Efeitos de exercícios para assoalho pélvico em mulheres idosas de diferentes níveis socioeconômicos / Effects of pelvic floor muscles exercises in elderly females from different socio-economic backgrounds

Este estudo visa avaliar os efeitos de um programa de exercícios para o assoalho pélvico (AP) em mulheres idosas de diferentes níveis socioeconômicos. Trata-se de estudo experimental longitudinal não controlado. Foram avaliadas 57 mulheres divididas em dois grupos, baixo (B) e alto (A) nível socioeconômico, que participaram de cinco encontros semanais de exercícios em grupo e responderam a questionários estruturados antes e após os encontros. O grupo B tinha maior porcentagem de mulheres não-brancas (30,4% versus 5,9%; p = 0,023), com mais dor (52,9% versus 82,6%; p = 0,021), incontinência urinária (2,9% versus 30,4%; p = 0,005), e falta de libido que as do grupo A (46,9% versus 75%; p = 0,046). Ambos os grupos referiram melhora dos sintomas urinários, consciência corporal e do assoalho pélvico após os exercícios em grupo, sugerindo que essa possa ser uma boa estratégia de abordagem de promoção de saúde em idosas de diferentes níveis socioeconômicos

Effects on the pelvic floor muscles in elderly females from different socio-economic backgrounds are assessed by a non-controlled longitudinal experimental study. Fifty-seven females were evaluated and divided into two groups: low (B) and high (A) socio-economic background, who participated in five weekly meetings involving group exercises and answered structured questionnaires prior to and posterior to meetings. Group B had the highest percentage of non-white females (30.4% versus 5.9%; p = 0.023), with more pain (52.9% versus 82.6%; p = 0.021), urinary incontinence (2.9% versus 30.4%; p = 0.005), and lack of libido, than those of Group A (46.9% versus 75%; p = 0.046). The two groups improved urinary symptoms, body and pelvic floor muscles awareness after group exercises. The above suggests that it may be a good strategy in health promotion in the elderly from different socio-economic backgrounds

Prevalencia de incontinencia fecal en personas que acuden a policlínicos de un hospital universitario / Frequency of fecal incontinence in ambulatory patients

Abstract Background: Fecal incontinence (FI) affects quality of life and is a cause embarrassment, hampering the collection of data about the problem. It is more common in older people and it is important to know risk the factors and scope of the problem. Aim: Determine the prevalence and risk factors associated to FI in a population of patients consulting in a health center. Material and Methods: A self-applied questionnaire was answered by a randomly selected sample of 1136 ambulatory patients aged 50 ± 15years (59% females), excluding those who consulted in colorectal surgery and gynecology. Demographic variables, obstetric history, history of anorectal surgery, anorectal symptoms, involuntary urine loss, and the FI Wexner or Cleveland Clinic Fecal Incontinence scores were recorded. Results: Thirty one percent of respondents had some degree of FI. In multivariate analysis presence of anorectal pain, urinary incontinence and number of vaginal deliveries were significantly associated with FI. Conclusions: Prevalence of FI in this study is similar, though slightly higher, to data reported in national and international publications.

Resumen Introducción: La incontinencia fecal (IF) es una entidad que afecta la calidad de vida y produce vergüenza, esto hace difícil la obtención de datos fidedignos en cuanto a su prevalencia. Dado el aumento de la población mayor en nuestro país y su relación con la aparición de IF, es importante conocer los factores de riesgo y magnitud del problema, para así realizar prevención además de un diagnóstico y tratamiento precoz. Objetivo: Determinar la prevalencia y los factores asociados a IF en personas que acuden a un centro de salud por otra causa. Material y Método: Se realizó una encuesta auto aplicada en el Hospital Clínico de la Universidad de Chile, entre mayo y junio de 2012. La muestra se seleccionó en forma aleatoria incluyendo pacientes mayores de 20 años que acudieron a diversos policlínicos, excluyéndose los policlínicos de coloproctología y ginecología. Se registraron variables demográficas, antecedentes obstétricos, antecedentes quirúrgico sanorrectales, sintomatología anorrectal, pérdida involuntaria de orina, y la escala de incontinencia fecal de Wexner o CCFIS. Resultados: De un total de 1.136 individuos, 59,2% eran mujeres y la edad promedio fue de 50,53 ± 15,49 años. Un 31,07% presentaba algún grado de IF. En el análisis multivariado la presencia de dolor e incontinencia de orina, así como el número de partos presentaron una asociación significativa con la IF. Conclusión: Las cifras de prevalencia de IF en este estudio son algo mayores con respecto a datos nacionales e internacionales.

