Vaginal stretching therapy and class IIIB vaginal laser treatment for pelvic floor myofascial pain: a randomized clinical trial.

PURPOSE: Several treatment options are proposed for the management of pelvic floor myofascial pain (PFMP). Manual therapy, such as vaginal stretching (VS), is one of these options. Photobiomodulation therapy (PBMT) with a laser device is a treatment option for PFMP that has been tested on other muscles. The aim of this study was to evaluate the effect of VS combined or not with PBMT for PFMP treatment. METHODS: One hundred three women with PFMP were enrolled in a double-blind randomized trial and assigned to VS+PBMT (10 treatments over 2 weeks with 100 mw delivering 12 joules to surface intravaginally, using near-infrared light 808 nm) and VS+shamPBMT treatment groups. Pain severity was assessed by Visual Analog Scale (VAS). Pelvic floor muscle function was assessed by Oxford Scale and surface electromyography. Urinary symptoms were evaluated by ICIQ-OAB and ICIQ-SF questionnaires, and intestinal constipation was assessed by ROMA criteria. RESULTS: There was a significant improvement in pain intensity (VAS) after treatment in both groups, with no difference between groups (p = 0.46). More than 50% of the women complained of severe pain before treatment, and after treatments, it was reported by less than 20% of women (p < 0.001), with no difference between groups (p = 0.08). Urinary symptoms improved in both groups (p < 0.001) with no difference between groups (p = 0.37). Intestinal constipation improved in the VS+PBMT group only (p = 0.01). CONCLUSION: VS and VS with near-infrared vaginal laser therapy were equally effective at decreasing myofascial pelvic pain and reducing urinary symptoms TRIAL REGISTRATION: REBEC (Registro Brasileiro de Ensaios Clínicos; Brazilian Registry of Clinical Trials) under no.RBR-2TDCQ4 (November 11, 2018).

[Urinary symptoms and the pelvic floor muscle function after delivery]. / Sintomas urinários e função muscular do assoalho pélvico após o parto.

PURPOSE: to evaluate the prevalence of urinary symptoms and association between pelvic floor muscle function and urinary symptoms in primiparous women 60 days after vaginal delivery with episiotomy and cesarean section after labor. METHODS: a cross-sectional analysis was conducted on women from an out patient clinic in São Paulo state, Brazil, 60 days after delivery. Pelvic floor muscle function was assessed by surface electromyography (basal tone, maximal voluntary contraction and mean sustained contraction) and by a manual muscle test (grades 0-5). In an interview, the urinary symptoms were identified and women with difficulty to understand, with motor/neurological impairment, pelvic surgery, diabetes, restriction for vaginal palpation and practicing exercises for pelvic floor muscles were excluded. The χ2 and Fisher Exact test were used to compare proportions and the Mann-Whitney test was used to analyze mean differences. RESULTS: 46 primiparous were assessed on average 63.7 days postpartum. The most prevalent symptoms were nocturia (19.6%), urgency (13%) and increased daytime urinary frequency (8.7%). Obese and overweight women had 4.6 times more of these symptoms (PR=4.6 [95%CI; 1.2-18.6; p value=0.0194]). Stress urinary incontinence was the most prevalent incontinence (6.5%). The mean values found for the basic tone, maximal voluntary contraction and sustained contraction were: 3 µV, 14.6 µV and 10.3 µV. Most of the women (56.5%) had grade 3 muscular strength. There was no association between urinary symptoms and pelvic floor muscle function. CONCLUSION: the prevalence of urinary symptoms was low 60 days postpartum and there was no association between pelvic floor muscle function and urinary symptoms.

Sintomas urinários e função muscular do assoalho pélvico após o parto / Urinary symptoms and the pelvic floor muscle function after delivery

OBJETIVO: avaliar a prevalência de sintomas urinários e a associação da função muscular do assoalho pélvico com sintomas urinários de primíparas com 60 dias pós-parto vaginal com episiotomia e cesariana depois do trabalho de parto. MÉTODOS: análise tipo corte transversal da função muscular do assoalho pélvico 60 dias pós-parto de mulheres atendidas ambulatorialmente. Foi avaliada a função muscular (tônus basal, contração voluntária máxima e contração sustentada média) por eletromiografia de superfície e por graduação de força (graus 0-5). Em entrevista, foram identificados os sintomas urinários e excluídas as mulheres com dificuldade de compreensão, déficit motor/neurológico de membros inferiores, cirurgia pélvica prévia, diabetes, contraindicação para palpação vaginal e praticantes de exercícios para musculatura do assoalho pélvico. Foram utilizados os testes do χ2 e Exato de Fisher para comparar proporções e o teste Mann-Whitney para comparar médias. RESULTADOS: foram avaliadas 46 puérperas, com média de 63,7 dias pós-parto. Os sintomas mais prevalentes foram noctúria (19,6 por cento), urgência (13 por cento) e aumento de frequência urinária diurna (8,7 por cento). Puérperas obesas e com sobrepeso tiveram 4,6 vezes mais queixa destes sintomas (RP=4,6 [IC95 por cento 1,2-18,6; valor p=0.0194]). A perda urinária aos esforços foi a mais prevalente das incontinências (6,5 por cento). Os valores médios encontrados para tônus de base, contração voluntária máxima e contração sustentada média foram 3µV, 14,6µV e 10,3µV e a maioria (56,5 por cento) apresentou grau 3 de força muscular. Não se observou associação entre sintomas urinários e função muscular do assoalho pélvico. CONCLUSÃO: a prevalência de sintomas urinários foi baixa aos 60 dias pós-parto e não houve associação entre função muscular do assoalho pélvico e sintomas urinários.

PURPOSE: to evaluate the prevalence of urinary symptoms and association between pelvic floor muscle function and urinary symptoms in primiparous women 60 days after vaginal delivery with episiotomy and cesarean section after labor. METHODS: a cross-sectional analysis was conducted on women from an out patient clinic in São Paulo state, Brazil, 60 days after delivery. Pelvic floor muscle function was assessed by surface electromyography (basal tone, maximal voluntary contraction and mean sustained contraction) and by a manual muscle test (grades 0-5). In an interview, the urinary symptoms were identified and women with difficulty to understand, with motor/neurological impairment, pelvic surgery, diabetes, restriction for vaginal palpation and practicing exercises forpelvic floor muscles were excluded. The χ2 and Fisher Exact test were used to compare proportions and the Mann-Whitney test was used to analyze mean differences. RESULTS: 46 primiparous were assessed on average 63.7 days postpartum. The most prevalent symptoms were nocturia (19.6 percent), urgency (13 percent) and increased daytime urinary frequency (8.7 percent). Obese and overweight women had 4.6 times more of these symptoms (PR=4.6 [95 percentCI; 1.2-18.6; p value=0.0194]). Stress urinary incontinence was the most prevalent incontinence (6.5 percent). The mean values found for the basic tone, maximal voluntary contraction and sustained contraction were: 3 µV, 14.6 µV and 10.3 µV. Most of the women (56.5 percent) had grade 3 muscular strength. There was no association between urinary symptoms and pelvic floor muscle function. CONCLUSION: the prevalence of urinary symptoms was low 60 days postpartum and there was no association between pelvic floor muscle function and urinary symptoms.