Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.549
Filtrar
2.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
3.
Int Braz J Urol ; 46(1): 5-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851453

RESUMO

The exact prevalence of pelvic organ prolapse is difficult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic floor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The "Integral theory" of Petros and the "Levels of Support" model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse. The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.


Assuntos
Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/fisiopatologia , Colágeno/fisiologia , Feminino , Humanos , Menopausa/fisiologia , Obesidade/complicações , Obesidade/fisiopatologia , Paridade , Diafragma da Pelve/fisiopatologia , Prolapso de Órgão Pélvico/terapia , Fatores de Risco
4.
Int Braz J Urol ; 45(6): 1196-1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808408

RESUMO

AIMS: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. MATERIALS AND METHODS: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. RESULTS: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). CONCLUSION: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.


Assuntos
Disfunção Erétil/reabilitação , Exercícios de Alongamento Muscular/métodos , Diafragma da Pelve/fisiopatologia , Assistência Perioperatória/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Gradação de Tumores , Estadiamento de Neoplasias , Neurorretroalimentação , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
5.
Br J Nurs ; 28(15): 968-974, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393761

RESUMO

Pelvic floor dysfunction is a common problem, particularly for women. A weakness in the pelvic floor muscles can lead to one or more disorders developing, such as urinary incontinence or a pelvic organ prolapse. To combat this, it is advised that the pelvic floor muscles are exercised to strengthen them and help them become more supportive. However, more than 30% of women are unable to detect their pelvic floor muscles to produce an effective contraction. The introduction of neuromuscular electrical stimulation (NMES) in pelvic healthcare poses a significant benefit in the rehabilitation of the pelvic floor muscles.


Assuntos
Terapia por Estimulação Elétrica , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Contração Muscular/fisiologia , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Incontinência Urinária/terapia
6.
Adv Exp Med Biol ; 1211: 41-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31468357

RESUMO

This study aims to verify whether an integrated rehabilitation protocol comprising neuromuscular manual therapy and focused mechanical-acoustic vibrations can significantly reduce pelvic floor dysfunctions in women affected by stress, urge, or mixed urinary incontinence. Sixty-two women were treated with a combination of neuromuscular manual therapy and mechanical-acoustic vibrations at the level of superficial pelvic floor muscle groups. The results were analyzed before the beginning and after the end of the study protocol with the myometric measuring device MyotonPRO, the Pelvic Floor Disability Index (PFDI-20), and the Pelvic Floor Impact Questionnaire (PFIQ-7). Two patients withdrew from the study after the first visit. The 60 remaining patients showed significant improvements of myometric parameters, with the percentage variations ranging from +8.5% to +20.7% for the muscle logarithmic decrement, from -11.2 to -13.9% for muscle frequency, and from -4.8% to -12.3% for muscle stiffness. There has been a reduction of 56% in the perceived disability induced by urinary incontinence, measured with the PFDI-20, and 43% reduction in the impact of the problem on daily living, measured with the PFIQ-7. We conclude that a combination of neuromuscular manual therapy and mechanical-acoustic vibrations effectively reduces pelvic symptoms in patients affected by urinary incontinence, with minimal invasiveness.


Assuntos
Incontinência Urinária/terapia , Vibração , Feminino , Humanos , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia
7.
Medicine (Baltimore) ; 98(35): e16907, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464923

RESUMO

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.


Assuntos
Assistência Integral à Saúde/métodos , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/reabilitação , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/reabilitação , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Educação em Saúde/métodos , Humanos , Incidência , Idade Materna , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Distribuição Aleatória , Incontinência Urinária por Estresse/etiologia
8.
Fisioterapia (Madr., Ed. impr.) ; 41(4): 227-236, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183100

