Botulinum-toxin-A injection following conservative management in patients with dyssynergic defaecation only improves symptoms in the short term: a retrospective study

Objective: Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD. Methods: A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy. Results: The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks. The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1-32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant. Conclusion: Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy. (AU)

Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire.

OBJECTIVE: The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability). METHODS: Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient. RESULTS: Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Validation and cross-cultural adaptation of the Brazilian Portuguese version of the questionnaire for the assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum.

INTRODUCTION AND HYPOTHESIS: Pelvic floor dysfunction may be treated and prevented during pregnancy and postpartum, as it decreases women's quality of life. The aim of the present study was to translate and validate the Brazilian Portuguese questionnaire for the assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum. METHODS: This is a cross-sectional study. Two translators fluent in German translated the German version of the questionnaire into English. The back translation was performed by two other translators. The final version was tested on Brazilian pregnant/puerperal women. The participants answered the questionnaire twice, with an interval of 7-10 days between sessions. They also completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). To evaluate the test-retest reliability, we used the intraclass correlation coefficient (ICC), Cronbach's alpha coefficient, to test the internal consistency, and Pearson's linear correlation to assess construct validity. RESULTS: Sixty-six women were included (77% pregnant; 23% puerperal women), with a mean age of 26.5 ± 5.8 years and a body mass index of 26.4 ± 5.7 kg/cm2. There were no missing ceiling or floor effects. The construct validity presented a moderate correlation with the role physical domain of the SF-36 (r = -0.48), the ICC test-retest showed good reliability of 0.72, and the internal consistency was 0.71. CONCLUSIONS: These results provide evidence that the questionnaire for the assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum is a valid and reliable instrument when utilized in Brazilian pregnant and postpartum women.

Pelvic floor distress inventory (PFDI)-systematic review of measurement properties.

INTRODUCTION AND HYPOTHESIS: The Pelvic Floor Distress Inventory (PFDI) and PFDI-20 have been translated and validated into several languages ​​with different measurement property values ​​and are recommended by the International Consultation on Incontinence (ICI) as grade A for assessing pelvic floor dysfunction. Thus, the aim of the current study was to investigate the measurement properties of the PFDI and PFDI-20. METHODS: Systematic review conducted in August 2020 through a search performed in PubMed, SCOPUS, WoS, ScienceDirect, CINAHL, and Google Scholar for studies that evaluated the measurement properties of the PFDI and PFDI-20. The data were analyzed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS: Initially, 2857 studies were found, and 7 studies on PFDI and 25 on PFDI-20 were analyzed. The PFDI presented high quality of evidence for hypothesis testing, moderate for test-retest reliability and responsiveness, and very low quality of evidence for content validity. The PFDI-20 presented high quality of evidence for criterion validity, hypothesis testing, and responsiveness, moderate quality for test-retest reliability and measurement errors, and very low quality of evidence for content validity. It was not possible to rate the quality of evidence of the internal consistency of the PFDI and PFDI-20. No studies assessed the cross-cultural validity. CONCLUSION: Only the hypothesis testing presented high quality of evidence for the PFDI. Criterion validity, hypothesis testing, and responsiveness presented a high quality of evidence for the PFDI-20. Due to the high degree of recommendation of the PFDI and PFDI-20 given by the ICI, further studies are needed to reevaluate all the measurement properties of these instruments.

Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Anthropometric indicators as predictors of pelvic floor muscle distress in young women.

AIM: To identify anthropometric indicators that could predict pelvic floor muscle distress (PFMD) in young women. METHOD: A cross-sectional study was conducted, whose sample consisted of 54 women aged between 18 and 35 years. The Pelvic Floor Distress Inventory was used to assess the PFMD. The anthropometric indicators evaluated were body mass index (BMI) being measured the weight and height, body fat percentage (skinfolds), waist circumference (WC), waist-to-hip ratio (WHR), and relative fat mass (RFM), which is calculated from height and WC. Descriptive and inferential statistics (Spearman correlation, simple linear regression, and receiver operating characteristic curve) were used, with a significance level of 5%. RESULTS: The PFMD and the anthropometric indicators BMI (r = .43), body fat percentage (r = .42), WC (r = .46), WHR (r = .49), and RFM (r = .48) showed a positive and moderate correlation (P < .01). In all, 24%, 23%, 20%, and 18% of the PFMD can be credited to RFM, WC, WHR, and body fat percentage, respectively. The cut-off point for RFM was 38.44 for the symptom of pressure in the lower abdomen and 36.24 for symptom of stress urinary incontinence and incomplete emptying of the bladder. CONCLUSION: Anthropometric indicators of body fat percentage, WC, WHR, and RFM can be predictors of PFMD in young women minimally symptomatic.

