Efeito de um treinamento de músculos pélvicos em grupo para mulheres com incontinência urinária: um ensaio clínico randomizado / Effect of a training of pelvic muscles in group for women with urinary incontinence: arandomized clinical test

Introdução: A incontinência urinária (IU) é um problema muitas vezes subestimado, não recebendo a devida atenção. Dentre as possibilidades de tratamento conservador da IU, o treinamento dos músculos do assoalho pélvico (TMAP) supervisionado deve ser recomendado como primeira linha de tratamento para as mulheres. O TMAP pode ser desenvolvido em grupos, individualmente e em casa. Objetivos: Ainda há poucos estudos na literatura envolvendo TMAP em grupo com protocolos definidos que possam ser facilmente compreendidos e reproduzidos pelos pacientes. O objetivo deste estudo é demonstrar a eficácia de um protocolo de TMAP em grupo comparado a um protocolo de TMAP domiciliar para mulheres com IU. Métodos: Este foi um estudo experimental controlado randomizado cego que seguiu as recomendações do CONSORT. Os instrumentos de avaliação foram a escala PERFECT, ICIQ-SF e PISQ-12. O principal resultado foi a melhora da função dos músculos do assoalho pélvico (MAP) e os resultados secundários foram a melhora da qualidade de vida (QV) e da função sexual (FS). Resultados: Com doze semanas de tratamento o protocolo do grupo TMAP apresentou-se como uma forma de tratamento mais eficaz para IU, pois apresentou melhora nos itens potência e QV. Ao observar a efetividade dos protocolos, após vinte e quatro semanas, ambos foram efetivos apenas no que se refere aos desfechos secundários, QV e FS. Conclusão: Pode-se supor que a intervenção em grupo, utilizada nesta amostra específica, constitui uma estratégia de intervenção fisioterapêutica factível e viável, capaz de beneficiar muitas mulheres com IU, além de ser uma ferramenta de fácil compreensão e acompanhamento pelos pacientes.

Comparison of parasacral transcutaneous electrical stimulation and transcutaneous posterior tibial nerve stimulation in women with overactive bladder syndrome: A randomized clinical trial.

OBJECTIVE: To compare the effects of parasacral transcutaneous electrical stimulation with the effects of transcutaneous posterior tibial nerve stimulation in women with overactive bladder syndrome (OAB). STUDYDESIGN: A randomized clinical trial was performed with 50 women aged 40-76 years with symptoms of OAB, divided into two groups: the parasacral transcutaneous electrical stimulation (PS) group and the transcutaneous posterior tibial nerve stimulation (PTN) group. Both groups underwent the same protocol, at home, for 6 weeks, applying electrical stimulation three times per week. The tools used for evaluation were the King's Health Questionnaire (KHQ), the Overactive Bladder-Validated 8-question Awareness Tool (OAB-V8) and the Incontinence Severity Index (ISI). Statistical analysis was undertaken using independent t-test, Mann-Whitney test, Chi-squared test and generalized estimating equations. RESULTS: After 6 weeks of treatment, OAB-V8 showed a significant improvement in the PTN group compared with the PS group (Mann-Whitney test, p = 0.019). Post-intervention, no between-group differences were seen in terms of KHQ domains, average KHQ symptom scale and proportions of categories of ISI. All variables showed a significant effect of time after 6 weeks of treatment for both groups (p < 0.005). CONCLUSION: Both forms of transcutaneous electrical stimulation seem to be effective and safe for home treatment of women with OAB.

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery.

OBJECTIVE: To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). METHODS: The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. RESULTS: A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). CONCLUSION: The type of delivery was not associated with differences in the short-term development of postpartum PFD.

Vibratory perineal stimulation for the treatment of female stress urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: The pelvic floor muscles (PFM) play an important part in the urinary continence mechanism. Changes in their structure and functionality may lead to a predisposition to pelvic floor dysfunction such as urinary incontinence (UI), which is the involuntary loss of urine. Some techniques for conservative treatment of UI are already well documented. However, new approaches have been found that require scientific proof of their effectiveness, such as vibratory stimulation (VS). Thus, we performed a systematic review of studies that investigated the use of perineal VS (PVS) for the treatment of stress UI. MATERIALS AND METHODS: This study followed the recommendations of the Cochrane Collaboration for systematic reviews. Studies that used PVS for the treatment of female UI were eligible. RESULTS: A total of 56 studies were found, of which ten were duplicates and were excluded. Analysis of the titles and abstracts led to the exclusion of 30 studies, leaving 16 for detailed analysis. Of these, only three were included as they fulfilled all the eligibility criteria previously established for the present study. In spite of the heterogeneity of the protocols, all the studies had the goal of assessing the effects of vibration on the PFM, and the stimulation was found to be effective in reducing urinary leakage, improving muscle strength and consequently the patients' quality of life. CONCLUSIONS: Because of the heterogeneity and the small number of studies, it is not possible to draw a conclusion as to the effectiveness of PVS for the treatment of stress UI, and further studies are needed to provide scientific support for its use.

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI. METHODS: Cochrane's recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group. RESULTS: Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI. CONCLUSION: PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.

Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies / Sinergismo da musculatura abdomino-pélvica em mulheres hígidas: uma revisão sistemática

Abstract Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.