Clinical Observation of Electroacupuncture at Huiyang (BL35) and Zhongliao (BL33) plus Scalp Acupuncture for Female Stress Urinary Incontinence / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of electroacupuncture at Huiyang (BL35) and Zhongliao (BL33) plus scalp acupuncture in treating female stress urinary incontinence (SUI), for providing clinical evidence in the treatment of SUI.Method Ninety eligible female SUI patients were randomized into an observation group and a control group. The observation group was intervened by electroacupuncture at Huiyang and Zhongliao plus scalp acupuncture, while the control group was asked to practice contracting anus. The urine leakage degree, residual urine volume in bladder and clinical efficacy were compared.ResultAfter treatment, there was a significant difference in comparing urine leakage degree between the two groups (P<0.05); there was a significant between-group difference in comparing the residual urine volume (P<0.05); the cured and markedly-effective rate was 62.2% in the observation group versus 35.6% in the control group, and the difference was statistically significant (P<0.05). ConclusionElectroacupuncture at Huiyang and Zhongliao plus scalp acupuncture can produce a more significant clinical efficacy compared with rehabilitation training in treating female SUI.

Calidad de vida en mujeres con alteraciones del piso pélvico: revisión de la literatura / Quality of life in women with pelvic floor disorders: literature review

Antecedentes: El riesgo de desarrollar prolapso genital aumenta con la edad, con un efecto negativo en la calidad de vida. Objetivo: Describir el efecto de los trastornos del piso pélvico en la calidad de vida en las distintas dimensiones, sin mediar intervenciones. Método: Se realizó una búsqueda en las bases de datos Pubmed, Cinhal, Proquest y Scielo durante mayo de 2011. Resultados: Los síntomas generan un gran impacto en la calidad de vida afectando la función sexual, actividades cotidianas y generando efectos negativos en aspectos psicosociales, como la imagen corporal y el desempeño de las mujeres. Conclusión: Es necesario generar una atención integral centrada en síntomas, función sexual, educación y apoyo emocional.

Background: The risk of develop genital prolapse increases with age, with a negative effect in quality of life. Objective: The aim of this review is to describe the effect of pelvic floor disorders on quality of life in the different dimensions in women, without any interventions. Method: It developed a review in Pubmed, Cinhal, Proquest and Scielo database during may of 2011. Results: The symptoms produce a great impact on quality of life affecting sexual function, daily activities and it produce negative psychosocial effects like body image and women's performance. Conclusion: Must be necessary generate a integral attention to women, focused on symptoms, sexual function, education and emotional support.

Neuromodulación en patologías de piso pélvico / Neuromodulation in pelvic floor dysfunctions

Através de la historia la neuromodulación ha demostrado ser una alternativa de tratamiento eficaz en el manejo de diversas disfunciones del piso pélvico. Distintas técnicas intentan conseguir un objetivo común, sin embargo, el éxito terapéutico es disímil dependiendo de la severidad y tipo de patología. Describimos los aspectos clínicos y operacionales relacionados con las diversas técnicas, así como los mecanismos de acción propuestos para la neuromodulación.

Through hystory, neuromodulation have proved to be an effective alternative of management of pelvic floor dysfunctions. Several technical alternatives try to reach a same therapeutic objetive, however, depending on the severity and type of symptom their succes differ. We describe the clinical and technical aspects related to those different technics so as the mechanisms of action that are propose for the neuromodulation.

