fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2022-7-1-92-101fcmedicine-520Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESДисфункция тазового дна у женщин: современные представления о проблеме (обзор литературы)Pelvic floor dysfunction in women: current understanding of the problemhttps://orcid.org/0000-0002-5984-1109РемнёваО. В.RemnevaO. V.

Ремнёва Ольга Васильевна, доктор медицинских наук, профессор, заведующая кафедрой акушерства и гинекологии 

656038, г. Барнаул, пр. Ленина, д. 40

Olga V. Remneva, MD, DSc, Professor, Head of the Department ofObstetrics and Gynecology

40, Lenina Prospekt, Barnaul, 656038

rolmed@yandex.ruhttps://orcid.org/0000-0002-6895-7103ИванюкИ. С.IvanyukI. S.

Иванюк Ирина Сергеевна, аспирант заочной формы обучениякафедры акушерства и гинекологии 

656038, г. Барнаул, пр. Ленина, д. 40

Irina S. Ivanyuk, MD, PhD Student, Department of Obstetrics andGynecology

40, Lenina Prospekt, Barnaul, 656038

https://orcid.org/0000-0003-3013-7764ГальченкоА. И.Gal'chenkoA. I.

Гальченко Анжелика Ивановна, кандидат медицинских наук,доцент, доцент кафедры акушерства и гинекологии 

656038, г. Барнаул, пр. Ленина, д. 40

Anzhelika I. Gal'chenko, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology

40, Lenina Prospekt, Barnaul, 656038

ФГБОУ ВО «Алтайский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияAltai State Medical UniversityRussian Federation2022310320227192101Copyright © Ремнёва О.В., Иванюк И.С., Гальченко А.И., 20222022Ремнёва О.В., Иванюк И.С., Гальченко А.И.Remneva O.V., Ivanyuk I.S., Gal'chenko A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/520

Дисфункция тазового дна (ДТД) является тревожной проблемой, которая затрагивает многих женщин. Это состояние возникает в результате повреждения соединительной ткани связочного аппарата тазового дна. Дисфункция тазового дна является многофакторным заболеванием. С жалобами, вызванными данным состоянием, пациентки часто обращаются к врачам разных специальностей, что обусловливает различия статистических данных. Вагинальные роды напрямую связаны с появлением патологии тазового дна, чаще недержания мочи, пролапса и недержания кала. Хроническое повышение внутрибрюшного давления, повреждение нервов и сопутствующие заболевания у людей с ожирением способствуют дисфункции тазового дна. Неоспорима роль генетических факторов в возникновении пролапса гениталий. Как правило, на начальных стадиях пролапс не вызывает беспокойств у женщин. Прогрессирование заболевания приводит к возникновению серьезных изменений анатомических структур тазового дна. Женщины с симптоматическими расстройствами испытывают физический и эмоциональный стресс. Заболевание все чаще встречается у женщин репродуктивного возраста. Стандартом в лечении пролапса тазовых органов считается оперативная коррекция. Однако лечение пролапса I–II стадии, по классификации POP-Q, следует начинать с консервативных методов. Однако в настоящее время отсутствуют конкретные схемы лечения и нет четко сформированного мнения относительно упражнений Кегеля. Методом выбора при лечении пациенток с недержанием мочи является тренировка мышц тазового дна в режиме биологической обратной связи. Одним из эффективных консервативных методов является использование пессариев. Доказательства хороших результатов лечения проявлений ДТД лазером в виде многоцентровых рандомизированных плацебо-контролируемых исследований отсутствуют. Несмотря на большой интерес исследователей к пролапсу гениталий, частота тяжелых проявлений данной патологии не снижается. Также не существует единого взгляда на диагностические подходы. В статье представлен обзор литературных данных последних лет, касающихся этиологии, современных методов диагностики и лечения проявлений дисфункции тазового дна у женщин.

Here we review the recent literature on pelvic floor dysfunction, which is increasingly common in women of reproductive age and represents a significant medical problem occurring as a result of injured pelvic floor ligaments. Pelvic floor dysfunction is largely associated with vaginal delivery and might lead to urinary and fecal incontinence as well as pelvic organ prolapse. Intraabdominal hypertension, nerve damage, obesity, and genetic predisposition are among the major contributors to pelvic floor dysfunction. Being asymptomatic at the early stage, pelvic floor dysfunction gradually leads to the irreversible alterations in pelvic floor anatomy, ultimately deteriorating quality of life. Surgery remains a gold standard in the treatment of pelvic organ prolapse, yet POP-Q stage I-II prolapse should be treated conservatively. Currently, there are no specific treatment regimens and no evidence-based opinion regarding Kegel exercises and laser therapy. Biofeedback pelvic floor muscle training is the treatment of choice for urinary incontinence. Use of pessaries represents another efficient approach to conservative treatment.

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The authors declare that there are no conflicts of interest present.