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.

Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis.

Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords "athlete," "urinary incontinence," and "women" in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.

Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is the most common urinary complaint among women and is defined by the International Continence Society as any involuntary loss of urine due to physical effort, sneezing or coughing. Many women with SUI state that the loss of urine occurs after performing repetitive movements, which may suggest that it is the result of fatigue of the pelvic floor muscles (PFM). Thus, we performed the systematic review of the literature on the influence of PFM fatigue on the development or worsening of the symptoms of SUI in women. METHODS: The PubMed, Scopus, EMBASE, PEDro, LILACS, SciELO, Cochrane Library, Google Scholar, CINAHL and Periódicos CAPES databases were searched for articles using the keywords "fatigue", "pelvic floor", "stress urinary incontinence" and "women", in Portuguese and in English. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed descriptively. RESULTS: Of the 2,010 articles found, five met the inclusion criteria and were analyzed. They were published between 2004 and 2015, and included a total of 30,320 women with ages ranging from 24 to 53.6 years. Of the studies analyzed, three showed an association between fatigue and SUI, and two did not show such an association. CONCLUSIONS: This study confirmed that PFM fatigue can influence the development and/or worsening of SUI.

Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review / Exercícios terapêuticos para dor lombar e pélvica gestacional: uma revisão sistemática

Abstract Introduction: During pregnancy, a woman's body goes through many changes, and lower back and pelvic pain are common and may persist after pregnancy. Although the literature point physical therapy as an effective therapeutic tool, there are few studies on the effects of physical therapy intervention through exercises for this purpose. Objective: To perform a systematic review on the use of Physiotherapy, through therapeutic exercises, for the prevention and treatment of pregnancy low back and pelvic pain. Methods: A systematic search for randomized trials (RCTs) was conducted on the databases PubMed, PEDro, Cochrane, EMBASE, LILACS and Periódicos Capes. There was no date or language restriction. The terms included in the search were: "pregnancy", "low back pain", "pelvic pain", "exercise therapy" and their descriptors in Portuguese. Methodological quality was assessed using the PEDro scale and a descriptive analysis of the studies was performed. Results: Eight studies, including 1781 pregnant women, were selected. Among them, one study addressed the issue of low back pain, two focused on pelvic pain and five on low back and/or pelvic pain. Seven studies presented high methodological quality, and only one study had low methodological quality. Limited evidence on low back pain was found, and conflicting evidence on pelvic pain, and low and/or pelvic pain. Conclusion: RCTs on the subject are scarce and heterogeneous, making it impossible to reach a consensus or any conclusions about which protocol of therapeutic exercise is more effective in the use of physiotherapy for pregnancy low back and pelvic pain.

Resumo Introdução: Na gravidez o organismo materno passa por muitas transformações e a dor lombar e a dor pélvica são frequentes, podendo persistir após a gestação. Embora a literatura venha apontando a Fisioterapia como recurso terapêutico efetivo, existem poucos estudos sobre os efeitos da intervenção fisioterapêutica por meio de exercícios para esse fim. Objetivo: Desenvolver uma revisão sistemática sobre a abordagem da Fisioterapia, por meio de exercícios terapêuticos, na prevenção e no tratamento da dor lombar e pélvica gestacional. Métodos: Realizou-se uma busca sistemática por ensaios clínicos randomizados (ECRs) nas bases de dados PubMed, PEDro, Cochrane, EMBASE, LILACS e Periódicos Capes. Não houve restrição de data e de idioma. Os termos compreendidos na busca foram: "pregnancy", "low back pain", "pelvic pain", "exercise therapy" e seus descritores em português. A qualidade metodológica foi avaliada por meio da escala PEDro, e uma análise descritiva dos estudos foi realizada. Resultados: Oito estudos, incluindo 1781 gestantes, foram selecionados. Dentre eles, um estudo aborda a temática da dor lombar, dois sobre dor pélvica e cinco sobre dor lombar e/ou pélvica. Sete estudos apresentaram alta qualidade metodológica, e somente um estudo apresentou qualidade metodológica baixa. Foram encontradas evidências limitadas para dor lombar e evidências conflitivas para dor pélvica e para dor lombar e/ou pélvica. Conclusão: Os ECRs sobre o tema ainda são escassos e heterogêneos, impossibilitando estabelecer consenso e conclusões sobre qual protocolo de exercícios terapêuticos é mais eficaz no manejo fisioterapêutico da dor lombar e pélvica gestacional.