Added value of dynamic magnetic resonance images in pelvic floor dysfunction / Valor agregado das imagens de ressonância magnética dinâmica na disfunção do assoalho pélvico

ABSTRACT Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p < 0.001). Physical examination found a single pathology in 80.8 % of cases. Anterior rectocele (AR) was the most frequent isolated diagnosis on physical examination (68 %). On the Dynamic and Multiplanar Evaluation of the Pelvic Floor, anterior rectocele was diagnosed as an isolated condition in 10.9 %. In 231 cases, anterior rectocele was associated with up to 5 other pelvic floor disorders. The number of individuals with associated pathologies of the posterior and anterior compartments tripled. It modified physical examination findings in 17 % of individuals and, in 63.5 %, allowed the identification of additional pelvic floor pathologies that were missed by physical examination. The Dynamic and Multiplanar Evaluation of the Pelvic Floor had greater added value in patients with anterior rectocele (59.6 % vs. 20.9 %; p < 0.001). Female gender was also associated with a greater diagnostic yield (p < 0.001). Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic floor dislocations, allowing a comprehensive therapeutic planning.

RESUMO Objetivo A disfunção do assoalho pélvico tem alta prevalência na população adulta. A avaliação dinâmica e multiplanar do assoalho pélvico (DMRIPF) representa uma ferramenta ideal para o gerenciamento multidisciplinar. O objetivo desta análise é avaliar o valor agregado da avaliação dinâmica e multiplanar do assoalho pélvico em pacientes com suspeita de distúrbios do assoalho pélvico. Métodos Análise retrospectiva de uma série consecutiva de pacientes submetidos à avaliação dinâmica e multiplanar do assoalho pélvico por suspeita de distúrbios do assoalho pélvico entre Abril de 2005 e Julho de 2019. Resultados 359 pacientes foram incluídos. O número médio de diagnósticos alcançados pelo exame físico foi de 1,2vs. 2,5 pela avaliação dinâmica e multiplanar do assoalho pélvico p < 0,001. O exame físico encontrou uma única patologia em 80.8 % dos casos. A retocele anterior (RA) foi o diagnóstico isolado mais frequente no exame físico (68 %). Na avaliação dinâmica e multiplanar do assoalho pélvico, a retocele anterior foi diagnosticada como uma condição isolada em 10.9 %. Em 231 casos, a retocele anterior foi associada a até 5 outros distúrbios do assoalho pélvico. O número de indivíduos com patologias associadas dos compartimentos posterior e anterior triplicou. Modificou os achados do exame físico em 17 % dos indivíduos e em 63.5 %; permitiu a identificação de outras patologias do assoalho pélvico que foram esquecidas pelo exame físico. A avaliação dinâmica e multiplanar do assoalho pélvico teve maior valor agregado em pacientes com retocele anterior (59.6 % vs.20.9 %; p < 0,001. O sexo feminino também foi associado a um maior rendimento diagnóstico p < 0,001. Conclusão A avaliação dinâmica e multiplanar do assoalho pélvico permite a detecção de defeitos multicompartimentários que, de outra forma, poderiam não ser detectados, ou mesmo alterar o diagnóstico clínico inicial, representando uma ferramenta ideal para a abordagem multidisciplinar das luxações do assoalho pélvico, permitindo um planejamento terapêutico abrangente.