Evaluacion del ffecto de la magnetoterapia, la lectroterapia y los ejercicios del suelo pelvico como tratamiento rehabilitador en la incotinencia uiinaria / Evaluation of the magnetotherapy effect and the pelvis floor excercises as a rehabilitator treatment in urinary incontinente

La incontinencia urinaria tiene elevada prevalencia, preferentemente en mujeres, afectando la vida personal y social de los enfermos. Evaluamos el impacto del tratamiento rehabilitador del suelo pélvico sobre síntomas y signos de incontinencia en 28 pacientes, 25 mujeres y 3 hombres con edades promedio de 53.9 y 66.6 años En las mujeres predominó la incontinencia asociada a otras patologías del suelo pélvico, seguida por la mixta y en los hombres la secundaria a prostatectomía. Evaluamos la incontinencia al inicio y evolutivamente mediante historia clínica, necesidad de uso de colectores, prueba decompresa y diario miccional. Aplicamosmagnetoterapia en región pélvica, electroterapia estimuladora de musculatura perineal y ejercicios para fortalecimiento muscular pélvico sola o combinada. Once pacientes abandonaron el tratamiento, 53% curaron, 29% tuvieron mejoría notable y 18% mantienen el tratamiento. Concluimos que la rehabilitación del suelo pélvico constituye una terapia útil y definitiva para curar o mejorar la incontinencia urinaria.

The urinary incontinence has high prevalence preferably among women, We evaluated the impact of rehabilitative treatment of pelvic floor in symptoms and signs of incontinence in 28 patients 25 women with age average 53,9 years and 3 masculine with age average 66,6 years. We applied them rehabilitative treatment that included Magnetoteraphy, stimulate electrotherapy to the perineal musculature and pelvic exercises, alone or in combination. Principal results: the urinary incontinence prevailed as diagnosis, in the feminine sex, associated with other pelvic pathologies, followed mixed incontinence and men secundary toprostatectomy. Eleven patients leave treatment, 53% cure, 29% improvement and 18% are still in treatment. We conclude that remarkable improvement the symptoms evidenced benefits of rehabilitative treatment of pelvic floor for urinary incontinente.

Evaluating the NGC(TM) Evidence Based Guideline of Prompted Voiding for Use in Korea / 성인간호학회지

PURPOSE: The purpose of this study was to evaluate the applicability of the evidence based guideline for prompted voiding by Lyons & Specht (2001) in National Guideline Clearinghouse(TM) for use in Korea based on the experts' opinions. METHOD: The target expert group consisted of 8 registered nurses, 6 physicians, and 5 nursing professors who are experts in urinary incontinence. This study used a questionnaire survey. The appropriateness, applicability, and the present application of each recommendation in the guideline were analyzed with descriptive statistics using the SPSS program, with content analysis based on the experts' opinions. RESULT: The scores on each recommendation's appropriateness showed the high degree of agreement among nurses, physicians, and nursing professors. However, the recommendation for 'use of oxybutinin' showed the lowest score as 5.89. It was notable that the most recommendations scored lower for applicability compared with appropriateness. The reasons for lower scores for applicability were the lack of clinicians' knowledge of assessment and management, and the lack of resources in clinical settings in Korea. CONCLUSION: This study will augment the understanding of the actual urinary incontinence management in Korean clinical settings and can be used as the baseline data for further study of tailoring international guidelines into local and national clinical settings.

The Significance of Beaking Sign on Cystography in Stress Urinary Incontinence

PURPOSE: To evaluate the clinical and urodynamic significance of the beaking sign at cystography in patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: We retrospectively reviewed the cystograms of 253 patients with SUI, defining the beaking sign as the triangular contrast collection below the bladder base in the resting state without overt leakage. Various clinical parameters including patient age, symptom duration, parity, the one-hour pad test, and urodynamic study data including Valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP) were compared between the beaking-positive and the beaking-negative group. The distribution of Blaivas type in SUI between these two groups was also analysed. RESULTS: The beaking sign was observed in 153 patients (60%). Those who were older and showed greater parity more often belonged to the beaking-positive group than the beaking-negative (p<0.05). Both VLPP and MUCP were significantly lower in the beaking-positive group than in beaking-negative group (p=0.03; p=0.01, respectively). Type-0 or -I SUI was more common in the beaking-negative group, while the frequency of other types was similar between the two groups. CONCLUSION: The beaking sign has clinical and urodynamic significance, reflecting functional deficiencies of the intrinsic sphincter, and may possibly be regarded as an additional parameter in the planning of treatment.