Resumo Introdução: O treinamento dos músculos do assoalho pélvico é amplamente utilizado no tratamento de disfunções do assoalho pélvico, como a incontinência urinária, e durante sua execução evita-se a contração abdominal, entretanto vários estudos defendem a utilização do sinergismo entre estes grupos musculares. Objetivo: Revisar sistematicamente os estudos que buscam identificar a presença de sinergismo entre os músculos do abdômen e do assoalho pélvico e sua funcionalidade em mulheres sem disfunções do assoalho pélvico. Metodologia: Para a realização da revisão, foram seguidas as recomendações propostas pela Colaboração Cochrane para revisões sistemáticas. A busca na literatura incluiu as bases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL e EMBASE, além de busca manual, do início das bases até agosto de 2013. Foram incluídos estudos observacionais transversais com mulheres saudáveis que foram avaliadas quanto à presença de sinergismo entre os músculos abdominais e do assoalho pélvico. Resultados: Foram incluídos 10 artigos e todos demonstraram a existência de sinergismo entre os músculos abdominais e músculos do assoalho pélvico em mulheres saudáveis nas posturas supina, sentada e em ortostase. Conclusão: Dessa forma, pode-se concluir que há sinergismo entre os músculos do abdômen e do assoalho pélvico em mulheres saudáveis. Conhecer melhor o comportamento dessas musculaturas e do sinergismo pode favorecer a elaboração de estratégias de prevenção e tratamento das disfunções dos músculos do assoalho pélvico feminino.

Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study.

INTRODUCTION AND HYPOTHESIS: The Pilates method is a form of physical exercise that improves the control of the core muscles, improving the conditioning of all the muscle groups that comprise the core, including the pelvic floor muscles (PFM). Thus, this study had the goal of verifying the existence of differences in the functioning of the PFM in women who practice the Pilates method and sedentary women. METHODS: This was an observational, cross-sectional pilot study. A sample size calculation was performed using preliminary data and it determined that the sample should have at least 24 individuals in each group. The participants were 60 women aged 20 to 40 years; 30 women practiced the Pilates method (PMG) and 30 were sedentary (SG). An anamnesis file was used to collect personal data and assess the knowledge and perception of the PFM. The Perina perineometer and vaginal palpation were used to determine the functionality of the PFM. RESULTS: There was no significant difference between the PMG and the SG in any of the variables analyzed. CONCLUSIONS: We concluded that the functionality of the PFM in younger women who practice the Pilates method is not different from that of sedentary women.

Prevalência e tipo de perda urinária em participantes dos grupos de tratamento no setor de Fisioterapia do Centro de Saúde IAPI de Porto Alegre/RS / Prevalence and type of urinary incontinence in participants of treatment groups in the Physical Therapy department at IAPI Health Centre at Porto Alegre/RS

Objetivo: Este estudo objetivou identificar nos participantes dosgrupos de tratamento no setor de Fisioterapia do Centro de SaúdeIAPI de Porto Alegre/RS, a prevalência e tipo de perda urinária existente.Material e métodos: A amostra foi composta por 32 indivíduos,do sexo masculino e feminino, idade 65 a 84 anos. Foi utilizado oQuestionário ICIQ-SF, que avalia o impacto da IU na qualidade devida e a qualificação da perda urinária, e um questionário que tratoude verificar a história gestacional e urológica. Resultados e conclusão:Observou-se neste estudo uma alta prevalência de perda urináriano grupo estudado e o tipo mais encontrado foi a hiperatividadevesical. Apesar de a prevalência de perda urinária ter sido significativae interferido na qualidade de vida dos indivíduos estudados, pôde-seperceber que os indivíduos não deixaram de participar do grupo detratamento devido à perda urinária.

Objective: This study aimed at identifying the prevalence andtype of pre-existing urinary incontinence in participants of treatmentgroups in the Physical Therapy department at IAPI Health Centreat Porto Alegre/RS. Methods: The sample included 32 patients, maleand female, 65 to 84 years old. Was used the ICIQ-SF Questionnaire,which assesses the impact of incontinence on quality of lifeand classification of urinary loss, and a questionnaire for verifyingpregnancy and urological history. Results and conclusion: We observeda high prevalence of urinary incontinence in the study group andoveractive bladder was the more often found type. Although prevalenceof urinary incontinence has been significant and interferedwith quality of life of the patients, was observed that patients donot stop participating in the treatment group due to urinary loss.

A Fisioterapia em um grupo de reeducação perineal masculino / Physical therapy in a group of male perineal reeducation

Este estudo investigativo propõe-se a elucidar a infl uênciada intervenção fi sioterapêutica em grupo no tratamento desintomas urinários irritativos (SUI) e sintomas urinários obstrutivos(SUO). Material e métodos: Estudo qualitativo, exploratório edescritivo, que apresenta fundamentos do trabalho da Fisioterapiano grupo denominado Grupo de Reeducação Perineal Masculino.Resultados e conclusão: Além da melhora dos SUI e SUO, este estudodemonstrou que a fi sioterapia em grupo para a população estudadaé uma boa opção terapêutica e apresentou resultados satisfatórios,tanto físicos como psicossociais...

The aim of this investigative study was to elucidate theinfl uence of a group-based physical therapy intervention in the treatmentof irritative urinay symptoms (IUS) and obstructive urinarysymptoms (OUS). Methods: Qualitative, exploratory and descriptivestudy, based in physical therapy work of a group called Group ofMale Perineal Reeducation. Results and conclusion: In addition tothe improvement of IUS and OUS, this study demonstrated thatgroup physical therapy is a good therapeutic option and presentedsatisfactory results, both physical and psychosocial...