Efectividad de la reeducación del suelo pélvico en adultas mayores con incontinencia urinaria de esfuerzo / Effectiveness of pelvic floor re-education in elder women with stress urinary incontinence

Introducción: Durante el proceso de envejecimiento pueden originarse diferentes síndromes en el adulto mayor. Entre los más comunes está la incontinencia urinaria de esfuerzo, con alteraciones en vejiga y estructuras del área pélvica, así como en el funcionamiento de las vías urinaria bajas. Objetivo: Evaluar la efectividad de la reeducación del suelo pélvico en mujeres adultas mayores con incontinencia urinaria de esfuerzo. Métodos: Estudio descriptivo y longitudinal en mujeres adultas mayores con incontinencia urinaria de esfuerzo del Centro Gerontológico de Guano, Ecuador. Universo de 20 pacientes, 100 por ciento de la población diagnosticada, edades ≥ 65 años, sin otros antecedentes de trastornos médicos. Resultados: Se destaca como antecedentes de los sujetos estudiados: índice de masa corporal: 60 por ciente de obesidad, seguido del 25 por ciento de sobrepeso, ginecobstétricos: 95 gestaciones, 77 por ciento partos normales y 12 por ciento de cesarias. En la evaluación inicial, mediante la escala de valoración modificada de Oxford, en el 60 por ciento de las adultas se obtuvo grado 2, caracterizada por contracciones musculares débiles del suelo pélvico, evaluación insatisfactoria. En la segunda medición se obtuvieron resultados significativamente superiores a los de la primera medición, 70 por ciento se evaluó satisfactoriamente. Durante el proceso de reeducación del suelo pélvico, se establecieron relaciones de integración entre los elementos participación activa y consiente del paciente, equipo de salud y familia, en función de una mayor calidad de vida, de importancia para el tratamiento. Conclusiones: Se alcanzó el 70 por ciento de efectividad en la reeducación de suelo pélvico aplicada a las mujeres adultas mayores con incontinencia urinaria de esfuerzo(AU)

Introduction: In the aging process, different syndromes can appear in the elderly. Stress urinary incontinence is among the most common, with alterations in the bladder and the pelvic area structures, as well as in the functioning of the lower urinary tract. Objective: To assess the effectiveness of pelvic floor re-education in elder women with stress urinary incontinence. Methods: Descriptive and longitudinal study in elder women with stress urinary incontinence in the Gerontological Center of Guano, Ecuador. Group sample of 20 patients, 100% of the population diagnosed, ages? 65 years, without other pathological background. Results: It is highlighted as a background of subjects studied: body mass index: 60 percent of obesity, followed by 25 percent of overweight; gineco-obstetrics: 95 gestations, 77 percent normal births and 12 percent of C-sections. In the initial assessment, through the modified Oxford valuation scale, in 60 percent of adults, Grade 2 was obtained. That was characterized by weak pelvic floor muscle´s contractions, unsatisfactory evaluation. In the second measurement, the obtained results were significantly higher than those of the first measurement, and 70 percent is evaluated as satisfactorily. During the process of pelvic floor's re-education, integration relationships were established between the elements, also active and conscious participation of the patient, the health team and the family, in order to obtain a greater life quality which is important for the treatment. Conclusions: 70 percent of effectiveness is achieved in pelvic floor re-education performed in elder women presenting stress urinary incontinence(AU)

The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction.

INTRODUCTION: In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS: This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 22 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction, encompassing around 390 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in male lower urinary tract and pelvic floor dysfunction. Male-specific imaging (ultrasound, radiology, CT, and MRI) has been a major addition whilst appropriate figures have been included to supplement and help clarify the text. CONCLUSIONS: A consensus-based Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Validation of the Brazilian Portuguese version of the pelvic floor bother questionnaire.

