Leonardo Robson Pinheiro Sobreira Bezerra

Quality of life of Brazilian women with urinary incontinence and the impact on their sexual function

INTRODUCTION AND OBJECTIVE Sexual function may be affected in women with urinary incontinence (UI), but data regarding this association are controversial. The aim of this study was to assess the impact of sociodemographic characteristics in the sexual function of Brazilian women with UI. STUDY DESIGN Cross-sectional study with 251 women with UI in the period from April to June 2014. Firstly, sociodemographic and pelvic floor dysfunctions (PFD) characteristics were compared between groups of women with and without sexual activity. Secondly, we compared the variables above with the total score of Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Questionnaire (PISQ-12). For continuous variables, we used the Mann-Whitney or Kruskal-Wallis test; for categorical variables we used the chi-square statistic considering the difference of p<0.05. RESULTS Women with sexual activity tend to be younger, to be premenopausal, have a steady partner and not be hypertensive. The mean total score of PISQ-12 was 27.30. Women who attended elementary school, with coital UI, with moderate constipation and symptomatic prolapse have worse sexual function. Premenopausal women with mixed urinary incontinence have worse sexual function than those with stress urinary incontinence. CONCLUSION The association between sexual dysfunction and UI deserves special attention from health professionals. The care of the maintenance or restoration of sexual well-being should be offered to all women, regardless of age, since UI may affect sexual life and QoL of these women.

Ascites and Encapsulating Peritonitis in Endometriosis: a Systematic Review with a Case Report

Endometriosis can have several different presentations, including overt ascites and peritonitis; increased awareness can improve diagnostic accuracy and patient outcomes. We aim to provide a systematic review and report a case of endometriosis with this unusual clinical presentation. The PubMed/MEDLINE database was systematically reviewed until October 2016. Women with histologically-proven endometriosis presenting with clinically significant ascites and/or frozen abdomen and/or encapsulating peritonitis were included; those with potentially confounding conditions were excluded. Our search yielded 37 articles describing 42 women, all of reproductive age. Ascites was mostly hemorrhagic, recurrent and not predicted by cancer antigen 125 (CA-125) levels. In turn, dysmenorrhea, dyspareunia and infertility were not consistently reported. The treatment choices and outcomes were different across the studies, and are described in detail. Endometriosis should be a differential diagnosis of massive hemorrhagic ascites in women of reproductive age.

The effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review

OBJECTIVE to assess the effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review. METHOD systematic review of randomized controlled studies conducted in the MEDLINE, Cochrane, Scopus and the Virtual Library on Health (Biblioteca Virtual em Saúde, BVS) databases. RESULTS six articles were included in this review. All studies used the Pelvic Floor Muscle Training as the main procedure to prevent urinary incontinence. The results pointed to a positive and effective intervention in the post-partum period. CONCLUSION there is evidence that programs of exercise of the pelvic floor musculature performed both in the immediate and late post-partum result in a significant increase in muscle strength and contribute to prevent urinary incontinence.

Pelvic floor muscle function and quality of life in postmenopausal women with and without pelvic floor dysfunction

This study aims to compare pelvic floor muscle (PFM) function in postmenopausal women with and without pelvic floor dysfunction (PFD) and the relation between PFM function and quality of life.

Defecatory dysfunction and fecal incontinence in women with or without posterior vaginal wall prolapse as measured by pelvic organ prolapse quantification (POP-Q)

INTRODUCTION AND HYPOTHESIS Pelvic Floor Dysfunction is a complex condition that may be asymptomatic or may involve a loto f symptoms. This study evaluates defecatory dysfunction, fecal incontinence, and quality of life in relation to presence of posterior vaginal prolapse. METHODS 265 patients were divided into two groups according to posterior POP-Q stage: posterior POP-Q stage ≥2 and posterior POP-Q stage <2. The two groups were compared regarding demographic and clinical data; overall POP-Q stage, percentage of patients with defecatory dysfunction, percentage of patients with fecal incontinence, pelvic floor muscle strength, and quality of life scores. The correlation between severity of the prolapse and severity of constipation was calculated using ρ de Spearman (rho). RESULTS Women with Bp stage ≥2 were significantly older and had significantly higher BMI, numbers of pregnancies and births, and overall POP-Q stage than women with stage <2. No significant differences between the groups were observed regarding proportion of patients with defecatory dysfunction or incontinence, pelvic floor muscle strength, quality of life (ICIQ-SF), or sexual impact (PISQ-12). POP-Q stage did not correlate with severity of constipation and incontinence. General quality of life perception on the SF-36 was significantly worse in patients with POP-Q stage ≥2 than in those with POP-Q stage <2. CONCLUSIONS The lack of a clinically important association between the presence of posterior vaginal prolapse and symptoms of constipation or anal incontinence leads us to agree with the conclusion that posterior vaginal prolapse probably is not an independent cause defecatory dysfunction or fecal incontinence.

The impact of chronic pelvic pain and its associated symptoms on women’s quality of life in a tertiary care hospital in Brazil

Introduction Chronic pelvic pain (CPP) is a common manifestation of multiple diseases, and might be related to gynecological, musculoskeletal and gastrointestinal causes. CPP is often associated with reduced quality of life (QOL). Objective To investigate whether pain intensity correlates negatively with the QOL in Brazilian women with CPP. Methods We recruited women with CPP referred to our outpatient service from December 2014 to December 2015. QOL was assessed using the Short Form Health Survey (SF-36) while clinical and demographic data were obtained using a standardized form. Statistics included Spearmans rank coefficient test and chi-square test. Results The total SF-36 score correlated negatively with pain intensity as measured by visual analog scale (rho = -0.46). Significant correlations were seen in the role-physical (rho = -0.596), physical functioning (rho = -0.463), role-emotional (rho = -0.402) and bodily pain (rho = -0.471) domains, but not in the other SF-36 domains. There was a positive association between presence of acyclic chronic pain and history of being at emergency rooms for pain control (p = 0.026, chi-square test). Conclusions Pain intensity correlates negatively with QOL in Brazilian women with CPP, but different QOL domains are affected in a heterogeneous fashion. Further research is needed in order to determine the specific reasons behind such differences.