Physiotherapy for bowel diseases in children

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

[1], [2], [3], [4]

Indications for physiotherapy for intestinal diseases in children

Physiotherapy for bowel diseases in children is prescribed depending on the type of disorders. In irritable bowel syndrome with constipation, with functional constipation, the following recommendations were developed.

• With hypermotor dyskinesia, electrophoresis papaverine, platyphylline, no-shpy on the abdomen. The drug electrode 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 region can be used. Use the apparatus of the ICV-4, assign a low-heat dose every other day. 5-8 procedures per course. With prolonged constipation, it is advisable to apply paraffin or ozocerite applications to the abdomen, sinusoidally modulated currents (I and IV types of work) for 3-5 minutes, the course of 8-10 procedures.
• When hypomotor dyskinesia should be increased motor activity (outdoor games, walks). Mandatory active hardening, wiping, douche, in winter time the total ultraviolet irradiation according to the basic scheme. To increase the regulatory function of the central nervous system, endonasal electrophoresis of vitamin B6 is indicated.
• To improve the tone of the intestine, improve the motor function, assign sinusoidally modulated currents from the apparatus "Amplipulse". Electrodes are located in the projection of the large intestine (alternately over the ascending, transverse and descending sections) and in the segmental zones (in the upper lumbar spine) PP-P, FM: 30-50 Hz, GM; 75-100% for 5-10 minutes, 10-12 procedures daily. Also carry out electrophoresis of prosirin.

In children with disorders of the autonomic nervous system, procedures are prescribed taking into account the vegetative homeostasis. With sympathicotonia, a general electrophoresis is prescribed according to Vermel SB, electrophoresis of the collar zone according to E. Shcherbak. With euphyllin, papaverine, bromine, magnesium. 10-12 procedures are enough for the course.

Assign water procedures, calming the nervous system - coniferous 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, strengthens the inhibitory processes in the cerebral cortex. Aromatic substances of needles reflexively increase blood flow in the internal organs and muscles, which contributes to the reduction of the overall peripheral resistance of the vasculature (spasmolytic action).

In vagotonia, electrophoresis is prescribed with calcium chloride on the collar zone, electrophoresis with caffeine, mezatonum. On the course of 10-12 procedures.

Applied therapeutic baths: salt-coniferous (200 g of sea salt and 100 g of pine extract per 200 liters of water), carbon dioxide (1000 g of bicarbonate of sodium per 200 liters of water).

For children, the baths are prescribed for 5-10 minutes, depending on the age from 2-3 years in a day or daily. The course is enough for 10-15 baths, the water temperature is 36-37 °.

With functional disorders of the intestine shows the drinking of mineral waters acting on nerve receptors embedded in the intestinal wall and relieving spasm, improving the motor function. Water of small and medium mineralization is shown, hypomotor dyskinesia can use highly mineralized mineral waters.

Hydrocarbonate-sulphate sodium-magnesium drinking water increases the release of pancreatic juice and bile, restores impaired motor and evacuation activity of the intestine, corrects various types of metabolism in the body. Cold water increases the motor activity of the stomach and enhances intestinal motility, slows the transport of ions in the cells of the mucous membrane. Mineral water quickly passes from the stomach into the intestines, has a laxative effect.

Hydrocarbonate ions inhibit cAMP-dependent phosphorylation of enzymes, a decrease in the secretion of hydrochloric acid. Deficiency of protons inhibits the formation of pepsins, gastrin and secretin, enhances peristalsis. Sulfate ions in the intestine are practically not absorbed, but increase its motor function, providing a laxative effect. Calcium and magnesium ions strengthen 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 development of antibacterial and biologically active components.

In the treatment of diseases of the gastrointestinal tract, accompanied by a decrease in intestinal motility, children are prescribed mineral waters Ekateringofskaya, Essentuki No. 17, Izhevsk, Karmadon, Lipetsk, Semigorsk, Batalinskaya, Lysogorsk, Galitskaya and others.

Hydrocarbonate chloride and sodium-calcium drinking water in a warm state normalize the strengthened motor skills, slow the rate of water transfer from the stomach to the duodenum, relaxing the muscular layer of the intestine slim the stool. In the intestine, warm mineral water restores disturbances in secretory, motor and evacuation activity and corrects various types of metabolism.

Sodium cations, getting into the interstipium and blood, restore the osmolarity, which weakens the intestinal peristalsis. Calcium ions increase the contractile function of the smooth muscle elements of the intestinal wall. Potassium ions restore increased motor function and evacuation function.

Use mineral waters Borjomi, Krainka, Narzan, Slavyanovskaya, Smirnovskaya, etc. These waters are also used in irritable bowel syndrome with a penchant for diarrhea.

With gynermotor dyskinesia, mineral water is prescribed in a warm form (40-45 ° C), it is taken on an empty stomach for 35-60 minutes before eating, slowly, in small sips 3-4 times a day.

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

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

The course of treatment with mineral drinking water on an outpatient basis is 28-40 days, in the resort - 21-26 days. Repeated course of drinking treatment is carried out after 3-4 months.

In complexes of treatment of dyskinesias of the intestine it is necessary to include therapeutic gymnastics and massage of the abdominal region for reflex action on the intestinal function, the tone of the muscles of the abdominal wall.