RESUMO

Antecedentes: La incontinencia urinaria femenina es un problema de salud de elevada prevalencia, costes sociales y económicos. El entrenamiento muscular del suelo pélvico es el tratamiento conservador más utilizado en mujeres con cualquier tipo de incontinencia urinaria, pero requiere de la adhesión a dichos programas de entrenamiento. Sin embargo, los estudios publicados hasta la fecha alertan de la falta de adherencia a estos programas, identificándose como una barrera para el proceso de recuperación. Objetivo: El objetivo de este trabajo es describir la adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Estrategia de búsqueda y selección de estudios: Se realizó una revisión bibliográfica en las bases de datos PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, La biblioteca Cochrane Plus, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science y Scopus, completándose con una estrategia de búsqueda manual. Los artículos incluidos fueron ensayos controlados aleatorizados o análisis secundarios de los mismos, publicados entre 2007 y 2018. La evaluación de la calidad metodológica se realizó con la escala PEDro, realizándose la implementación de las normas PRISMA. Resultados: Siete artículos se incluyeron en esta revisión. Las tasas de adherencia variaron entre el 92 y el 53,55% en el corto plazo y entre el 80 y el 38,1% en el seguimiento. Los sistemas de medición se basaron en diarios, cuestionarios y datos recogidos por los fisioterapeutas. La falta de homogeneidad en los estudios supone una limitación para un metaanálisis válido. Conclusiones: Las tasas de adherencia del entrenamiento muscular del suelo pélvico en incontinencia urinaria femenina son bajas, siendo necesarias acciones que puedan homogeneizar los sistemas de medición y las estrategias de mejora de la adherencia terapéutica


Introduction: Female urinary incontinence is a health problem of high prevalence, social and economic costs. Training of the pelvic floor muscles is the most used conservative treatment in women with any type of urinary incontinence, but requires adherence to these programs. However, studies published to date warn of the lack of adherence to these programs, identifying this as a barrier to the recovery process. Objective: The objective of this work is to describe the adherence to pelvic floor muscle training in women with urinary incontinence. Search strategy and study selection: A bibliographic review was made in the databases PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, The Cochrane Plus library, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science and Scopus, completing with a manual search strategy. The articles included were randomised controlled trials, or secondary analyses of these, published between 2007 and 2018. The evaluation of the methodological quality was carried out using the PEDro scale, with the implementation of the PRISMA standards. Results: Seven articles were included in this review. Adherence rates varied between 92% and 53.55% in the short term, and between 80% and 38.1% in the follow-up. The measurement systems were based on diaries, questionnaires, and data collected by the physiotherapists. The lack of homogeneity in the studies is a limitation for a valid meta-analysis. Conclusions: The adherence rates of pelvic floor muscle training in female patients with urinary incontinence are low, and actions are needed to standardise measurement systems, as well as strategies to improve therapeutic adherence


Assuntos
Humanos , Feminino , Cooperação e Adesão ao Tratamento , Incontinência Urinária/terapia , Diafragma da Pelve/fisiologia , Modalidades de Fisioterapia/instrumentação , Incontinência Urinária/reabilitação , Inquéritos e Questionários , Diafragma da Pelve/fisiopatologia
9.
Taiwan J Obstet Gynecol ; 58(4): 505-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307742

RESUMO

OBJECTIVES: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs. MATERIALS AND METHODS: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions. RESULTS: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05). CONCLUSION: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.


Assuntos
Incontinência Fecal/fisiopatologia , Prolapso de Órgão Pélvico/complicações , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Adulto , Fatores Etários , Estudos Transversais , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Exame Ginecológico/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Tocologia , Força Muscular/fisiologia , Enfermeiras e Enfermeiros , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/terapia , Prognóstico , Medição de Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
10.
Curr Sports Med Rep ; 18(7): 255-257, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31283625

RESUMO

Due to the unique demands of sport participation on the body, female athletes are at increased risk for pelvic floor dysfunction (PFD) and relative energy deficiency in sport (RED-S). A high number of female athletes suffer from PFD, especially urinary incontinence. Several biomechanical and physiological risk factors may play a role in the development of PFD in female athletes. RED-S has been shown to be associated with PFD. The goal of this commentary is to discuss RED-S as a risk factor for PFD and propose a mechanism for this relationship.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Distúrbios do Assoalho Pélvico/etiologia , Atletas , Feminino , Humanos , Diafragma da Pelve/fisiopatologia , Fatores de Risco , Fenômenos Fisiológicos da Nutrição Esportiva , Incontinência Urinária/complicações
11.
Curr Urol Rep ; 20(7): 38, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31147796

