Page Twelve P H Y S I O T H E R A P Y September, 1957

TREATMENT NOTES
B y M . G . D O B E Y N , M .C ;S :p : - >

PERINEOMETRY IN P.P; STRESS INCONTINENCE 
AMONG AFRICAN PATIENTS'.! ,

V ESICO —  vaginal - fissure, stress' incontinence anu obstetrical drop-foot are . m o r e f r ’equently' encountered 
in H ospitals am ong A frican p atients.than am ong E uropean 
women. M any A frican w om en' particularly those living in 
inaccessible 'districts,, still, consider childbirth ju st one o f the 
routine occurrences in’ their lives, f o r , which nobody 
should need help. F o r th a t reason they "do not understand 
the necessity for visiting a doctor, o r ; a H ospital for ante­
natal exam inations or even for the birth itself. The majority 
— naturally not all— o f the V.V.F. o r stress incontinence 
cases would probably be prevented-by ante-natal attendances, 
when difficulties likely to  occur during labour can.be assessed 
and prepared for as much as possible.

Because E uropean women,'.on the whole, understand the 
need for proper ante-natal care, they are, as a result, less 
troubled with complications, o f this type.

H owever, w h e n .a  condition such as Perineal weakness 
w ith stress incontinence arises following a difficult labour 
this is som ething sufficiently, distressing and out of the 
ordinary for an A frican w om an to seek medical aid. (V.V.F. 
o r obstetrical palsy may occur for the same reason). A t 
some stage in their, general treatm ent these cases will often 
be referred to  thie Physiotherapy D epartm ent.

A  typical case o f perineal weakness and stress inconti­
nence could arise in the following m anner:—

A  woman gives birth to a child out in the “ bundu,” 
under very difficult conditions, and w ithout any medical 
o r nursing aid. Some weeks later the constant weakness 
and leakage o f urine which follows causes her to seek 
medical help, and eventually she arrives for treatm ent 
a t the Physiotherapy D epartm ent.

F o r such cases a routine treatm ent of exercises and 
faradic stim ulation to  the perineum  is used with m arked 
success. A fter the exercises, and if  the condition o f the 
vagina permits its use, a Perineom eter is o f great value in 
giving the patient visual p ro o f o f progressive im provem ent, 
which is encouraging, and aids m orale. Jfr acts as a, stimulus 
to provoke a m ore intense muscular reaction than one 
where the patient is merely told to  tighten the perineum. 
In addition the correct muscles are fu lly . exercised and 
extraneous movem ents can be checked.. The progress 
chart, simply kept in the form  o f a graph, provides a record 
fo r the doctor, the physiotherapist and the patient.

T he Perineom eter consists o f a very soft rubber tube 
filled with air, which is inserted into the vagina. This is 
connected to a clock-like pressure gauge by a narrower 
tube, and any contraction o f the muscles form ing the peri­
neum  is im mediately recorded and measured on the dial 
o f the pressure gauge.

. I f  the patient is told to tighten the pelvic floor by feeling 
as if she is checking a flow o f urine and also, at the same 
time, as if checking a  bowel movement, the dial will show 
the strength o f these contractions. She should be encouraged 
to  tighten the muscles m ore strongly every day, but not to 
overstrain. The movements will naturally be difficult at 
first, but the daily im provem ent recorded on the ch art is 
encouraging.

Surging faradism  and the usual exercises for strengthening 
the perineum  form  a m ajor p art o f the com plete treatm ent, 
but there is no doubt th at the perineom eter can be a most 
helpful adjunct.

LETTER TO EDITOR f
JO H A N N E SB U R G ! : ■ , , ' n .
Septem ber, 1957. ..
D ear M adam , '  ■ v  . '  . - • ■ . ,

Brian Blankenberg, a young, blind, coloured m an; is very 
keen to proceed overseas to 'train  as a Physiotherapist at the 
R oyal N atio n al-In stitu te for the- Blind, in L ondon. The 
efforts o f certain individuals in approaching such bodies as 
the B.E.S.L. and the S.A. Council for the Blind, on Mr. 
Blankenberg’s behalf, have succeeded in raising about £900 
tow ards the estim ated cost' of • training, subsistence and 
travel, viz., £1,600.

These praisew orthy efforts have come to  th e notice o f the 
N atal and Zululand Branch. M oreover, som e o f our mem­
bers have had the pleasure o f meeting Brian Blankenberg and 
have been very favourably impressed by his intelligence and 
general bearing. H is force o f character is dem onstrated by 
the fact th a t he carried o n 'a t school to  m atriculate in spite 
o f decreasing'visual acuity.

As a result, th e Branch, at its M ay meeting, decided to 
raise a token donation am ong the Physiotherapists o f N atal, 
setting a target o f £20. ’’ .

A lthough it is felt th at there'm ay be difficulties in the way' 
o f having such a fund-raising drive on behalf o f an individual 
adopted as an official activity o f the S.A.S.P., the M embers 
o f this B ranch believe th a t many of- their- fellow Physio­
therapists throughout the country will wish to  be associated 
with them  in helping this very deserving cause.

T here is every reason to believe that, once th e financial 
difficulties are overcome,' Brian B lankenberg will eventually 
qualify and become the first C oloured Physiotherapist 
in South Africa.

Any contributions to  this fund will be gratefully received b y : 
Miss H obson,

Y .W .C A .,
Esplanade,

D U R B A N .
Yours faithfully,

B ranch President.

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