With hypermotor dyskinesia, gymnastic exercises for relaxing the muscles of the trunk, abdominal wall and limbs are shown. It requires a diaphragmatic breathing training, a light massage of the abdomen. With a careful vibrating massage and gentle kneading of the muscles of the abdominal wall, it is possible to reflexively relieve spasm of the intestine in children.

In the hypomotor variant of the disorders, therapeutic gymnastics, which strengthens the muscles of the abdominal press and backs, is of great importance. Periodic increase in intra-abdominal pressure stimulates bowel function. Recommend also swimming in the pool.

With functional encopresis, it is possible to stimulate the anal sphincter on the SNIM-1 apparatus. However, diadynamic currents cause strong stimulation under the electrodes, which limits their use in children. For this reason, the Smolensk Regional Children's Clinical Hospital is currently using electric stimulation on Amplipul-4, -5 devices, where sinusoidal modulated currents are used that have less irritating effect.

The treatment of patients suffering from encopresis is carried out according to the following procedure: the rectal electrode is sterilized and placed in a gauze pad before insertion into the rectum to a depth of 2.5-5 cm (depending on the age) and placed in a pouch of 8 layers of gauze. Wet the pad with 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 cm ^2, together with a gasket moistened with saline or warm water, is placed above the bosom and connected to the negative pole of the current source.

Exposure to certain types of current is carried out in the rectified mode (II-mode) in the following sequence.

1. For 15 s continuously modulated sinusoidal current (1st type of operation) is fed with a modulation frequency of 100 Hz with a modulation depth of 50%. In this case, the patient feels a slight vibration in the rectum. The current is increased gradually to expressed, but painless sensations, increasing to 1-5 mA.
2. For 3.5 minutes, a continuously modulated sinusoidal current (1st type of operation) with a modulation frequency of 50 Hz at a modulation depth of 100% is applied. The current strength is gradually increased to sensation of patients with rhythmic painless contractions of the abdominal wall, perineum, sphincters of the urethra and external sphincter anus,
3. For 2.5 minutes, an alternating current is applied with alternating currents modulated with a frequency of 50 Hz and 150 Hz (TY-Y type of operation), with a modulation depth of 100%. The current is brought to the senses of a small vibration, alternating with rhythmic contractions of the muscles.
4. Within 6 minutes, a current is sent in the form of a pause. In this case, modulated oscillations with a frequency of 50 Hz, with a modulation depth of 100%, alternate with pauses after 1 second (TT-th kind of work). This kind of current causes short-term pronounced contractions of muscles with subsequent relaxation. The current is gradually increased to a sensation of intense, but painless and well tolerated muscle contractions.

Procedures are carried out daily. The number of procedures in the course of treatment does not exceed 10. In those cases when after 5-6 procedures an improvement is noted, the treatment should be stopped and resumed after a two-week rest. In case of relapse, the course of electrostimulation should be repeated in a month. This method is used in children from 6-7 years.

Children of preschool age (from 4 to 6 years old) can use the technique of electrostimulation of the muscles of the pelvic floor. One electrode (75 cm ² ) is fixed with a lining in the lower abdomen above the bosom and connected to the negative pole of the current source. Two other electrodes (50 cm ² ) connected together are placed on the back surface 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 the exposure time are the same as in the previous procedure,

In children with functional encopresis, a positive effect occurs during MIL-therapy. Magnetolaser treatment is carried out according to the standard program by a 10-day course on the apparatuses of "Milta", "Rikta", "Mustang", etc. The purpose of laser treatment:

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

In the treatment of constipation in children, reflexotherapy is also widely used. The technique is effective for correcting vegetative dysfunctions and motor (hypo- and hypermotor) disorders, including various ways of affecting acupuncture points. Among the varieties of reflexotherapy, acupuncture, moxibustion, canal massage, magnetic vacuum therapy, acupressure, laser puncture are distinguished. Acupuncture points are selected taking into account the nature of vegetative dysfunctions and motor disorders in the large intestine.

Sanatorium-and-spa treatment of children with pathology of the gastrointestinal tract

Sanatorium-and-spa treatment of children with pathology of the digestive system is the most important stage of the rehabilitation system. The richness of the various medical factors prevalent in various regions of Russia opens up ample opportunities for the stage-by-stage rehabilitation of children's health.

In the place of the device, children's sanatoriums are divided into local and located in the resort area. Preference should be given to improving the health of children in local sanatoria, unless there is a sharp change in climate and there is no long move.

Selection of children with chronic diseases of the gastrointestinal tract for sanatorium treatment is carried out in the following order. B children's sanatoria located outside the resorts, take children aged 1 to 14 years inclusive, in children's sanatoriums and at resorts - from 3 to 14 years. In the Smolensk region, diseases of the gastrointestinal tract in children can be treated in sanatoria "Mother and Child" (Borovoi village), as well as in the sanatorium. NM Przhevalsky (Demidov district).

In Russia and the CIS countries there is a significant number of local sanatoria and resorts that provide rehabilitation and rehabilitation treatment for children with diseases of the digestive system: 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), Slaviansky (Ukraine), Staraya Russa ), Tamisk (Russia), Truskavets (Ukraine), Ust-Kachka (Russia), Khmilnik (Ukraine ), Shira (Russia). Shmakovka (Russia).

In recent years, foreign resorts for the improvement of children with diseases of the gastrointestinal tract have become very popular: Bad Durkheim (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), Kayafa (Greece), Caldas de -Melavella (Spain), Karlovy Vary (Czech Republic), Contrexeville (France), Ciacano Terme (Italy), etc.