RESUMO

PURPOSE OF REVIEW: Pelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction. RECENT FINDINGS: Today, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training component, is not an effective treatment. Biofeedback is an adjunct to the pelvic floor training. In the current review, we develop the role of pelvic floor physical therapy in management of children with non-neuropathic voiding dysfunction and compare it with biofeedback therapy alone.


Assuntos
Biorretroalimentação Psicológica , Distúrbios do Assoalho Pélvico/reabilitação , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Transtornos Urinários/terapia , Criança , Humanos , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/fisiopatologia , Resultado do Tratamento , Micção , Transtornos Urinários/etiologia
12.
Wiad Lek ; 72(3): 368-373, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31050982

RESUMO

OBJECTIVE: Introduction: In Poland, urinary incontinence (UI) is the ninth in frequency of reported health problem, which occurs in 15.4% of women over 60 years of age (data of the Central Statistical Office of 2016). The search for optimal treatment methods for this disease and objective methods for assessing the effectiveness of therapy is a challenge for an interdisciplinary team of specialists. The aim: To examine the effect of Extracorporeal Magnetic Innervation (ExMI) on the Irisin concentration in women with stress urinary incontinence. PATIENTS AND METHODS: Materials and methods: A total of 52 women were included in the analysis: 28 participants were allocated to the experimental group (EG) and 24 to the control group (CG). EG patients completed ExMI therapy, whereas no therapeutic intervention was applied to the CG. Irisin concentration, severity of urinary incontinence (RUIS) were measured in all women at the initial and final assessments. RESULTS: Results: By comparing the initial and final assessment results we have been able to demonstrate a statistically significant differences in the measured variables in the EG. No statistically significant differences in the measured variables were reported for the CG at the initial and final assessments. No correlation was observed between the Irisin concentration results and severity of urinary incontinence in the EG at the final assessment. CONCLUSION: Conclusions: There is a need for further studies of biochemical parameters in the assessment of pelvic floor muscle dysfunction.


Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Terapia por Exercício , Feminino , Humanos , Terapia de Campo Magnético/métodos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Projetos Piloto , Polônia , Incontinência Urinária por Estresse/terapia
13.
Maturitas ; 125: 57-62, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133219

RESUMO

OBJECTIVES: Treatments for genitourinary syndrome of menopause (GSM) may not be suitable for all women, may not be completely effective, and may cause adverse effects. Therefore, there is a need to explore new treatment approaches. The objectives were to evaluate the feasibility of using a pelvic floor muscle training (PFMT) program in postmenopausal women with GSM, and to investigate its effect on symptoms, signs, activities of daily living (ADL), quality of life (QoL) and sexual function. STUDY DESIGN: Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a randomized controlled trial (RCT) on PFMT for urinary incontinence. This substudy was composed of two pre-intervention evaluations, a 12-week PFMT program and a post-intervention evaluation. MAIN OUTCOME MEASURES: Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises. The effects of the PFMT program were assessed by measuring GSM symptoms ('Most Bothersome Symptom' approach, ICIQ-UI SF), GSM signs (Vaginal Health assessment scale), GSM's impact on ADL (Atrophy Symptom questionnaire), QoL and sexual function (ICIQ-VS, ICIQ-FLUTSsex) and leakage episodes. RESULTS: Thirty-two women participated. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in GSM symptoms and signs (p < 0.01) as well as in its impacts on ADL, QoL and sexual function (p < 0.05). CONCLUSIONS: A study including a PFMT program is feasible, and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence. This intervention should be assessed through a RCT.