INTRODUCTION AND HYPOTHESIS: The Pelvic Floor Bother Questionnaire (PFBQ) was designed to identify the presence and degree of bother associated with common pelvic floor symptoms. The PFBQ can be used in clinical practice and for research purposes, but it is not available in Brazilian Portuguese. We aimed to validate a cross-culturally adapted Brazilian Portuguese version of the PFBQ. METHODS: A pilot-tested version of the PFBQ translated from English was evaluated with Brazilian patients suffering from pelvic floor disorders. Internal reliability, test-retest reliability, validity, and responsiveness to change were assessed. RESULTS: A total of 147 patients (mean age, 60.49 years) were enrolled in the study. The Brazilian Portuguese version of the PFBQ demonstrated good reliability (α = 0.625; ICC = 0.981). There was strong agreement beyond chance for each item (κ = 0.895-1.00). The PFBQ correlated with stage of prolapse (p < 0.01), number of urinary (ρ = 0.791, p < 0.001) and fecal (ρ = 0.78, p < 0.001) incontinence episodes, and obstructed defecation (ρ = 0.875, p < 0.001). CONCLUSIONS: The Brazilian Portuguese version of the PFBQ is a reliable, valid, and user-friendly instrument that can be used for assessing the presence and severity of pelvic floor symptoms in clinical and research settings in Brazil.

Transcultural translation and validation of the FIGO Assessment Scoring System (FASS) to Portuguese language.

INTRODUCTION AND HYPOTHESIS: Our aim was to validate the Brazilian Portuguese version of the International Federation of Gynecology and Obstetrics (FIGO) Assessment Scoring System (FASS) to identify and quantify signs and symptoms related to pelvic floor dysfunction. METHODS: One hundred and seventy-nine women aged 18-82 (47.68 ± 14.42) years participated in this validation study. Collected data included a sociodemographic and clinical questionnaire, application of the FASS, and physical examination using the Pelvic Prgan Prolapse Quantification (POP-Q) system. The translation and cross-cultural adaptation were performed following the international methodology. The psychometric properties tested were criterion validity, construct validity, stability, and reliability. For this purpose, the comparison with POP-Q findings and between symptomatic and asymptomatic patients, test-retest and internal consistency (Cronbach's alpha) were used, respectively. The intraclass correlation coefficient (ICC) was calculated to assess the level of agreement between evaluations (inter- and intraobservers). P < 0.05 was considered statistically significant. RESULTS: The calculated Cronbach's alpha coefficient was 0.76, indicating strong reliability for the validation sample. Symptomatic women had different scores on all FASS items as well as total score when compared with asymptomatic women (p < 0.001). Intraobserver coefficient ranged from 0.91 (urinary symptoms) to 0.98 (FASS total score), indicating excellent concordance level in all items. Interobserver coefficient ranged from 0.47 (intestinal symptoms) to 0.90 (FASS total score), indicating moderate to excellent correlation. CONCLUSIONS: The psychometric properties tested in the FASS Portuguese version proved to be a valid and reliable for evaluating signs and symptoms related to pelvic floor function in Brazilian women.

Physiotherapy methods to facilitate pelvic floor muscle contraction: A systematic review.

AIM: To undertake a systematic review of the literature on physical therapy methods to facilitate voluntary pelvic floor muscles (PFM) contraction. METHODS: The databases consulted were PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PEDro and CINHAL. The study included randomized controlled trials, quasi-experimental trials and systematic reviews. The GRADE scale was used to assess methodological quality. RESULTS: Six manuscripts were included. The methods investigated included instruction regarding the anatomy and function of the PFM, vaginal palpation, palpation on the central perineal tendon, interruption of urinary flow, biofeedback using a perineometer, vaginal cones, hypopressive exercise, PFM contraction associated with diaphragmatic breathing; and coactivation of abdominal muscles. The studies showed improvement in PFM contraction, but most were of low methodological quality. Only one study was characterized as being of high methodological quality. CONCLUSION: All the studies observed improvement in PFM contraction using various methods, but none were superior over the others. The studies revealed no adverse effects of the interventions used. Patient preferences should be taken into account in clinical decision-making. More studies of high methodological quality on this topic are needed.

