Physiotherapy for intestinal diseases in children

In addition to organic diseases of the gastrointestinal tract, children often develop functional bowel diseases (up to 80%), which require physiotherapeutic treatment methods. These diseases are polyetiological, require treatment aimed at the main links of pathogenesis, primarily at normalizing the functions of the nervous and endocrine systems, restoring impaired motor and secretory functions of the intestine.

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Indications for physiotherapy for bowel diseases in children

Physiotherapy for bowel diseases in children is prescribed depending on the type of disorder. For irritable bowel syndrome with constipation, for functional constipation, the following recommendations have been developed.

• In case of hypermotor dyskinesia, electrophoresis of papaverine, platifillin, no-shpa is prescribed to the abdominal area. The electrode with the medicine is connected to the anode, the indifferent electrode is placed on the segmental zone (thoracic or lumbar spine). In older children, inductothermy of the abdominal area can be used. The IKV-4 device is used, a low-heat dose is prescribed every other day. 5-8 procedures per course. In case of long-term constipation, it is advisable to use paraffin or ozokerite applications to the abdominal area, sinusoidally modulated currents (I and IV type of work) for 3-5 minutes, a course of 8-10 procedures.
• In case of hypomotor dyskinesia, motor activity should be increased (active games, walks). Active hardening, rubbing, dousing, and general ultraviolet irradiation according to the basic scheme in winter are mandatory. Endonasal electrophoresis of vitamin B6 is indicated to improve the regulatory function of the central nervous system.
• To increase the tone of the intestines and improve motor function, sinusoidally modulated currents from the Amplipulse device are prescribed. The electrodes are placed in the projection of the large intestine (alternately above the ascending, transverse and descending sections) and on segmental zones (in the upper lumbar spine) RR-P, FM: 30-50 Hz, GM; 75-100% for 5-10 min, 10-12 procedures daily. Prozerin electrophoresis is also performed.

In children with dysfunctions of the autonomic nervous system, procedures are prescribed taking into account autonomic homeostasis. In case of sympathicotonia, general electrophoresis according to Vermel S.B., electrophoresis of the collar zone according to Shcherbak E.A. with euphyllin, papaverine, bromine, magnesium are prescribed. 10-12 procedures are enough for a course.

Prescribed are water procedures that calm the nervous system - pine baths. Essential oils and terpenes contained in the extract penetrate well through the sebaceous glands and hair follicles into the surface layers of the skin, reducing its sensitivity. Vapors of volatile aromatic substances rise from the surface of the water, exciting the olfactory receptors of the nasal cavity and the mucous membrane of the respiratory tract. The procedure reduces the excitability of the central nervous system, enhances inhibitory processes in the cerebral cortex. Aromatic substances of pine needles reflexively increase blood flow in the internal organs and muscles, which helps to reduce the overall peripheral resistance of the vascular network (antispasmodic effect).

In case of vagotonia, electrophoresis with calcium chloride is prescribed to the collar zone, electrophoresis with caffeine, mesaton. The course consists of 10-12 procedures.

Medicinal baths are used: salt-pine baths (200 g of sea salt and 100 g of pine extract per 200 l of water), carbonic baths (1000 g of sodium bicarbonate per 200 l of water).

Children are prescribed baths for 5-10 minutes depending on age from 2-3 years old every other day or daily. A course of 10-15 baths is enough, water temperature 36-37 °.

In case of functional disorders of the intestine, drinking mineral waters is recommended, which act on the nerve receptors embedded in the intestinal wall and relieve spasms, improving motor function. Waters of low and medium mineralization are recommended, in case of hypomotor dyskinesia, highly mineralized mineral waters can be used.

Hydrocarbonate-sulphate sodium-magnesium drinking waters enhance the secretion of pancreatic juice and bile, restore impaired motor and evacuation activity of the intestine, and correct various types of metabolism in the body. Cold water increases the motor activity of the stomach and enhances intestinal peristalsis, slows down the transport of ions in the cells of the mucous membrane. Mineral water quickly passes from the stomach to the intestine, has a laxative effect.

Hydrocarbonate ions inhibit cAMP-dependent phosphorylation of enzymes, and reduce secretion of hydrochloric acid. Proton deficiency inhibits the formation of pepsins, gastrin, and secretin, and enhances peristalsis. Sulfate ions are practically not absorbed in the intestine, but they increase its motor function, exerting a laxative effect. Calcium and magnesium ions enhance the contractile function of the smooth muscle elements of the intestinal wall and restore motor activity. Naphthenes, humins, bitumens, and phenols are quickly absorbed into the blood in the stomach and upper parts of the small intestine, stimulating the intestinal microflora and promoting the production of antibacterial and biologically active components.