Assuntos
Atrofia/fisiopatologia , Terapia por Exercício/métodos , Menopausa , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/reabilitação , Vagina/fisiopatologia , Atividades Cotidianas , Idoso , Atrofia/patologia , Terapia por Estimulação Elétrica , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/reabilitação , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Sexualidade , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/psicologia , Vagina/patologia
14.
Dig Dis ; 37(6): 478-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096249

RESUMO

OBJECTIVES: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation. METHODS: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response. RESULTS: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and -colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention. CONCLUSION: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low -muscle tone.


Assuntos
Ataxia/fisiopatologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Defecação , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Adolescente , Canal Anal/fisiopatologia , Ataxia/complicações , Criança , Pré-Escolar , Constipação Intestinal/complicações , Feminino , Seguimentos , Humanos , Masculino , Manometria , Reto/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Ther Umsch ; 73(9): 541-546, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113319

RESUMO

Etiology, Diagnosis, and Management of Female Bladder Outlet Obstruction Abstract. Bladder outlet obstruction affects up to every fourth woman. This condition is causing difficulties to void. Patients complain about frequency, an urge to void, or they describe the feeling of post-void residual urine. Increased post-void residual urine or a pathological micturition pattern with increased pressure or pathological flow curves are suggestive for a bladder outlet obstruction. Common causes are genital organ prolapse, previous incontinence surgery, or dysfunctional voiding. Correspondingly, the underlying etiology is determining therapy: surgical correction of the pelvic organ prolapse usually eliminates the obstructive situation; a tightly placed incontinence sling should be loosened or incised, while dysfunctional disorders can be well addressed by pelvic floor rehabilitation.


Assuntos
Diafragma da Pelve/fisiopatologia , Obstrução do Colo da Bexiga Urinária , Retenção Urinária , Emoções , Feminino , Humanos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Urodinâmica
16.
Curr Gastroenterol Rep ; 21(5): 21, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31016468

RESUMO

PURPOSE OF REVIEW: Biofeedback therapy (BFT) is effective for managing pelvic floor disorders (i.e., defecatory disorders and fecal incontinence). However, even in controlled clinical trials, only approximately 60% of patients with defecatory disorders experienced long-term improvement. The review serves to update practitioners on recent advances and to identify practical obstacles to providing biofeedback therapy. RECENT FINDINGS: The efficacy and safety of biofeedback therapy have been evaluated in defecatory disorders, fecal incontinence, and levator ani syndrome. Recent studies looked at outcomes in specific patient sub-populations and predictors of a response to biofeedback therapy. Biofeedback therapy is effective for managing defecatory disorders, fecal incontinence, and levator ani syndrome. Patients who have a lower bowel satisfaction score and use digital maneuvers fare better. Biofeedback therapy is recommended for patients with fecal incontinence who do not respond to conservative management. A subset of patients with levator ani syndrome who have dyssynergic defecation are more likely to respond to biofeedback therapy.


Assuntos
Doenças do Ânus/terapia , Biorretroalimentação Psicológica/métodos , Constipação Intestinal/terapia , Incontinência Fecal/terapia , Distúrbios do Assoalho Pélvico/terapia , Doenças do Ânus/etiologia , Doenças do Ânus/fisiopatologia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Defecação/fisiologia , Incontinência Fecal/etiologia , Humanos , Dor/etiologia , Dor/fisiopatologia , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/fisiopatologia
17.
Tech Coloproctol ; 23(5): 429-434, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31016549