MR Imaging of Pelvic Floor in Stress Urinary Incontinence

PURPOSE: To demonstrate the anatomy of the female pelvic floor and to determine the anatomic differences between normal controls and women with stress urinary incontinence, using MRI. MATERIALS AND METHODS: Five healthy, young, nulliparous women and 12 with stress urinary incontinence un-derwent MR imaging. We obtained FSE T2-weighted axial images, 3mm thick, of the region extending from the urethrovesical junction to the perineal membrane. The following parameters were determined : angle, asymmetry and signal intensity of the levator ani muscles, the distance between the urethra and symphysis, and the presence, shape and angulation of urethropelvic ligament. RESULTS: In contrast to normal controls, frequent findings in women with stress incontinence were as follows : increased angle(43%), asymmetry(43 %) and higher signal intensity(67%) of the levator ani muscles; increased distance between the urethra and symphysis; loss(43 %), discontinuity (60 %) and dorsal angulation(43%) of the urethropelvic ligament. CONCLUSION: In women with stress urinary incontinence, MRI clearly demonstrates the anatomy of the female pelvic floor, changes in the levator ani muscles, the distance between the urethra and symphysis, and the ure-thropelvic ligament. The modality can therefore be used to evaluate the anatomical changes occurring in cases of stress urinary incontinence.

Introital Ultrasonography in Female Urinary Incontinence

PURPOSE: To evaluate the usefulness of introital ultrasonography in the assessment of female urinary incontinence. MATERIALS AND METHODS: Introital ultrasonography was performed in fifteen patients with stress urinasy incontinence(mean age 50) and six patients without symptoms of incontinence(mean age 37). Using a sagittalsection of the anterior pelvis in the plane of the symphysis pubib the posterior rethrovesical angle, the pubourethral distance and the pubo-yretgrak abgle were measured at rest and during stree(Valsalva's maneuverstate). The student T-test and the ANOVA test were used in statistical analysis. RESULTS: The posterior urethrovesical angles of the controls were 125.3 degrees (+/- 10.9) at rest and 125.7 degrees (+/-7.6) during stress. In thepatients, the corresponding angles were 135.3 degrees (+/-11.3) and 139.6 degrees (+/-10.8). The posterior urethrovesical angles increased 0.3 degrees (+/-4.7) in the controls and 5.6 degrees (+/-4.0) in the patients(p=0.018). In the controls, thepubo-urethral distances were 21.8mm(+/- 5.8) at rest and 18.2mm(+/-7.1) during stress, while in the patients thesedistances were 18.4mm(+/-3.9) and 12.6mm(+/-4.4). The pubo-urethra distance decreased 3.5mm(+/-1.5) in the controls and 5.8mm(+/-2.3) in the patients(p=0.039). In the patients with mild incontinence(Gradel), the posterior urethrovesical angles increased 3.4 degrees (+/-2.8) : 132.3 degrees (+/-12.5) at rest and 135.6 degrees (+/-12.8) during stress. In the patients with moderate incontinence(Grade II), the angles increased 8.1 degrees (+/-3.8) : 136.0 degrees (+/-6.5) at rest and 144.1 degrees (+/-5.9) during stress. The change of the posterior urethrovesical angle was related to the grade of urinary incontinence in the patients(p<0.05). There was no statistical significancy in the pubo-urethral angle(p=0.315). CONCLUSION: Introital ultrasonography may be useful for assessment of stress urinary incontinence.