摘要
产后压力性尿失禁是指女性在产后12个月内首次出现因腹压增高导致的不自主漏尿现象,该病在产后女性中发病率较高,其发生与盆底经筋系统的筋纵与筋痹密切相关。中医经筋理论认为,足三阴、足阳明和足太阳经筋循行于盆底及腰骶区域,通过“束骨利关节”的生理功能,维持盆腹的力学平衡,其对盆底功能的影响具有重要的理论价值。妊娠及分娩过程中,气血耗伤、筋骨失衡导致经筋失养,引发盆底支撑结构松弛及尿道控尿功能障碍。文章基于经筋的生理、病理特点,将中医经筋理论与现代筋膜链理论深度融合,从“气血虚滞,筋骨失衡”角度揭示产后压力性尿失禁的经筋病机,提出以“病在筋,调之筋”为核心的康复治疗策略,突破了传统单一的盆底肌训练模式。采用经筋针刺以解结通痹、腹式呼吸以优化腹内压、髋部肌肉锻炼以重建臀肌与盆底肌群协同性等三种治疗方案,恢复盆底肌群的张力与协调性,纠正骨盆旋移及腰骶应力失衡,有效缓解尿失禁症状。为产后压力性尿失禁的中西医结合临床诊疗提供理论依据,拓展了经筋理论在产后康复领域应用范围。
Postpartum stress urinary incontinence(PSUI)is defined as the involuntary leakage of urine induced by increased intra-abdominal pressure,occurring for the first time within 12 months postpartum.This condition represents a highly prevalent disorder among postpartum women,with its pathogenesis closely associated with the longitudinal and arthralgic changes in the tendinomuscular system of the pelvic floor meridians.According to the theory of meridians and tendons in Traditional Chinese Medicine(TCM),the three Yin,Yangming,and Taiyang meridians and their associated tendons traverse the pelvic floor and lumbosacral regions.These structures maintain the mechanical equilibrium of the pelvis and abdomen through their physiological function of"binding bones and facilitating joint movement."Their regulatory influence on pelvic floor function warrants signifi cant theoretical exploration.during the gestational and parturition periods,the depletion of qi and blood,coupled with musculo skeletal imbalance,leads to malnourishment of the meridians and tendons,resulting in the relaxation of pelvic floor support struc tures and urethral sphincter dysfunction.This study integrates the TCM theory of meridians and tendons with the contemporary theory of fascial chains,elucidating the pathogenesis of PSUI from the perspective of"deficiency and stagnation of qi and blood,imbalance of tendons and bones."It proposes a comprehensive rehabilitation strategy centered on the principle of"the disease lies in the tendons,regulate the tendons,"thereby transcending the conventional model of isolated pelvic floor muscle training.The therapeutic protocol encompasses three principal interventions:acupuncture along the tendons to alleviate nodules and ar thralgia,diaphragmatic breathing to optimize intra-abdominal pressure,and gluteal muscle training to reestablish the synergistic relationship between the gluteal and pelvic floor muscle groups.This multifaceted approach aims to restore the tension and coordi nation of pelvic floor musculature,correct pelvic rotation and lumbosacral stress imbalance,and effectively mitigate urinary in continence symptoms.The findings provide a theoretical foundation for the integrated TCM and Western medicine clinical man agement of PSUI and expand the application of meridian theory in the field of postpartum rehabilitation.
作者
尤怡水
董宝强
张凯旋
张峰
王鑫乐
张嫱
YOU Yishui;DONG Baoqiang;ZHANG Kaixuan;ZHANG Feng;WANG Xinle;ZHANG Qiang(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China)
出处
《实用中医内科杂志》
2026年第2期74-78,共5页
Journal of Practical Traditional Chinese Internal Medicine
基金
国家自然科学基金资助项目(81574050)
辽宁省科学技术基金项目(2022-NLTS-13-04)
辽宁省教育厅高校基本科研项目(LJ212410162040)。
关键词
经筋理论
压力性尿失禁
盆底功能
解结
产后康复
Meridian sinew theory
Stress urinary incontinence
Pelvic floor function
Untie sinew adhesions
Postpartum re habilitation
