernie de la paroi post\u00e9rieure du vagin <br>Rectoc\u00e8le : contenant la face ant\u00e9rieure du rectum<br>Elytroc\u00e8le : contenant le cul-de-sac de Douglas<br>Ent\u00e9roc\u00e8le : contenant les anses gr\u00eales<br>Sigmo\u00efdoc\u00e8le ; contenant le sigmo\u00efde<br>Epiplooc\u00e8le : contenant le grand \u00e9piploon<\/td><\/tr><tr><td>\u00c9tage  post\u00e9rieur anal<\/td><td>H\u00e9droc\u00e8le : Hernie \u00e0 travers l&rsquo;anus souvent b\u00e9ant du cul-de-sac de Douglas, accompagnant un prolapsus rectal<br>Intussuception: Invagination rectale ou \u00ab\u00a0prolapsus rectale interne\u00a0\u00bb<br>Prolapsus rectal : Ext\u00e9riorisation du rectum par l&rsquo;anus<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Symptomatologie<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u00ab\u00a0Boule \u00e0 vulve\u00a0\u00bb<\/li>\n\n\n\n<li>Pesanteur pelvienne<\/li>\n\n\n\n<li>Troubles fonctionnels : dysurie, dysch\u00e9sie (constipation terminale), rapports sexuels difficiles<\/li>\n\n\n\n<li>Incontinence urinaire associ\u00e9e 50%<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Classification des prolapsus vaginaux<\/p>\n\n\n\n<p>Latin : \u00ab\u00a0pro\u00a0\u00bb= en avant ; \u00ab\u00a0labi\u00a0\u00bb = tomber<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Examen manuel : toucher vaginal<\/li>\n\n\n\n<li>Manoeuvre des valves : pose du speculum<\/li>\n\n\n\n<li>Type de prolapsus : reconnaissance de l&rsquo;organe prolab\u00e9<\/li>\n\n\n\n<li>Degr\u00e9 du prolapsus : gradation du prolapsus<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Degr\u00e9 du prolapsus<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Grade 0 : pas de prolapsus m\u00eame \u00e0 l&rsquo;effort<\/li>\n\n\n\n<li>Grade 1 : prolapsus isol\u00e9 \u00e0 l&rsquo;effort<\/li>\n\n\n\n<li>Grade  2 : organe engag\u00e9 dans la fili\u00e8re vaginale<\/li>\n\n\n\n<li>Grade 3 : organe ext\u00e9rioris\u00e9 du vagin<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Cotation POP-Q<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"658\" height=\"478\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-55.avif\" alt=\"\" class=\"wp-image-6005\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-55.avif 658w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-55-300x218.avif 300w\" sizes=\"auto, (max-width: 658px) 100vw, 658px\" \/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Prolapsus ant\u00e9rieur : cystoc\u00e8le<\/h4>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Hernie de la vessie entra\u00eenant la paroi vaginale ant\u00e9rieure<\/p>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"514\" height=\"365\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-56.avif\" alt=\"\" class=\"wp-image-6006\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-56.avif 514w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-56-300x213.avif 300w\" sizes=\"auto, (max-width: 514px) 100vw, 514px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"418\" height=\"426\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-57.avif\" alt=\"\" class=\"wp-image-6007\" style=\"width:194px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-57.avif 418w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-57-294x300.avif 294w\" sizes=\"auto, (max-width: 418px) 100vw, 418px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"324\" height=\"305\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-58.avif\" alt=\"\" class=\"wp-image-6008\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-58.avif 324w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-58-300x282.avif 300w\" sizes=\"auto, (max-width: 324px) 100vw, 324px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h4 class=\"wp-block-heading\">Prolapsus moyen : hyst\u00e9roptose<\/h4>\n\n\n\n<p>Chute de l&rsquo;ut\u00e9rus dans le fond vaginal<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"506\" height=\"475\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-59.avif\" alt=\"\" class=\"wp-image-6009\" style=\"width:208px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-59.avif 