Luciana Laureano Paiva

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis

Introduction and hypothesisUrinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI.MethodsCochrane’s recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group.ResultsTen studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI.ConclusionPFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.

Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis

Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords “athlete,” “urinary incontinence,” and “women” in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.

Association between the Functionality of Pelvic Floor Muscles and Sexual Satisfaction in Young Women

Objective The objective of this study is to associate the results obtained while assessing the pelvic floor muscles (PFM) functionality with the score of sexual satisfaction of young adult women. Methods This is an observational and cross-sectional study. The inclusion criteria were women aged between 20 and 40 years who have had sexual intercourse, nulliparous, BMI lower than 25 kg/m(2), and absence of pelvic floor dysfunction. The evaluation consisted of both the medical history and assessment of the PFM functionality using the Perina pressure biofeedback and Oxford Scale. We measured sexual satisfaction using the Female Sexual Quotient questionnaire and used the Kolmogorov-Smirnov test to verify the normality of the data. We analyzed non-parametric variables using the Spearman correlation test. The significance level was 5%. Results A total of 80 women with a median age of 26 years and median BMI of 21.64 kg/m(2) participated in this study. We divided the subjects into two groups, best and worse PFM functionality, according to median Perina pressure biofeedback and Oxford scale. We found no difference between the groups when comparing the sexual satisfaction scores. There was only a slight significant correlation between the Contraction Voluntary Average obtained using the pressure biofeedback and the primary domain (r = 0.27; p = 0.01). Conclusion This study found a slight correlation between PFM functionality and the functionality of the primary domain of the Female Sexual Quotient questionnaire. Therefore, it is not possible to state whether there is an association between the PFM functionality and female sexual satisfaction in young adults.

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD).

Vibratory perineal stimulation for the treatment of female stress urinary incontinence: a systematic review

Introduction and hypothesisThe pelvic floor muscles (PFM) play an important part in the urinary continence mechanism. Changes in their structure and functionality may lead to a predisposition to pelvic floor dysfunction such as urinary incontinence (UI), which is the involuntary loss of urine. Some techniques for conservative treatment of UI are already well documented. However, new approaches have been found that require scientific proof of their effectiveness, such as vibratory stimulation (VS). Thus, we performed a systematic review of studies that investigated the use of perineal VS (PVS) for the treatment of stress UI.Materials and methodsThis study followed the recommendations of the Cochrane Collaboration for systematic reviews. Studies that used PVS for the treatment of female UI were eligible.ResultsA total of 56 studies were found, of which ten were duplicates and were excluded. Analysis of the titles and abstracts led to the exclusion of 30 studies, leaving 16 for detailed analysis. Of these, only three were included as they fulfilled all the eligibility criteria previously established for the present study. In spite of the heterogeneity of the protocols, all the studies had the goal of assessing the effects of vibration on the PFM, and the stimulation was found to be effective in reducing urinary leakage, improving muscle strength and consequently the patients’ quality of life.ConclusionsBecause of the heterogeneity and the small number of studies, it is not possible to draw a conclusion as to the effectiveness of PVS for the treatment of stress UI, and further studies are needed to provide scientific support for its use.

Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies

Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.

Perfil das pacientes do ambulatório de uroginecologia de um hospital público de Porto Alegre com relação à incontinência urinária e à qualidade de vida

Introducao: A incontinencia urinaria (IU) e a perda involuntaria de urina e pode ser classificada de acordo com os sintomas, sendo os tipos mais comuns: IU de esforco (IUE), IU de urgencia (IUU) e IU mista (IUM). Ela causa impacto fisico e psicologico negativo, piorando a qualidade de vida. A fisioterapia pelvica e importante no tratamento conservador da IU, pois e segura, nao invasiva e com minimos efeitos colaterais. Objetivos: Descrever o perfil das mulheres avaliadas pela fisioterapia pelvica no Ambulatorio de Uroginecologia do Hospital de Clinicas de Porto Alegre (HCPA) com relacao a IU e qualidade de vida. Metodos: Estudo descritivo, transversal e retrospectivo, realizado a partir de informacoes dos prontuarios das pacientes avaliadas pela fisioterapia pelvica no Ambulatorio de Uroginecologia do HCPA, de agosto de 2013 a dezembro de 2014. Resultados: Dos 164 prontuarios analisados, a media de idade das pacientes foi de 58,07 anos (±10,98), 55% realizaram parto normal, 51% fizeram episiotomia, todas eram multiparas, 60,4% apresentavam prolapso de orgao pelvico e a IUM foi a mais prevalente, sendo que 71,3% perdiam urina em jato. Quanto a forca dos musculos do assoalho pelvico, a maioria apresentava grau 2 (31,1%), seguido de grau 1 (28%) e grau 3 (24,4%), conforme a Escala de Oxford Modificada, e 75,6% acionavam musculatura acessoria. O International Consultation on Incontinence Questionnaire - Short Form (ICIS-SF) mostrou que o impacto da IU foi grave em 62,8%. Conclusao: Este estudo permitiu identificar as principais demandas da populacao feminina com IU, facilitando o delineamento de estrategias de reabilitacao eficazes e compativeis com a pratica clinica. Palavras-chaves: Assoalho pelvico; incontinencia urinaria; qualidade de vida; fisioterapia