When treating gastrointestinal diseases accompanied by decreased intestinal motility, children are prescribed the following mineral waters: Yekateringofskaya, Essentuki No. 17, Izhevskaya, Karmadon, Lipetskaya, Semigorskaya, Batalinskaya, Lysogorskaya, Galitskaya and others.

Hydrocarbonate-chloride and sodium-calcium drinking waters in warm form normalize increased motility, slow down the rate of water passage from the stomach to the duodenum, relax the muscular layer of the intestine and reduce stool. In the intestines, warm mineral water restores disorders of secretory, motor and evacuation activity and corrects various types of metabolism.

Sodium cations, entering the interstitium and blood, restore osmolarity, which weakens intestinal peristalsis. Calcium ions enhance the contractile function of the smooth muscle elements of the intestinal wall. Potassium ions restore increased motility and evacuation function.

The mineral waters Borjomi, Krainka, Narzan, Slavyanovskaya, Smirnovskaya and others are used. These waters are also used for irritable bowel syndrome with a tendency to diarrhea.

For hypermotor dyskinesia, mineral water is prescribed warm (40-45 °C), drunk on an empty stomach 35-60 minutes before meals, slowly, in small sips, 3-4 times a day.

For hypomotor dyskinesia, drink cool mineral water (18-25 °C) on an empty stomach 40 minutes before meals, slowly, in small sips, 3-4 times a day.

The daily volume of mineral water is calculated at 3 ml/kg of body weight for children aged 4-5 years.

The course of treatment with mineral drinking waters in outpatient conditions is 28-40 days, at a resort - 21-26 days. A repeated course of drinking treatment is carried out after 3-4 months.

Treatment complexes for intestinal dyskinesia must include therapeutic exercises and massage of the abdominal area for a reflex effect on intestinal function and the tone of the abdominal wall muscles.

In case of hypermotor dyskinesia, gymnastic exercises for relaxation of the muscles of the trunk, abdominal wall and limbs are indicated. Diaphragmatic breathing training and light abdominal massage are necessary. Careful vibration massage and light kneading of the abdominal wall muscles can reflexively relieve intestinal spasm in children.

In the case of the hypomotor variant of disorders, therapeutic gymnastics that strengthen the abdominal and back muscles is of great importance. Periodic increase in intra-abdominal pressure stimulates bowel function. Swimming in a pool is also recommended.

In case of functional encopresis, it is possible to perform anal sphincter stimulation using the SNIM-1 device. However, diadynamic currents cause strong irritation under the electrodes, which limits their use in children. For this reason, the Smolensk Regional Children's Clinical Hospital currently uses electrical stimulation using the Amplipulse-4, -5 devices, which use sinusoidal modulated currents that have a less irritating effect.

Treatment of patients suffering from encopresis is carried out according to the following method: the rectal electrode is sterilized before insertion into the rectum to a depth of 2.5-5 cm (depending on age) and placed in a gauze pad made in the form of a bag of 8 layers of gauze. The pad is moistened with a physiological solution or warm water. The rectal electrode is connected to the positive pole of the current source. The second (indifferent) electrode in the form of a lead plate with an area of 100 cm2 ^together with a pad moistened with a physiological solution or warm water is placed above the pubis and connected to the negative pole of the current source.

The impact of individual types of current is carried out in rectified mode (II mode) in the following sequence.

1. For 15 seconds, a constantly modulated sinusoidal current (1st type of operation) is applied with a modulation frequency of 100 Hz at a modulation depth of 50%. The patient feels a slight vibration in the rectum. The current strength is gradually increased to a pronounced but painless sensation, increasing to 1-5 mA.
2. For 3.5 minutes, a constantly modulated sinusoidal current (1st type of operation) is applied with a modulation frequency of 50 Hz at a modulation depth of 100%. The current strength is gradually increased until the patient feels rhythmic painless contractions of the muscles of the abdominal wall, perineum, urethral sphincters and external anal sphincter,
3. For 2.5 minutes, a current of intermittent frequency is applied with alternation of currents modulated by a frequency of 50 Hz and 150 Hz (TU-Y type of work) every 1 s, with a modulation depth of 100%. The current strength is brought to the point of causing a sensation of fine vibration, alternating with rhythmic muscle contractions.
4. Current is supplied in the form of a pause-sending for 6 minutes. In this case, modulated oscillations with a frequency of 50 Hz, with a modulation depth of 100%, alternate with pauses every 1 s (TT type of work). This type of current causes short-term pronounced muscle contractions with their subsequent relaxation. The current strength is gradually increased to the sensation of intense, but painless and well-tolerated muscle contractions.

