Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?

AIMS: The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP). METHODS: Fifty-eight women with a mean age of 55.4 (± 9.8) years old with stage II POP were randomly assigned to participate in the PFMT group, the hypopressive exercises associated with PFMT (HE + PFMT) group or the control group. Each treatment group underwent a 3-month course of treatment. The three groups received lifestyle advice regarding weight loss, constipation, coughing, and the avoidance of heavy lifting. Participants were evaluated before and after the treatment. Maximal voluntary contraction (MVC) and endurance were assessed using the Modified Oxford grading system. To evaluate muscle activation, surface electromyography (SEMG) was used. RESULTS: The two treatment group significantly increase pelvic floor muscle function as measured by MVC (P < 0.001) using the Modified Oxford grading system, as well as muscle activation (P < 0.001), measured by SEMG. The PFMT group was superior regarding endurance (P = 0.007). Both groups were superior to the control group regarding MVC, endurance and muscle activation. CONCLUSION: Adding hypopressive exercises to PFMT does not improve PFM function. Both treatment groups performed better than the control group.

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women.

INTRODUCTION AND HYPOTHESIS: We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). METHODS: Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. RESULTS: In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 µv) than in the pregnant group (30 µv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). CONCLUSION: In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Cervical cancer mortality trends in Brazil: 1980-2009.

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the country's major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (-5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial.

CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

Cervical cancer mortality trends in Brazil: 1980-2009 / Tendência da mortalidade por câncer do colo do útero no Brasil: 1980 a 2009 / Tendencia de la mortalidad por cáncer del cuello de útero en Brasil: 1980 a 2009

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the country's major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (­5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

O objetivo deste estudo foi fornecer um quadro quanto à tendência da mortalidade por câncer do colo de útero no Brasil, em suas regiões e estados, entre 1980 e 2009. Estudo ecológico de série temporal, com uso de informações sobre óbitos (Sistema de Informações sobre Mortalidade - SIM) e base demográfica (Instituto Brasileiro de Geografia e Estatística - IBGE). Foram realizadas análises das tendências da mortalidade por meio da regressão de Poisson. Houve estabilização nas taxas de mortalidade no Brasil. Nas regiões, houve queda no Sul (-4,1%), Sudeste (-3,3%) e Centro-Oeste (-1%); aumento no Nordeste (3,5%) e Norte (2,7%). As maiores reduções foram observadas em São Paulo (-5,1%), Rio Grande do Sul, Espírito Santo e Paraná (-4,0%). Os maiores aumentos foram observados na Paraíba (12,4%), Maranhão (9,8%) e Tocantins (8,9%). No Brasil, houve estabilização na mortalidade por câncer do colo do útero. No entanto, houve redução em 3 regiões e em 10 estados, enquanto, em 2 regiões e em outros 10 estados, a mortalidade segue aumentando. Uma das razões para essa disparidade pode ser o menor acesso ao tratamento para as pacientes de áreas menos desenvolvidas.

El objetivo fue analizar la mortalidad por cáncer de cuello de útero en Brasil, en sus macrorregiones y estados en el período de 1980 a 2009. Se trata de un estudio ecológico de serie temporal, con uso de información sobre óbitos del Sistema de Información sobre Mortalidad (SIM), y base demográfica del Instituto Brasileño de Geografía y Estadística (IBGE). Se realizaron análisis de las tendencias de la mortalidad, mediante la regresión de Poisson. En Brasil se observó la estabilización en las tasas de mortalidad. En las macrorregiones, hubo caída en el Sur (-4,1%), Sudeste (-3,3%) y Centro-Oeste (-1%); aumento en el Nordeste (3,5%) y Norte (2,7%). En los estados, las principales caídas fueron observadas en São Paulo (-5,1%), Rio Grande do Sul, Espírito Santo y Paraná (-4%). Los mayores aumentos se observaron en Paraíba (12,4%), Maranhão (9,8%) y Tocantins (8,9%). Conclusión: Brasil presenta estabilización en las tasas de mortalidad. No obstante, hubo una reducción en 3 macrorregiones y en 10 estados, mientras que en 2 macrorregiones y en 10 estados la mortalidad sigue aumentando. Una de las razones para esa disparidad puede ser el menor acceso al tratamiento para las pacientes de áreas menos desarrolladas.

Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial / Eficácia do treinamento da musculatura do assoalho pélvico e de exercícios hipopressivos para o tratamento do prolapso de órgãos pélvicos em mulheres: ensaio clínico randomizado

CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

CONTEXTO E OBJETIVO: Estudos anteriores mostraram que mulheres com disfunção do assoalho pélvico possuem diminuição da área de secção transversal (AST) do músculo levantador do ânus. Uma forma de avaliar os efeitos de um programa de treinamento é mensurar a AST do músculo por ultrassonografia. O objetivo foi avaliar a eficácia do treinamento da musculatura do assoalho pélvico e de exercícios hipopressivos no aumento da AST do músculo levantador do ânus em mulheres com prolapso de órgãos pélvicos. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, randomizado e controlado realizado no Ambulatório de Uroginecologia da Universidade Federal de São Paulo. MÉTODOS: Cinquenta e oito mulheres com prolapso de órgãos pélvicos estádio II foram divididas em três grupos para tratamento fisioterapêutico: (GI) grupo de treinamento dos músculos do assoalho pélvico, (GII) grupo de exercícios hipopressivos e (GIII) grupo controle. As pacientes se submeteram a avaliação ultrassonográfica transperineal com transdutor de frequência 4-9 MHz. Foi mensurada a AST do músculo levantador do ânus antes e após 12 semanas de tratamento fisioterapêutico. RESULTADOS: Os grupos foram homogêneos no que se refere a idade, número de gestações, número de partos vaginais, índice de massa corpórea e estado hormonal. Diferença significante foi observada na AST de GI e GII antes e após o tratamento (P < 0,001) e isso não ocorreu com o GIII (P = 0,816). CONCLUSÕES: A AST do músculo levantador do ânus aumentou significativamente com tratamento fisioterapêutico em mulheres com prolapso de órgãos pélvicos. Treinamento dos músculos do assoalho pélvico e exercícios hipopressivos são semelhantes no que se refere ao aumento da AST do músculo levantador do ânus.