RESUMO

BACKGROUND: Fecal incontinence (FI) and chronic constipation (CC) are disabling symptoms that cause a significant public health problem. The pathophysiology of combined constipation and FI is not fully understood. Our aim was to delineate the clinical, physiological and anatomical factors that may contribute to the association of FI and CC. METHODS: A retrospective study was performed in a pelvic floor unit in a tertiary medical center. Consecutive female patients diagnosed with CC were included, and further divided into two groups according to the co-occurrence of FI. Demographic characteristics, anorectal physiology (obtained by manometry) and pelvic anatomical pathology (as assessed by dynamic pelvic ultrasound) were recorded and subsequently compared. RESULTS: A total of 267 women were included in the study. Of those, 62 patients (23%) had an associated FI (CCFI). The CCFI group had higher body mass index (BMI) levels and a trend toward younger average age as compared to the group without FI (CCNFI). The number of vaginal and instrumental deliveries was similar in both groups. Anal resting and squeeze pressures were significantly lower in the CCFI group (64 ± 21 vs 48 ± 18, p = 0.004 and 141 ± 136.2 vs. 97.5 ± 38.6, p = 0.02, respectively). Rectal sensation abnormalities were common, but did not differ between both groups. Dyssynergic defecation and rectocele were more common in the CCNFI group (68% vs. 51%, p = 0.04 and 39% vs. 24%, p = 0/045, respectively. CONCLUSIONS: Lower anal pressures and higher BMI were found among women with coexisting FI and CC. Pelvic floor anatomical and functional abnormalities are common in women diagnosed with CC and FI, but dyssynergia and diagnosis of significant rectocele, which cause obstructed defecation, were more common in the CCNFI group.


Assuntos
Constipação Intestinal/complicações , Incontinência Fecal/etiologia , Adolescente , Adulto , Idoso , Doença Crônica , Constipação Intestinal/diagnóstico por imagem , Constipação Intestinal/fisiopatologia , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Retocele/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
18.
Physiotherapy ; 105(2): 235-243, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30979506

RESUMO

BACKGROUND: Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription. OBJECTIVE: To investigate the efficacy of pelvic floor muscle training in treating ED and PE. DATA SOURCES: A computerized literature search of CINAHL®, Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science. STUDY SELECTION: All studies where participants were males greater than 18years with ED or PE, with no history of neurological injury or previous major urological surgery were included. STUDY APPRAISAL: Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus. RESULTS: Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity. LIMITATIONS: The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling. CONCLUSION: Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42016047261.


Assuntos
Disfunção Erétil/fisiopatologia , Disfunção Erétil/reabilitação , Terapia por Exercício/métodos , Diafragma da Pelve/fisiopatologia , Ejaculação Precoce/fisiopatologia , Ejaculação Precoce/reabilitação , Humanos , Masculino
19.
Trials ; 20(1): 237, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023381

RESUMO

BACKGROUND: Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU. METHODS: Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs. DISCUSSION: The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered. TRIAL REGISTRATION: Netherlands Trial Register, ID: NL5816 . Registered on 18 July 2016.


Assuntos
Terapia por Exercício/métodos , Grupo Associado , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Incontinência Urinária por Estresse/prevenção & controle , Feminino , Humanos , Estudos Multicêntricos como Assunto , Países Baixos , Período Pós-Parto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Fatores de Proteção , Psicoterapia de Grupo , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/fisiopatologia
20.
J Sports Sci ; 37(14): 1663-1672, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30822258

RESUMO

Urinary incontinence is the complaint of involuntary loss of urine and is a social and hygienic problem. While pregnancy and delivery have been described as etiological factors, observational studies show that urinary incontinence is also prevalent in nulliparous female athletes. Therefore, the general belief that physically fit women have stronger pelvic floor muscles preventing them from developing urinary incontinence may be questioned. The aim of this study was to systematically review studies investigating the prevalence of urinary incontinence in nulliparous female athletes. The electronic databases Medline, Embase, Cinahl, and Cochrane Library were systematically searched for eligible studies. Two independent researchers assessed the quality of the included studies and extracted the data in a standardised data extraction spreadsheet. Twenty-three studies were included in this systematic review. The urinary incontinence prevalence measured during sport activity varied from 5.7% to 80%. Urinary incontinence prevalence differs based on the type of sport. Trampolinists were found to have the highest prevalence of urinary incontinence. The findings suggest that urinary incontinence occurs often in female athletes, especially those involved in high impact sports. Future studies should investigate the mechanisms by which high impact sport activities may affect pelvic floor muscles leading to the development of urinary incontinence.


Assuntos
Esportes/fisiologia , Incontinência Urinária/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Paridade , Diafragma da Pelve/fisiopatologia , Prevalência , Esportes/psicologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA