Evaluation of the female pelvic floor with infrared thermography: a cross sectional study.

BACKGROUND: Infrared thermography (IRT) is an easy-to-use, noninvasive and pain-free tool that can be used to evaluate function of the pelvic floor (PF) muscles. OBJECTIVE: To analyze vaginal manometry, temperature, and percentage of colors achieved through IRT of the PF muscles at rest and during maximum voluntary contraction. The relationship between PF muscles strength and IRT temperature was also assessed. METHODS: Two-hundred and thirty-one women (mean ± SD age: 58.4±5.9 years) participated in this study. IRT recorded the minimum, average, and maximum temperatures, and the colors of the PF area at rest and during maximum voluntary contraction. The pressure applied during the three maximum voluntary PF contractions was evaluated through vaginal manometry. RESULTS: The women had a PF average temperature of 36.4 ± 0.8°C. There were no differences in the IRT temperatures between rest and during PF muscles contraction. The percentages of white, red, orange, yellow, green, cyan, and blue colors were different at rest and during contraction. Warm colors became more visible in the center of the image during the PF muscles maximum voluntary contraction. There was a positive correlation between the PF average temperature and PF manometry (r=0.7; p=0.001). CONCLUSION: The IRT was not able to detect differences in the temperature of the PF area between at rest and during contraction. However, a strong correlation between PF temperature and vaginal manometry was found.

Impact of Pelvic Floor Muscle Training Isolated and Associated with Game Therapy on Mixed Urinary Incontinence: A Randomized Controlled Trial.

Objective: To verify whether pelvic floor muscle training (PFMT) associated with game therapy (GT) can potentiate improvements in PFM pressure, urinary loss, and perception of improvement in women with mixed urinary incontinence (MUI). Materials and Methods: A randomized and blinded trial was conducted with 32 women aged between 45 to 70 years presenting diagnosis of MUI. They were randomly divided into two groups: PFMT group and PFMT+GT group. Interventions occurred twice a week during 8 weeks. Primary outcome was PFM pressure, assessed by manometry, and secondary outcomes were 1-hour pad-test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and patients global impression of improvement for incontinence (PGI-I). Two-way analysis of variance and post hoc Tukey analysis were performed. Results: Initially, no significant difference between groups was found in variables of age, body mass index, educational level, marital status, gynecological and obstetric variables, life habits, and sexual activity. Besides, at baseline clinical variables also showed similar results between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. Time-group interaction did not present statistically significant differences for PFM pressure (P = 0.56), 1-hour pad-test (P = 0.75), and ICIQ-SF (P = 0.30) in intergroup analysis. All women reported being "much better or better," considering the comparison of urinary complaints in the beginning and end of treatment. Conclusion: There were no statistically significant differences between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. However, both treatments proved to be effective for MUI symptoms. Perception of improvement was highly improved, according to women's report.

Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol.

AIMS: To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. METHODS: To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. CONCLUSIONS: It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.

Comparison of pelvic floor muscle training isolated and associated with weight loss: a randomized controlled trial.

PURPOSE: To analyze whether pelvic floor muscle training (PFMT) associated with weight loss (WL) is better than isolated PFMT to provide additional beneficial effects to urinary symptoms in women with MUI. METHODS: A randomized, simple-blind parallel controlled trial was performed and included women with MUI aged between 40 and 65 years and body mass index between 25 and 40 kg/m2. The sample was randomized into two groups: 11 PFMT + WL and 11 PFMT. Data collection was performed in baseline and after interventions. The primary outcome was to investigate the loss of urine. Secondary aim includes PFM pressure and quality of life. PFMT was performed with two sets of eight repetitions in the first 4 weeks, and with three sets of eight repetitions in the final 4 weeks. The weight loss program was based on the calculation of total energy value needs. Data analysis was performed by SPSS 20.0 software and one-way ANCOVA. RESULTS: 22 volunteers participated in the study. There was no intergroup significant difference in post-intervention ICIQ-SF F(1, 19) = 7.115, p = 0.87, partial η2 = 0.001; manometry F(1, 19) = 0.608, p = 0.44, partial η2 = 0.003; pad test 1 h F(1, 19) = 0.185, p = 0.67, partial η2 = 0.01; QoL F(1, 19) = 1.018, p = 0.32, partial η2 = 0.05; and weight F(1, 19) = 0.251, p = 0.62, partial η2 = 0.01. CONCLUSIONS: Weight loss did not provide additional beneficial effects to PFMT in women with overweight or obesity grade I with MUI symptoms.