506w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-59-300x282.avif 300w\" sizes=\"auto, (max-width: 506px) 100vw, 506px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"477\" height=\"481\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60.avif\" alt=\"\" class=\"wp-image-6010\" style=\"width:208px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60.avif 477w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60-298x300.avif 298w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60-150x150.avif 150w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60-144x144.avif 144w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-60-80x80.avif 80w\" sizes=\"auto, (max-width: 477px) 100vw, 477px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"410\" height=\"477\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-61.avif\" alt=\"\" class=\"wp-image-6011\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-61.avif 410w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-61-258x300.avif 258w\" sizes=\"auto, (max-width: 410px) 100vw, 410px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"429\" height=\"438\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-62.avif\" alt=\"\" class=\"wp-image-6012\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-62.avif 429w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-62-294x300.avif 294w\" sizes=\"auto, (max-width: 429px) 100vw, 429px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h4 class=\"wp-block-heading\">Prolapsus post\u00e9rieur : rectoc\u00e8le<\/h4>\n\n\n\n<p>Hernie du rectum entra\u00eenant la paroi vaginale post\u00e9rieure<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"567\" height=\"455\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-63.avif\" alt=\"\" class=\"wp-image-6013\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-63.avif 567w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-63-300x241.avif 300w\" sizes=\"auto, (max-width: 567px) 100vw, 567px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"431\" height=\"347\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-64.avif\" alt=\"\" class=\"wp-image-6014\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-64.avif 431w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/09\/image-64-300x242.avif 300w\" sizes=\"auto, (max-width: 431px) 100vw, 431px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">La r\u00e9\u00e9ducation pelvi-p\u00e9rin\u00e9ale<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Fonction du plancher pelvien<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fonction v\u00e9sico-sphinct\u00e9rienne<\/li>\n\n\n\n<li>Fonction de statique pelvienne (maintien des organes)<\/li>\n\n\n\n<li>Fonction ano-rectal<\/li>\n\n\n\n<li>Fonction g\u00e9nito-sexuelle<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Bilan ROMP<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Relater<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Motif de consultation : fuites urinaires depuis 2 ans<\/li>\n\n\n\n<li>\u00c2ge : 58 ans (m\u00e9nopause souvent autour de 50 ans. Les grossesses permettent de retarder la m\u00e9nopause par \u00e9conomie des ovules)<\/li>\n\n\n\n<li>Profession : cadre sup\u00e9rieur<\/li>\n\n\n\n<li>Mode de vie : sport, projet, etc<\/li>\n\n\n\n<li>Poids : prise de poids r\u00e9cente de 8kg (m\u00e9nopause)<\/li>\n\n\n\n<li>Surpoids et ob\u00e9sit\u00e9<\/li>\n\n\n\n<li>ATCD obst\u00e9tricaux : accouchement voie basse par forceps<\/li>\n\n\n\n<li>R\u00e9\u00e9ducation post-grossesse<\/li>\n\n\n\n<li>\u00c2ge de l&rsquo;enfant : savoir si grossesse tardive car pas le m\u00eame potentiel de r\u00e9cup\u00e9ration<\/li>\n\n\n\n<li>ATCD chirurgicaux et m\u00e9dicamenteux : cancer, endom\u00e9triose, infections urinaires, diab\u00e8te, anorexie, maladie neuro, inflammatoire, hormonale, m\u00e9tabolique (thyro\u00efde)<\/li>\n\n\n\n<li>ATCD traumatiques : agressions sexuelles, violence au quotidien (p\u00e9rin\u00e9e lieu de la peur)<\/li>\n\n\n\n<li>ATCD familiaux : m\u00e8re op\u00e9r\u00e9e pour un prolapsus<\/li>\n\n\n\n<li>TTT m\u00e9dical : m\u00e9dicaments pouvant modifier le tonus musculaire (psychotrope de pallier 3)<\/li>\n\n\n\n<li>R\u00e9\u00e9ducations ant\u00e9rieures : 10 s\u00e9ances qu&rsquo;avec que du bio-feedback (il manque le passage debout)<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h5 class=\"wp-block-heading\">Relat\u00e9 et fonctionnement v\u00e9sico-sphinct\u00e9rien<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Circonstance\/m\u00e9canisme des fuites : toux\/\u00e9ternuement, \u00e0 la course, rire, sauts =&gt; incontinence urinaire d&rsquo;effort (UIE)<\/li>\n\n\n\n<li>Apr\u00e8s sortie, boisson alcoolis\u00e9e (bi\u00e8re) =&gt; incontinence urinaire par urgenturie (IUU)<\/li>\n\n\n\n<li>Volume : quelques gouttes<\/li>\n\n\n\n<li>Fr\u00e9quence des mictions : 3x\/j, boisson 1L\/j =&gt; ne boit pas car peur des fuites<\/li>\n<\/ul>\n\n\n\n<p>Relat\u00e9 et statique pelvienne<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sensation de lourdeur p\u00e9rin\u00e9ale<\/li>\n\n\n\n<li>B\u00e9ance vulvaire<\/li>\n<\/ul>\n\n\n\n<p>Relat\u00e9 et fonction ano-rectale<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fr\u00e9quence des selles : 3x\/semaine : trop bas, donc il faut boire plus : difficult\u00e9 \u00e0 retenir les gaz et les selles absente.<\/li>\n\n\n\n<li>G\u00e9nito-sexuelle : douleur ? perte de sensation ? s\u00e9cheresse ?<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Observer<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consentement \u00e9crit<\/li>\n\n\n\n<li>Le consentement peut s&rsquo;arr\u00eater \u00e0 tout moment.<\/li>\n\n\n\n<li>Avoir une ordonnance<\/li>\n\n\n\n<li>Possible de garder par\u00e9o, jupe, serviette, etc<\/li>\n<\/ul>\n\n\n\n<p>Examen global<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bilan abdominal assis\/debout<\/li>\n\n\n\n<li>Bilan respiratoire<\/li>\n\n\n\n<li>Examen p\u00e9rin\u00e9al : position en DD ou semi-assis, en d\u00e9lordose, genoux fl\u00e9chis et pieds \u00e9cart\u00e9s<\/li>\n\n\n\n<li>Examen visuel\n<ul class=\"wp-block-list\">\n<li>prolapsus\/b\u00e9ance<\/li>\n\n\n\n<li>apparence de la muqueuse (en bonne sant\u00e9 : rose et humide ; en vieillissant ; devient plus blanc)<\/li>\n\n\n\n<li>Contraction du p\u00e9rin\u00e9e (retenir une envie d&rsquo;uriner) : si le centre tendineux du p\u00e9rin\u00e9e remonte, alors testing \u00e0 3\/5<\/li>\n\n\n\n<li>Effort de toux (1 seule toux) : on doit pouvoir voir une contraction r\u00e9flexe de fermeture avec une ascension du centre tendineux du p\u00e9rin\u00e9<\/li>\n\n\n\n<li>Pousser le p\u00e9rin\u00e9 (comme pour chasser un gaz) : on doit pouvoir observer une petite descente du p\u00e9rin\u00e9 qui ne doit pas d\u00e9passer la ligne bi-ischiatique<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>=&gt; \u00ab\u00a0P\u00e9rin\u00e9e descendant\u00a0\u00bb (\u00e0 la toux ou \u00e0 la pouss\u00e9e) ou \u00ab\u00a0p\u00e9rin\u00e9e descendu\u00a0\u00bb (d\u00e9j\u00e0 en bas)<\/p>\n\n\n\n<p>Ecarter les l\u00e8vres pour d\u00e9gager l&rsquo;orifice vaginal et faire le m\u00eame d\u00e9roul\u00e9<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9roulement vaginal ant\u00e9rieur (cystoc\u00e8le= : ici C1 (petite)<\/li>\n\n\n\n<li>D\u00e9roulement vaginal post\u00e9rieur (rectoc\u00e8le) : ici R1<\/li>\n\n\n\n<li>Sortie de l&rsquo;ut\u00e9rus (hyst\u00e9roc\u00e8le) : ici rien (H0) <\/li>\n<\/ul>\n\n\n\n<p>Examen endo-cavitaire : avec gant lubrifi\u00e9 et avec l&rsquo;autre main \u00e9carter l&rsquo;orifice vaginal puis introduire \u00e0 45\u00b0 vers le bas puis \u00e0 plat et enfin \u00e9carter.  Consigne : serrer et remonter (comme pour se retenir). <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tetsing \u00e0 3\/5 pour remonter, 4\/5 avec fatigabilit\u00e9, 5\/5 sans fatigabilit\u00e9<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Mesurer<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Calendrier mictionnel (volume boisson et volume urine) : heure, volume (faire pipi dans un bol), fuite ?, pad test (peser la protection pour peser la fuite), circonstances. A faire sur 3j cons\u00e9cutifs dont 1j travailler.