Perfil de usuários que buscam atendimento fisioterapêutico para incontinência urinária em um centro de saúde do município de Porto Alegre / Profile of users seeking physical therapy for urinary incontinence in a health center in the city of Porto Alegre

A Incontinência Urinária, definida como qualquer perda involuntária de urina, é reconhecida como um problema de saúde pública multifatorial e que tem a opção terapêutica da Fisioterapia. Este trabalho objetiva descrever o perfil de usuários da atenção básica do Sistema Único de Saúde que buscaram atendimento fisioterapêutico para Incontinência Urinária em um Centro de Saúde de Porto Alegre, entre março de 2012 e abril de 2014. Trata-se de um estudo transversal, documental e retrospectivo, de abordagem quantitativa. Foram analisadas as anamneses de 95 pacientes (84 mulheres e 11 homens). A média de idade das mulheres foi 63 anos e 65,5 anos para os homens. O tempo desde o início dos sintomas obteve média de 25 anos entre as mulheres e 11 meses entre os homens. Entre as mulheres, 13,2% apresentam Diabete Mellitus, 48,8% relatam Hipertensão Arterial Sistêmica e 48,8% realizaram cirurgia pélvica. A média de partos foi 6,5 (59,5% parto normal - 30,9% com fórceps e 64,3% com episiotomia -, 9,5% cesariana e 26,2% ambos). Entre os homens, 36,3% apresentam Diabete Mellitus, 54,5% Hipertensão Arterial Sistêmica e 72,7% realizaram prostatectomia. O perfil de pacientes demonstrado nesse estudo foram adultos e idosos com mais de 40 anos, sobretudo mulheres que realizaram parto normal ou cirurgias pélvicas. No sexo masculino, observou-se alta incidência de pacientes que realizaram prostatectomia. Os pacientes avaliados apresentaram elevado percentual de Hipertensão Arterial Sistêmica. Verificou-se o elevado tempo de convívio com a Incontinência Urinária, principalmente entre as mulheres, por considerarem parte do envelhecimento, demonstrando a necessidade de maior esclarecimento da população acerca do tema.

The Urinary Incontinence (UI), defined as any involuntary loss of urine, is recognized as a multifactorial problem of public health and has therapeutic option physiotherapy. This paper aims to describe the user's profile of primary care of the Sistema Único de Saúde who sought physical therapy for UI in a Porto Alegre Health Centre and were attended by students of the Physical Therapy School of the Universidade Federal do Rio Grande do Sul, between March 2012 and April 2014. It is a documentary study with descriptive analysis of the variables. The case histories of 95 patients (84 women and 11 men) were analyzed. The average age of women was 63 years and 65.5 years for men. The time from onset of symptoms had an average of 25 years for women and 11 months among men. Among women, 13.2% have Diabetes Mellitus (DM), 48.8% reported systemic arterial hypertension (SAH) and 48.8% had pelvic surgery. The average number of births was 6.5 (59.5% vaginal delivery - 30.9% to 64.3% with forceps and episiotomy - 9.5% caesarean section and 26.2% both). Among men, 36.3% had DM, hypertension 54.5% and 72.7% underwent prostatectomy. The results show that the UI may be related to obstetric history, pelvic surgery and hypertension. There was the high convivial time with the UI, especially among women, because they consider part of aging, demonstrating the need for further clarification of the population on the subject.