The procedures are performed daily. The number of procedures in a course of treatment does not exceed 10. In cases where improvement is noted after 5-6 procedures, the treatment should be stopped and resumed after a two-week rest. In case of relapses, the course of electrical stimulation should be repeated in a month. This method is used in children from 6-7 years old.

In preschool children (4 to 6 years old), the technique of electrical stimulation of the pelvic floor muscles can be used. One electrode (75 cm2 ⁾ is fixed with a pad at the bottom of the abdomen above the pubis and connected to the negative pole of the current source. Two other electrodes (50 cm2 ⁾, connected together, are placed on the back of the upper third of the thigh below the gluteal fold and connected to the positive pole of the current source. The current parameters and exposure time are the same as in the previous technique,

In children with functional encopresis, a positive effect occurs when conducting MIL-therapy. Magnetic laser treatment is carried out according to the generally accepted program in a 10-day course on the devices "Milta", "Rikta", "Mustang" and others. The purpose of laser treatment:

• normalization of metabolic processes in the cells of the intestinal mucosa, impact on nerve endings and co-vascular vessels of the intestine and mesentery to improve microcirculation, normalization of motility. Affect the projection zone of the large intestine.
• anterior abdominal wall; paravertebrally on both sides at the level of the lumbosacral vertebrae. Within 6 months after treatment, most children show a persistent positive effect.

Reflexology is also widely used in the treatment of constipation in children. The technique is effective for correcting autonomic dysfunctions and motor (hypo- and hypermotor) disorders, and includes various methods of influencing acupuncture points. The types of reflexology include acupuncture, moxibustion, cupping massage, magnetic vacuum therapy, acupressure, and laser puncture. Acupuncture points are selected taking into account the nature of autonomic dysfunctions and motor disorders in the colon.

Sanatorium and resort treatment of children with pathology of the gastrointestinal tract

Sanatorium and resort treatment of children with digestive system pathology is the most important stage of the system of restorative treatment. The wealth of various therapeutic factors, common in different regions of Russia, opens up wide opportunities for stage-by-stage rehabilitation of children's health.

According to the location, children's sanatoriums are divided into local and those located in the resort area. Preference should be given to the health improvement of children in local sanatoriums, where there is no sudden change in climate and there is no long journey.

The selection of children with chronic gastrointestinal diseases for spa treatment is carried out in the following order. B children's sanatoriums located outside resorts accept children aged 1 to 14 years inclusive, in children's sanatoriums and at resorts - from 3 to 14 years. B In the Smolensk region, gastrointestinal diseases in children can be treated in the sanatoriums "Mother and Child" (Borovaya village), as well as in the sanatorium named after N.M. Przhevalsky (Demidovsky district).

In Russia and the CIS countries there are a significant number of local sanatoriums and resorts providing rehabilitation and restorative treatment for children with digestive diseases: Anvakan (Armenia), Arzni (Armenia), Arshan (Russia), Borjomi (Georgia), Darasun (Russia), Jermuk (Armenia), Druskininkai (Lithuania), Essentuki (Russia), Zheleznovodsk {Russia), Karachi (Russia), Morshin (Ukraine), Nalchik (North Ossetia), Pyatigorsk (Russia), Slavyansk (Ukraine), Staraya Russa (Russia), Tamisk (Russia), Truskavets (Ukraine), Ust-Kachka (Russia), Khmelnik (Ukraine), Shira (Russia). Shmakovka (Russia).

In recent years, foreign resorts have become very popular for the treatment of children with gastrointestinal diseases: Bad Dürkheim (Germany), Baden-Baden (Germany), Bad Ischl (Austria), Bad Kissengen (Germany), Bad Frankenhausen (Germany), Balf (Hungary), Bormio (Italy), Borsec (Romania), Vittel (France), Vichy (France), Gorna Banya (Bulgaria), Duszniki Zdrój (Poland), Caiafa (Greece), Caldes de Melavella (Spain), Karlovy Vary (Czech Republic), Contrexéville (France), Chiaciano Terme (Italy), etc.