<\/li>\n\n\n\n<li>Sch\u00e9ma PERFECT : \n<ul class=\"wp-block-list\">\n<li>Power : force<\/li>\n\n\n\n<li>Endurance : combien de seconde sans perdre 30% de la force<\/li>\n\n\n\n<li>R\u00e9p\u00e9tition : combien de r\u00e9p\u00e9titions \u00e0 la force max<\/li>\n\n\n\n<li>Fast contraction : combien de contractions encha\u00een\u00e9es<\/li>\n\n\n\n<li>El\u00e9vation<\/li>\n\n\n\n<li>Coactivation p\u00e9rin\u00e9e\/abdo<\/li>\n\n\n\n<li>Toux : r\u00e9flexe \u00e0 la toux<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Echelle de qualit\u00e9 de vie sp\u00e9cifique aux fuites urinaires<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Planifier<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>R\u00e9\u00e9duquer avec sonde biofeedback<\/li>\n\n\n\n<li>Boisson<\/li>\n\n\n\n<li>Calendrier mictionnel<\/li>\n\n\n\n<li>Stabilisation lombo-pelvi-p\u00e9rin\u00e9ale<\/li>\n\n\n\n<li>Travail contre r\u00e9sistance<\/li>\n\n\n\n<li>Electroth\u00e9rapie : excito-motrice (50-80Hz)\/inhibiteur (1-10Hz)<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Cas clinique<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Cas 1<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Madame G. est une femme de 45 ans, agent de voyage.<\/li>\n\n\n\n<li>Elle n\u2019est pas m\u00e9nopaus\u00e9e<\/li>\n\n\n\n<li>Pour se \u00ab remettre en forme \u00bb, elle pratique des s\u00e9ances de powerplate entre octobre et avril<\/li>\n\n\n\n<li>\u00e0 raison de deux s\u00e9ances par semaine, ce qui provoque un prolapsus ext\u00e9rioris\u00e9 (apparition<\/li>\n\n\n\n<li>d\u2019une \u00ab boule \u00bb s\u2019ext\u00e9riorisant hors de la vulve).<\/li>\n\n\n\n<li>Elle a deux enfants, de 8 ans et 4 ans, poids normal, ni \u00e9pisiotomie ni forceps.<\/li>\n\n\n\n<li>Elle n\u2019a pas de fuites urinaires mais des envies plus fr\u00e9quentes, 7 \u00e0 10 par jour, 0 par nuit, non<\/li>\n\n\n\n<li>pouss\u00e9es.<\/li>\n\n\n\n<li>Elle boit beaucoup, 1l 1\/2 eau et 3 caf\u00e9s par jour.<\/li>\n\n\n\n<li>Elle dit qu\u2019elle se sent \u00ab descendre \u00bb, \u00ab \u00e7a se voit \u00bb, elle est tr\u00e8s paniqu\u00e9e<\/li>\n\n\n\n<li>Elle n\u2019est pas constip\u00e9e, ne pousse pas, une selle tous les deux jours, bonne vidange, sensation<\/li>\n\n\n\n<li>de besoin pr\u00e9sente, mais petite difficult\u00e9 \u00e0 retenir les gaz.<\/li>\n\n\n\n<li>Elle ressent une pesanteur pelvienne++, une sensation d\u2019ouverture vaginale+++.<\/li>\n\n\n\n<li>Pas de g\u00eane aux rapports.<\/li>\n\n\n\n<li>Examen :<\/li>\n\n\n\n<li>Vulve ferm\u00e9e<\/li>\n\n\n\n<li>Lors de l\u2019effort de pouss\u00e9e descente NFCP, pas \u00e0 la toux,<\/li>\n\n\n\n<li>C2H2R0, m\u00eame apr\u00e8s 10 accroupissements1<\/li>\n\n\n\n<li>R2\/5 avec inspir+++, mauvaise commande p\u00e9rin\u00e9ale, l\u00e2cher OK<\/li>\n\n\n\n<li>Tr\u00e8s catastroph\u00e9e, refusant absolument d\u2019envisager une solution chirurgicale.<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Objectifs de r\u00e9\u00e9ducation<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Eviter agravation<\/li>\n\n\n\n<li>Orienter l&rsquo;activit\u00e9 physique<\/li>\n\n\n\n<li>Soulager les sympt\u00f4mes<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Moyens<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Encourager l&rsquo;activit\u00e9 physique : \u00e9viter la s\u00e9dentarit\u00e9 qui aggrave le prolapsus<\/li>\n\n\n\n<li>Activit\u00e9s conseill\u00e9es : yoga, natation, v\u00e9lo, course avec pr\u00e9caution (chaussures, foul\u00e9e, terrain souple, pessaire cube)<\/li>\n\n\n\n<li>Pour la vessie, \u00e9tablir un calendrier mictionnel et diminuer le caf\u00e9<\/li>\n\n\n\n<li>Pour la commande p\u00e9rin\u00e9ale : ne pas associer de temps respiratoire \u00e0 la contraction (l&rsquo;inspiration augmente la pression dans le p\u00e9rin\u00e9e). Privil\u00e9gier une action imag\u00e9e : serrer l&rsquo;anus comme pour se retenir.<\/li>\n\n\n\n<li>Pour v\u00e9rifier la contraction, on peut observer l&rsquo;\u00e9l\u00e9vation du centre tendineux du p\u00e9rin\u00e9e et par la palpation de la contraction.