Defectos del suelo pélvico y su impacto en la calidad de vida de la mujer / Pelvic floor defects and their impact on the women's quality of life

Introducción: los defectos del suelo pélvico son un motivo de consulta frecuente en las mujeres de edad mediana, su prevalencia es elevada, considerándose que casi un tercio de la población adulta y adulta mayor la padece. Objetivo: determinar la prevalencia de los defectos de suelo pélvico en las mujeres de edad mediana y su relación con la calidad de vida, en el policlínico Héroes del Moncada. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal de las pacientes de edad mediana y superior atendidas en nuestro consultorio desde septiembre de 2014 a enero de 2016. De las 376 pacientes mayores de 40 años en nuestra área fueron estudiadas 245 que accedieron formar parte de nuestro estudio, a las que fue realizado estudio clínico y aplicado el cuestionario PFIQ-7 sobre calidad de vida. Resultados: fueron identificados defectos del suelo pélvico en 103 pacientes representando el 42 por ciento del universo. Diversos factores de riesgo como el hábito de fumar, los trabajos con fuerza, así como la paridad se mostraron con significación estadística en relación a estos defectos. Un 59 por ciento del universo presentó afectación de la calidad de vida entre moderada y severa dependiente de defectos del suelo pélvico. Conclusiones: existió elevada prevalencia de defectos perineales repercutiendo de forma negativa en la calidad de vida de las pacientes afectadas, las cuales convivían conscientes de su defecto sin asistir a consulta para tratamiento oportuno(AU)

Introduction: Pelvic floor defects are a frequent cause of consultation among by average-aged women. Their prevalence is high, considering that almost one third of the adult and senior adult population suffers from it. Objective: To determine the prevalence of pelvic floor defects in average-aged women and their relationship with quality of life in Héroes del Moncada Polyclinic. Methods: An observational, descriptive, cross-sectional study of average- and senior-age patients consulted in our office from September 2014 to January 2016. Out of the 376 patients over 40 years of age in our area, 245 were studied, who agreed on being part of our study and were conducted a clinical study and the questionnaire PFIQ-7 on quality of life. Results: Pelvic floor defects were identified in 103 patients, which represents 42 percent of the universe. Various risk factors such as smoking, hard work, as well as parity were shown with statistical significance in relation to these defects. 59 percent of the universe had mild to severe quality of life impairment dependent on pelvic floor defects. Conclusions: There was a high prevalence of perineal defects with negative repercussions on the quality of life of the affected patients, who lived aware of their defect without attending a consultation for timely treatment(AU)

La integración en la transversalidad del compartimento posterior del suelo pélvico en el Hospital Universitario Comandante Manuel Fajardo (2013- 2015) / Posterior compartment of the pelvic floor and its integration in cross-sectional approach in Comandante Manuel Fajardo Hospital (2013-2015)

Introducción: las afecciones del suelo pélvico tienen alta prevalencia y su estudio debe ser realizado con enfoque transversal para proveer al paciente el tratamiento adecuado. Objetivo: describir las características clínicas de enfermedades del compartimento posterior con diagnóstico basado en enfoque transversal. Método: estudio descriptivo, transversal en pacientes atendidos en la consulta de Coloproctología en el Hospital Universitario Comandante Manuel Fajardo, desde septiembre 2013 hasta mayo 2015. El universo estuvo constituido por 67 pacientes. Fueron calculadas frecuencias y porcentajes para las variables cualitativas e intervalos de edad, y estadísticos descriptivos de la edad. Resultados: la mayoría de los pacientes fueron ≤ 45 años, con predominio de la tercera edad (43,3 por ciento). Las mujeres constituyeron la mayoría del grupo (80,6 por ciento). Los antecedentes de riesgo más frecuentes fueron los relacionados con la historia obstétrica, fundamentalmente la multiparidad (83,3 por ciento). La forma de presentación más frecuente fue la incontinencia anal. Predominó la afectación exclusiva del compartimento posterior (59,7 por ciento). La afectación bicompartimental predominante fue la anterior y posterior, determinada en su mayoría por incompetencia dual (única afección en 17,9 por ciento). No se detectó afectación tricompartimental. Conclusiones: las afecciones del compartimento posterior se asociaron en alta proporción a enfermedades de otros compartimentos del suelo pélvico, lo que ratifica la importancia del enfoque transversal(AU)