Atividade física e função da musculatura do assoalho pélvico em mulheres climatéricas: um estudo transversal / Physical activity and pelvic floor muscles function in climacteric women: a transversal study

Introdução: A mulher climatérica apresenta fraqueza muscular que pode gerar disfunções pélvicas. Aparentemente a prática regular de atividade física nesse período promove uma melhora da função muscular global. Objetivo: avaliar a função da musculatura do assoalho pélvico (MAP) de acordo com nível de atividade física em mulheres climatéricas. Métodos: estudo observacional, analítico e transversal. A amostra foi composta por 457 mulheres divididas de acordo com o nível de atividade física. A coleta de dados ocorreu através da aplicação da ficha de avaliação, aplicação do Questionário Internacional de Atividade Física (IPAQ), e avaliação por meio da palpação vaginal e manometria da MAP. Para análise estatística foram usados os testes de Kolmogorov-Smirnov, ANOVA, qui-quadrado e correlação de Pearson. Resultados: As mulheres classificadas como muito ativas obtiveram uma pressão média de 45,24cmH2O, as ativas apresentaram 29,03cmH2O e as sedentárias 27,20cmH2O, com diferença estatística entre os grupos (p=0,003). Conclusão: Quanto mais ativa for a mulher climatérica, melhor será a função da MAP.

Introduction: climacteric woman has muscle weakness that can lead to pelvic floor dysfunctions. Apparently the regular practice of physical activity in this period promotes an improvement of the global muscular function. Objective: to evaluate the pelvic floor muscles (PFM) function according to the level of physical activity in climacteric women. Methods: observational, analytical and transversal study. The sample consisted of 457 women divided according to the level of physical activity. Data collection was made through the application of evaluation form and International Physical Activity Questionnaire (IPAQ), and vaginal palpation and manometry from PFM. For statistical analysis were used the Kolmogorov-Smirnov, ANOVA, chi-square and Pearson correlation tests. Results: The very active women obtained an average pressure of 45, 24cmH2O, the actives presented 29, 03cmH2O and the sedentary 27, 20cmH2O, with statistcal difference between the groups (p = 0,003). Conclusion: The more active the climacteric woman is, the better her PFM function will be.

A manometry classification to assess pelvic floor muscle function in women.

OBJECTIVE: To develop a classification scale for manometry of pelvic floor muscles (PFM) in Brazilian women, according to the modified Oxford scale. METHODS: A cross sectional study, with 288 women enrolled in the Maternity, Natal, Brazil. Manometry and PFM strength data were collected and classified according to the modified Oxford scale. A simple linear regression was performed to determine the classification scale of manometry using the modified Oxford scale as the explanatory variable and the arithmetic mean of the manometry measurements as the response variable. RESULTS: The average age was 52.80 (±8.78; CI: 51.67-53.93) years. Manometry showed an average of 35.1 (±22.7; CI: 32.1-38.0) cmH2O and most women (29.7%) scored grade 3 on the modified Oxford scale. According to the proposed scale, values between 7.5 to 14.5 cmH2O correspond to very weak pressure; 14.6 to 26.5 cmH2O represent weak pressure; 26.6 to 41.5 cmH2O represent moderate pressure; 41.6 to 60.5 cmH2O represent good pressure, and values above 60.6 cmH2O correspond to strong pressure. CONCLUSION: Manometry values were rated on a five-point scale. It is possible to rank the pressure levels performed by voluntary contraction of PFM with this new scale.

The relationship between the presence of lower urinary tract symptoms and waist circumference.

PURPOSE: The aim of the study is to evaluate the pressure of the pelvic floor muscles (PFM) according to waist circumference (WC) and correlate the presence of urinary tract symptoms (UTS) with WC. PATIENTS AND METHODS: The study was observational and cross-sectional. One-hundred and sixty-four females between 45 and 65 years of age were evaluated. The sample was divided into two groups, according to WC: Group ≤80 (G≤80) was composed of females in whom WC was up to 80 cm; and Group >80 (G>80) was composed of females with WC above 80 cm. The subjects were assessed in terms of sociodemographic data, pre-existing conditions, urogynecological and obstetric history, and the presence of lower UTS (LUTS), as well as physical examination, measurement of WC, height, and weight. The PFM assessment was made by perineometry. To compare the mean between groups, the independent samples t-test was applied, and to correlate the WC with perineometry and LUTS, the Pearson's correlation test was used. RESULTS: The final sample was composed of 156 patients. The average age of participants was 55.21 (±24.5) years in G≤80 and 57.23 (±6.12) years in G>80. There were significant differences regarding the presence of LUTS between the groups (P<0.05); as to the perineometry, there was a significant difference (P=0.03) between the groups: 38.68±13.63 cmH2O for G≤80 and 30.11±11.20 cmH2O for G>80. There was a correlation between the presence of urinary urgency (r=0.7; P=0.00), nocturia (r=0.7; P=0.00), and urinary incontinence (r=0.9; P=0.00) with WC. CONCLUSION: Females with larger abdominal diameter have a higher prevalence of LUTS such as urinary incontinence, nocturia, and urinary urgency, as well as a lower PFM pressure. Furthermore, a relationship between LUTS with WC was also observed.