<\/li>\n\n\n\n<li>3 gestes \u00e0 ma\u00eetriser : contracter \/ maintenir \/ rel\u00e2cher <\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Eviter les facteurs d&rsquo;aggravation<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Surpoids<\/li>\n\n\n\n<li>Perte de poids rapide<\/li>\n\n\n\n<li>La toux : faire sa toilette bronchique par les AFE<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Entra\u00eenement musculaire<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Biofeedback permet de renforcer les fibres lentes (toniques) et les fibres rapides (phasiques). Faire les exercices en position debout et en dynamique\/d\u00e9stabilisation<\/li>\n\n\n\n<li>Pour le maintien : stimuler le maintien sur une dur\u00e9e de plus en plus longue progressivement<\/li>\n\n\n\n<li>Contre r\u00e9sistance manuelle<\/li>\n\n\n\n<li>Electroth\u00e9rapie : courant excito-moteur (50-80Hz) pour le gain de force et pour stimuler la proprioception, largeur d&rsquo;impulsion (250-300 microseconde), temps de passage du courant de 4 secondes et temps de pause 2x plus long (ou plus si fatigabilit\u00e9), temps de s\u00e9ance de 15mn<\/li>\n\n\n\n<li><\/li>\n\n\n\n<li>Entre les s\u00e9ances<\/li>\n\n\n\n<li>Refaire quotidiennement \u00e0 la maison les exercices ma\u00eetris\u00e9s. Les exercices non ma\u00eetris\u00e9s ne doivent pas \u00eatre fait seul sous risque de prendre de mauvaises habitudes<\/li>\n\n\n\n<li>Etre r\u00e9gulier : trouver des temps courts dans la journ\u00e9e pour faire les exercices (m\u00e9tro, feux rouge, etc)<\/li>\n\n\n\n<li>Avoir un programme d&rsquo;auto-entra\u00eenement<\/li>\n\n\n\n<li>Gymnastique hypopressive<\/li>\n\n\n\n<li>Postures invers\u00e9es (poirier, chien la t\u00eate en bas, pont fessier sur\u00e9lev\u00e9, etc)<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Cas 2<br>Mme L., 27 ans, postpartum, pesanteur pelvienne + IUE dans le post-partum imm\u00e9diat<br>Enseignante, 27 ans, premier enfant : b\u00e9b\u00e9 2 mois, poids de naissance 3,3kg.<br>Accouchement long et difficile (18h), forceps, p\u00e9rin\u00e9e complet (circulaire du cordon)<br>Pas d\u2019allaitement, pas de retour de couches, a du mal \u00e0 \u00eatre examin\u00e9e<br>IUE rare (2x dans les 1ers jours, actuellement OK), urgences mictionnelles, d\u00e9lai raccourci, 7<br>\u00e0 8 mictions\/j, 0\/nuit, ne pousse pas pour uriner mais ne vide pas toujours bien<br>Retient gaz et selles, ne pousse pas<br>Pesanteur, g\u00eane permanente m\u00eame en position assise<br>Rapports non repris, cicatrice non douloureuse<br>Examen : vulve ouverte ; pouss\u00e9e et toux : statique pelvienne OK ; ERV : tendance \u00e0 l\u2019ICP ;<br>Testing vaginal : \u00e9l\u00e9vateurs cot\u00e9s \u00e0 1\/5, ne l\u00e2che pas, ne va pas jusqu\u2019\u00e0 la symphyse ;<br>cicatrice d\u2019\u00e9pisiotomie : indur\u00e9e, douloureuse \u00e0 la pression, peu mobile.<\/h3>\n","protected":false},"excerpt":{"rendered":"<p>Le pelvis f\u00e9minin Ceinture osseuse Anatomie du petit bassin Disposition des visc\u00e8res dans l&rsquo;enceinte pelvienne Vagin, ut\u00e9rus et rectum forment un triple coudure qui \u00e9vite le glissement des organes dans l&rsquo;axe vaginal aux cours des&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=5880\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0R\u00e9\u00e9ducation p\u00e9rin\u00e9ale\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[400],"tags":[],"class_list":["post-5880","post","type-post","status-publish","format-standard","hentry","category-champs-specifiques-champ-pelvi-perineal"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5880","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5880"}],"version-history":[{"count":35,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5880\/revisions"}],"predecessor-version":[{"id":6146,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5880\/revisions\/6146"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5880"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5880"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5880"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}