Prolapso genital e reabilitação do assoalho pélvico / Pelvic floor rehabilitation and genital prolapse

O prolapso genital é condição comum e importante indicação de cirurgia ginecológica nos dias atuais. A quantificação do prolapso é realizada por meio do POP-Q, uma classificação internacionalmente reconhecida e preconizada pela Sociedade Internacional de Continência (ICS). O suporte dos órgãos pélvicos se dá por um sistema de suspensão, constituído de ligamentos, e outro de sustentação, constituído por fáscias e músculos, especialmente o levantador do ânus, que deve estar íntegro para que possa manter perfeito suporte dos órgãos e o hiato genital fechado. A fraqueza ou defeitos nesse músculo podem levar ao aparecimento de prolapso genital. O tratamento conservador tem ganhado espaço, especialmente em estágios menos avançados do prolapso. Consiste em mudanças nos hábitos de vida diária, tais como redução de peso, diminuição das atividades que aumentam a pressão abdominal, tratamento da constipação intestinal, e intervenções físicas, como o fortalecimento da musculatura do assoalho pélvico. Este estudo constitui um levantamento das evidências científicas acerca do tratamento conservador do prolapso genital, visando proporcionar uma visão mais atual do problema

The pelvic organ prolapse is a common condition and the main cause of gynecologic surgery nowadays. The quantification of genital prolapse is performed by means of POP-Q, an international classification recognized and indicated by the International Continence Society (ICS). The support of the pelvic organs relies on a suspension system, made of ligaments, and a sustentation system, made of fascies or muscles, especially the levator ani, that should be intact in order to give a perfect support for the organs and for close genital gap. The weakness or damages in this muscle can cause genital prolapse. The nonsurgical treatment has been used more frequently, especially in early stages of the prolapse. It consists of changing daily habits, such as reducing weight, decreasing activities that raise abdominal pressure, treating intestinal constipation, and other physical interventions, such as the strengthening of the pelvic floor musculature. This study is a bibliographic evidence-based research about the conservative treatment of the genital prolapse

O prolapso genital associado à incontinência urinária de esforço altera a função muscular do assoalho pélvico? / The association between pelvic organ prolapse and stress urinary incontinence changes the pelvic fl oor muscle function?

Prolapso genital é defi nido como deslocamento dasvísceras pélvicas em sentido caudal. Trata-se de afecção comum,especialmente em mulheres menopausadas e, não obstante, podeestar associado à incontinência urinária de esforço (IUE). Estudosmostram que mulheres com prolapso genital possuem funçãomuscular do assoalho pélvico diminuída. Objetivo: Verifi car se hádiferença entre a função dos músculos do assoalho pélvico (MAP)de mulheres incontinentes com ou sem prolapso genital. Métodos:Participaram dessa pesquisa 24 voluntárias divididas em dois grupos,a saber: Grupo I composto por 12 mulheres com IUE associada aoprolapso genital; e Grupo II, composto por 12 mulheres com IUEe sem prolapso genital associado. Avaliou-se a função dos MAP pormeio de palpação bidigital, utilizando-se as escalas de AvaliaçãoFuncional do Assoalho Pélvico (AFA) e Oxford, teste de tempomáximo de contração (endurance) e exame com perineômetro. Paraa análise estatística, utilizou-se o test t de Student, para comparar asmédias obtidas e o nível de signifi cância. Resultados: as mulheres comprolapso genital associado apresentaram menor AFA (p = 0,043),Oxford (p = 0,043) e tempo de sustentação da contração mensuradopelo perineômetro (p = 0,044). Conclusão: mulheres incontinentescom prolapso genital apresentam menor função muscular e menortempo de sustentação da contração...

Pelvic organ prolapse is defi ned as pelvic viscera displacementin caudal direction. In menopausal women is particularlycommon and it can be associated with stress urinary incontinence(SIU). Studies show that in women with pelvic organ prolapse,the pelvic fl oor muscle (PFM) function loses strength. Aim: Toverify if there is any diff erence between the function of the pelvicfl oor muscles (PFM) of incontinent women with or without pelvicorgan prolapse. Methods: Twenty four patients were divided intotwo groups: Group I with 12 women with SUI and Group II, with12 women with SUI associated with pelvic organ prolapse. Th efunction of PFM was evaluated using bidigital palpation, measuredby Functional Pelvic Floor Evaluation (AFA) and Oxford scales,maximum time of contraction test (endurance) and perineometerexam. Regarding the statistical analysis, the student test t was usedto compare the means and signifi cance level. Results: Women withpelvic organ prolapse associated showed lower AFA (p = 0,043),Oxford (p = 0,043) and holding contraction time measured byperineometer (p = 0,044). Conclusion: Incontinent women withpelvic organ prolapse showed lower PFM function and decrease ofmuscular endurance...