Introduction: pelvic floor illnesses have high prevalence and their study must be conducted with a cross-sectional approach to provide the patient with adequate treatment. Objectives: to describe the clinical characteristics of the posterior compartment illnesses by using cross-sectional approach-based diagnoses in patients seen at the coloproctology service of Manuel Fajardo university hospital from September 2013 to May 2015. Method: descriptive and cross-sectional study. The universe of study was 67 patients. Frequencies and percentages for qualitative variables and age intervals as well as summary statistics for age were all calculated. Results: many patients were 45 years and over, being the older age predominant (43.3 percent). Women were the majority in the group (80.6 percent). The most frequent risk antecedents were those related to obstetric history, mainly multiparity (83.3 percent). The most common form of presentation was anal incontinence. Single affection of the posterior compartment (59.7 percent) prevailed. The predominant bi-compartmental affection was the anterior and posterior one, mainly determined by dual incontinence (single affection in 17.9 percent of cases). Tricompartmental affection was not detected. Conclusions: the posterior compartment affections were greatly associated to diseases in other pelvic floor compartments, which supports the importance of using the cross-sectional approach(AU)

La integración en la transversalidad del compartimento posterior del suelo pélvico en el Hospital Universitario Comandante Manuel Fajardo (2013- 2015) / Posterior compartment of the pelvic floor and its integration in cross-sectional approach in Comandante Manuel Fajardo Hospital (2013-2015)

Introducción: las afecciones del suelo pélvico tienen alta prevalencia y su estudio debe ser realizado con enfoque transversal para proveer al paciente el tratamiento adecuado. Objetivo: describir las características clínicas de enfermedades del compartimento posterior con diagnóstico basado en enfoque transversal. Método: estudio descriptivo, transversal en pacientes atendidos en la consulta de Coloproctología en el Hospital Universitario Comandante Manuel Fajardo, desde septiembre 2013 hasta mayo 2015. El universo estuvo constituido por 67 pacientes. Fueron calculadas frecuencias y porcentajes para las variables cualitativas e intervalos de edad, y estadísticos descriptivos de la edad. Resultados: la mayoría de los pacientes fueron ≤ 45 años, con predominio de la tercera edad (43,3 por ciento). Las mujeres constituyeron la mayoría del grupo (80,6 por ciento). Los antecedentes de riesgo más frecuentes fueron los relacionados con la historia obstétrica, fundamentalmente la multiparidad (83,3 por ciento). La forma de presentación más frecuente fue la incontinencia anal. Predominó la afectación exclusiva del compartimento posterior (59,7 por ciento). La afectación bicompartimental predominante fue la anterior y posterior, determinada en su mayoría por incompetencia dual (única afección en 17,9 por ciento). No se detectó afectación tricompartimental. Conclusiones: las afecciones del compartimento posterior se asociaron en alta proporción a enfermedades de otros compartimentos del suelo pélvico, lo que ratifica la importancia del enfoque transversal(AU)

Introduction: pelvic floor illnesses have high prevalence and their study must be conducted with a cross-sectional approach to provide the patient with adequate treatment. Objectives: to describe the clinical characteristics of the posterior compartment illnesses by using cross-sectional approach-based diagnoses in patients seen at the coloproctology service of Manuel Fajardo university hospital from September 2013 to May 2015. Method: descriptive and cross-sectional study. The universe of study was 67 patients. Frequencies and percentages for qualitative variables and age intervals as well as summary statistics for age were all calculated. Results: many patients were 45 years and over, being the older age predominant (43.3 percent). Women were the majority in the group (80.6 percent). The most frequent risk antecedents were those related to obstetric history, mainly multiparity (83.3 percent). The most common form of presentation was anal incontinence. Single affection of the posterior compartment (59.7 percent) prevailed. The predominant bi-compartmental affection was the anterior and posterior one, mainly determined by dual incontinence (single affection in 17.9 percent of cases). Tricompartmental affection was not detected. Conclusions: the posterior compartment affections were greatly associated to diseases in other pelvic floor compartments, which supports the importance of using the cross-sectional approach(AU)

Defectos del suelo pélvico y su impacto en la calidad de vida de la mujer / Pelvic floor defects and their impact on the women's quality of life

