Ana Paula Magalhães Resende

Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography

The abdominal hypopressive technique (AHT) is performed mainly via transversus abdominis (TrA) activation and has been indicated for pelvic floor muscle (PFM) disorders. In some European countries, this technique has become widely used. This study aimed to investigate PFM and TrA activation during the AHT through surface electromyography.

Cervical cancer mortality trends in Brazil: 1980-2009

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

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

The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP).

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

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

Effects of the Paula method in electromyographic activation of the pelvic floor: a comparative study

Introduction and hypothesisTo determine if Paula method of circular muscles contraction e.g., those surrounding the eyes, mouth and fingers, could increase pelvic floor muscle (PFM) activity.MethodsThirty-four healthy, nulliparous volunteers were included, with an average age of 28 (±5.9) years and body mass index of 23.8 (±3.3) kg/m2. They were assigned to randomly perform the sequence: a PFM maximal voluntary contraction, a contraction of circular muscles, followed by a simultaneous combination of PFM and circular muscle contraction. The PFM were evaluated using surface electromyography.ResultsPFM activity at baseline was 22.6 (±10.9) μv. It was unchanged with Paula method contraction (p = 0.322). There were also no differences between values of PFM maximal voluntary contraction alone, 99.8 (±44.3) μv and in combination with the Paula method, 91.8 (±35.3) μv (p = 0.093).ConclusionsThe Paula method seems not to increase PFM activity in nulliparous women.

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

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

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Objective. The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no). Methods. This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores. Results. Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57 versus 2.06 ± 0.64; P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus 35.79 ± 11.66 μV; P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92 versus 18.05 ± 2.14; P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = − 0.193; P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785). Conclusion. The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

Impact of pelvic floor muscle training on the quality of life in women with urinary incontinence

OBJECTIVE To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI). METHODS Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the Kings Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05. RESULTS There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed. CONCLUSION PFM training resulted in significant improvement in the QOL of women with SUI.

Efeito da adição do biofeedback ao treinamento dos músculos do assoalho pélvico para tratamento da incontinência urinária de esforço

OBJETIVO: Verificar o efeito da adicao do biofeedback (BF) ao treinamento dos musculos do assoalho pelvico (TMAP) para o tratamento da incontinencia urinaria de esforco (IUE). METODOS: Estudo piloto prospectivo, randomizado e controlado, com mulheres com IUE sem deficiencia esfincteriana detectada ao estudo urodinâmico e que realizavam a correta contracao dos MAP. Foram excluidas mulheres com doencas neuromusculares e com prolapso genital graus III e IV. Foram randomizadas 40 mulheres em Grupo Controle e Grupo BF. O protocolo de TMAP com equipamento de BF foi constituido de tres series de dez contracoes lentas (tonicas), com tempo de manutencao de seis a oito segundos em cada contracao, seguido de um periodo de repouso de mesmo valor. Apos cada contracao sustentada, eram realizadas de tres a quatro contracoes rapidas (fasicas) em decubito dorsal e ortostatismo, duas vezes na semana, totalizando 12 sessoes. Avaliou-se o efeito da adicao do BF ao TMAP na qualidade de vida pelo Kings Health Questionnaire (KHQ), nos sintomas urinarios pelo diario miccional e na funcao dos musculos do assoalho pelvico (MAP) pela palpacao digital. A avaliacao foi realizada inicialmente e apos as 12 sessoes de tratamento. O resultado foi descrito em medias e desvios padrao. Para analise de homogeneidade e verificacao das diferencas entre os grupos utilizou-se o teste de Mann-Whitney, e para diferencas entre os momentos de observacao, o teste de Wilcoxon, com nivel de significância de 0,05. RESULTADOS: Diminuicao significativa nos escores dos dominios avaliados pelo KHQ na comparacao entre os grupos, exceto para o dominio saude geral (Grupo BF 32,8±26,9 versus Grupo Controle 48,4±29,5; p<0,13). Em concordância, observou-se melhora da funcao dos MAP apos o tratamento no grupo BF, na power (4,3±0,8; p=0,001), endurance (6,0±2,2; p<0,001) e fast (9,3±1,9; p=0,001). Quando comparados os grupos, o Grupo BF destacou-se positivamente em relacao ao power (Grupo BF 4,3±0,8 versus Grupo Controle 2,5±0,9; p<0,001), endurance (Grupo BF 6,0±2,2 versus Grupo Controle 2,7±1,9; p<0,001) e fast (Grupo BF 9,3±1,9 versus Grupo Controle 4,6±3,2; p<0,001). Reducao da frequencia urinaria noturna (1,2±1,2 versus 0,7±0,9; p=0,02) e da perda de urina nos esforcos (1,5±1,4 versus 0,6±0,8; p=0,001) foi observada no Grupo BF. CONCLUSAO: A adicao do BF ao TMAP para o tratamento da IUE, aplicado de acordo com o protocolo descrito, contribui para melhora da funcao dos MAP, reducao dos sintomas urinarios e melhora da qualidade de vida.

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

A eletromiografia de superficie tem grande importância clinica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade eletrica promovida pelo recrutamento das unidades motoras, ha boa correlacao entre o numero de unidades ativadas e a forca muscular. E um dos metodos de maior especificidade na avaliacao do assoalho pelvico, embora nao haja consenso em relacao a sua aplicacao. Essa revisao de literatura foi desenvolvida com o objetivo de agrupar as informacoes sobre o uso da eletromiografia de superficie na avaliacao do assoalho pelvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pelvico feminino por meio de eletromiografia de superficie. Apesar de sua metodologia ainda carecer de padronizacao, e um instrumento que deve ser considerado nas pesquisas cientificas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfuncoes do assoalho pelvico possuem alteracoes no tempo de ativacao dos musculos do assoalho pelvico (MAP) e musculos abdominais. Quanto a gestacao e puerperio, ainda faltam evidencias sobre possiveis alteracoes da ativacao eletrica dos MAP nesses periodos.