Fátima Faní Fitz

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.

Impacto do treinamento dos músculos do assoalho pélvico na qualidade de vida em mulheres com incontinência urinária

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.

Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study

Introduction: Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. Objective: To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Method: Forty-two women, with mean age of 58.1 years (±10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. Results: We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r=0.579, p<0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r=0.559, P<0.001). Conclusion: Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.

Pelvic floor muscle training for overactive bladder symptoms – A prospective study

INTRODUCTION Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. OBJECTIVE To verify the effects of isolated PFMT on the symptoms of OAB. METHOD Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. RESULTS There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. CONCLUSION The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.

Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial

To test if biofeedback (BF) added to pelvic floor muscle training (PFMT) increases the frequency of home exercises performed by women with stress urinary incontinence (SUI).

The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review

Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.

Impact of Breast Cancer Treatment on Female Sexual Function: A Systematic Review

INTRODUCTION: Breast cancer (BC) is the most common cancer in women worldwide and, nowadays, advances in BC screening and treatments have led to increasing rates of survival. This factor leads to a special concern about this women’s quality of life and among them, the sexuality. Sexual changes can become the most problematic aspect of a woman’s life. The impact of such changes can last for many years after successful treatment, and can be associated with serious physical and emotional side-effects. The aim of this study was to identify the most common type of female sexual dysfunction (FSD) after the treatment for BC. METHODS: It was performed a systematic review of studies published in the literature until July 2012 in the following database: MEDLINE, Pubmed, SciELO e Lilacs. It was used as used the descriptor: “breast cancer” associated with the following: “sexual dysfunction”, “sexual function” and “sexuality”. It were included studies which evaluated quantitatively the sexual dysfunction presence after BC treatment. It was considered sexual dysfunctions: disorders of desire, lubrication, arousal, orgasm and the presence of pain during the sexual intercourse. The exclusion criteria were narrative review, editorials, case studies and qualitative researches, because there is no objective data, making its compilation impossible. One researcher performed the studies search and two researchers, independently, evaluated the articles to be analyzed by means of structured guide with the following items: 1) sample characterizes, 2) type of treatment for BC and 3) method used to evaluate female sexual function. RESULTS: By reading the title, were chosen for inclusion in 97 articles, of which 85 were excluded after reading the abstract and another 2 were excluded after reading the entire article. It was included 10 studies which evaluated a total of 8. 465 women. The most frequent treatment for BC were: chemotherapy (100%), surgeries for BC (100%) and radiotherapy (83%). The most frequent sexual dysfunction were: decrease of desire/sexual interest (66%), difficulty in lubrication (50%), lack of arousal (33%) and pain during the sexual intercourse (11%). Other associated symptoms were described as fatigue, insomnia, physical problems, lack of satisfaction, shortness of intercourse, feeling less attractive, partner lack of understanding about their feelings and concern about partner desire/interest. DISCUSSION: in a recent study it was questioned the assessment of sexual function during a routine visits. The evidence showed that this theme approach increases the FSD diagnostic capability and improves access to treatment. Due to the high prevalence of these disorders in women who underwent treatment of BC and the various non-hormonal treatment options, it is important to underscore the tackling of this issue by Breast Cancer Specialist and/or Oncologist during consultation and forward for treatment when necessary. CONCLUSION: The FSD were identified as hypoactive sexual desire, lubrication difficult and lack of arousal. The studies demonstrated that the various treatment of BC negatively impact female sexual function.

Qual o índice de massa corporal de mulheres com disfunções dos músculos do assoalho pélvico que procuram tratamento fisioterapêutico

Overweight and obesity are reported as important risk factors for developing of female pelvic floor (PF) dysfunction. Thus, the objective was to verify the body mass index (BMI) of women with PF dysfunctions who sought physiotherapy treatment, and comparing it with national statistics. This is an observational study. There were evaluated the records of women with PF dysfunctions served by the Physiotherapy Service from 2004 to 2010, and included all women with the presence of any symptom of PF dysfunction. It was calculated the BMI of 312 women with PF dysfunction. The BMI mean was 28.1 kg/m2. Approximately 70% of these women were overweight or obese, a value higher than the national rate of 59%. The pathophysiological basis of the relationship between obesity and PF dysfunction is the correlation between BMI and intra-abdominal pressure. The identification of overweight and obesity should be part of the rehabilitation programs of the PF, since the reduction in body weight can contribute by reducing the severity of the disorder. With the present study it was observed that women seeking physiotherapy treatment for PF dysfunction have higher rates of obesity than the national female population.