Liliana Stüpp

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.

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.

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.

Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial

Introduction and hypothesisThe purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women.MethodsFifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique.ResultsThe PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment.ConclusionsOur findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.

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 is better than hypopressive exercises in pelvic organ prolapse treatment: An assessor-blinded randomized controlled trial

To verify if hypopressive exercises (HEs) can improve pelvic organ prolapse (POP) symptoms equally or better than pelvic floor muscle training (PFMT).

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).