Introducción: los defectos del suelo pélvico son un motivo de consulta frecuente en las mujeres de edad mediana, su prevalencia es elevada, considerándose que casi un tercio de la población adulta y adulta mayor la padece. Objetivo: determinar la prevalencia de los defectos de suelo pélvico en las mujeres de edad mediana y su relación con la calidad de vida, en el policlínico Héroes del Moncada. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal de las pacientes de edad mediana y superior atendidas en nuestro consultorio desde septiembre de 2014 a enero de 2016. De las 376 pacientes mayores de 40 años en nuestra área fueron estudiadas 245 que accedieron formar parte de nuestro estudio, a las que fue realizado estudio clínico y aplicado el cuestionario PFIQ-7 sobre calidad de vida. Resultados: fueron identificados defectos del suelo pélvico en 103 pacientes representando el 42 por ciento del universo. Diversos factores de riesgo como el hábito de fumar, los trabajos con fuerza, así como la paridad se mostraron con significación estadística en relación a estos defectos. Un 59 por ciento del universo presentó afectación de la calidad de vida entre moderada y severa dependiente de defectos del suelo pélvico. Conclusiones: existió elevada prevalencia de defectos perineales repercutiendo de forma negativa en la calidad de vida de las pacientes afectadas, las cuales convivían conscientes de su defecto sin asistir a consulta para tratamiento oportuno(AU)

Introduction: Pelvic floor defects are a frequent cause of consultation among by average-aged women. Their prevalence is high, considering that almost one third of the adult and senior adult population suffers from it. Objective: To determine the prevalence of pelvic floor defects in average-aged women and their relationship with quality of life in Héroes del Moncada Polyclinic. Methods: An observational, descriptive, cross-sectional study of average- and senior-age patients consulted in our office from September 2014 to January 2016. Out of the 376 patients over 40 years of age in our area, 245 were studied, who agreed on being part of our study and were conducted a clinical study and the questionnaire PFIQ-7 on quality of life. Results: Pelvic floor defects were identified in 103 patients, which represents 42 percent of the universe. Various risk factors such as smoking, hard work, as well as parity were shown with statistical significance in relation to these defects. 59 percent of the universe had mild to severe quality of life impairment dependent on pelvic floor defects. Conclusions: There was a high prevalence of perineal defects with negative repercussions on the quality of life of the affected patients, who lived aware of their defect without attending a consultation for timely treatment(AU)

Validation and cultural translation for Brazilian Portuguese version of the Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20).

INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders [urinary (UI) and/or fecal C (FI) incontinence, pelvic organ prolapse (POP)] may have a significant impact in womens' quality of life (QoL). The Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) help assess these disorders; however, we do not have them culturally translated in the Brazilian Portuguese language. METHODS: A cross-sectional study was performed of 185 women with pelvic floor disorders (PFD group) and 65 healthy patients (control group). A translated, pilot-tested, Brazilian Portuguese version were given to these women. Internal consistency, construct validity, and floor/ceiling effect were assessed. Test-retest was performed in 79 patients after 4 weeks, and responsiveness was assessed in 42 patients after surgical treatment. RESULTS: Internal consistency (Cronbach's alpha) was adequate between PFD and control groups on the PFDI-20 (0.816-0.844) and PFIQ-7 (0.823-0.846). Test-retest reliability was also adequate [intraclass correlation coefficient (ICC) 0.803-0.843]. Subscales [Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7) and Colorectal-Anal Impact Questionnaire (CRAIQ-7) from the PFIQ-7 demonstrated floor effect (42.70, 60, and 18.38 %, respectively) in the PFD group, with no influence at total score. No ceiling effect was observed. Construct validity was adequate at all correlations between clinical symptoms and subscales in both questionnaires in both groups. Responsiveness was demonstrated by a statistically significant reduction in scale/subscale scores from PFDI-20 and PFIQ-7 after surgical treatment. CONCLUSION: The PFDI-20 and PFIQ-7 presented adequate cultural translation and are reliable and valid in the Brazilian Portuguese language.