Effects of electrophysiological technique combined with pelvic floor muscle training on the rapid recovery of urinary incontinence after electroresection of prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To investigate the clinical effects of electrophysiological technique combined with pelvic floor muscle training on urinary incontinence after electroresection of benign prostatic hyperplasia (BPH) based on the concept of enhanced recovery after surgery (ERAS). 【Methods】 A total of 86 patients with urinary incontinence treated with electroresection of BPH during Oct.2019 and Feb.2022 were randomly divided into control group and observation group, with 43 cases in either group. All patients received health education plus pelvic floor muscle training, and the observation group also received electrophysiological treatment. The differences in the indexes before and after treatment were compared between the two groups. 【Results】 There were no significant differences in the 1 h pad test, ICIQ-SF score, maximum urinary flow rate (Qmax), post void residual (PVR), International Prostate Symptom Score (IPSS), 24 h urinary incontinence frequency, and Urinary Incontinence Quality of Life Questionnaire Score (I-QoL) before treatment between the two groups (P>0.05). However, after treatment, Qmax and I-QoL score were significantly higher in the observation group than in the control group, while the other 5 indicators were significantly lower in the observation group than in the control group (all P<0.05). The total clinical effective rate was significantly higher in the observation group than in the control group (P<0.05). 【Conclusion】 Electrophysiological technique combined with pelvic floor muscle training can effectively improve the symptoms of urinary incontinence and promote the recovery of urinary control function, which is in line with the concept of ERAS and is worthy of further research and promotion.

Application of Snyder’s hope theory in patients with pelvic floor exercise after prophylactic stoma retraction / 中国实用护理杂志

Objective:To explore the effect of pelvic floor muscle functional exercise based on Snyder hope theory in patients after prophylactic stoma retraction.Methods:74 patients with low rectal cancer who underwent prophylactic stoma retraction from July 2019 to June 2021 were randomly divided into intervention group and control group. The patients in the control group received routine nursing and pelvic floor muscle functional exercise. The patients in the intervention group received functional exercise intervention based on Snyder′s hope theory on the basis of the control group. The hope level and self-care ability of the patients in the two groups were evaluated before the intervention and 3 months after stoma restitution. The anal function of the patients in the two groups was evaluated 1 month and 3 months after stoma restitution.Results:Before the intervention, there was no significant difference in the score of hope level and self-care ability between the two groups ( P>0.05). Three months after the operation, the score of hope level in the observation group was 36.20 ± 3.82, which was higher than that in the control group (31.26 ± 5.03) ( t = 4.63, P<0.05). Three months after the operation, the self-care ability score of the observation group was 123.57 ± 10.82, which was higher than that of the control group (108.23 ± 9.48) ( t = 6.31, P<0.05). One month and three months after stoma retraction, the anal function scores of the observation group were 12.03 ± 3.94, 5.91 ± 2.05 respectively, which were lower than those of the control group (13.86 ± 2.19, 7.26 ± 1.74) ( t = 2.40, 2.99, both P<0.05). Conclusion:Pelvic floor muscle functional exercise based on Snyder′s hope theory can improve the hope level of patients after stoma retraction, improve their anal function and improve their self-care ability.

Effectiveness of Theory Based Intervention Using Social Media to Reduce Urinary Incontinence Among Postpartum Women in Hebron City Hospitals: Randomized Controlled Trial

@#Introduction: Urinary incontinence (UI) is a condition which is common and is closely linked to vaginal delivery. Pelvic floor muscle exercise (PFME) are considered the first line management of UI and regular practice of PFME is a key factor in its effectiveness. This study was designed to investigate the effectiveness of theory-based intervention using social media to reduce UI among postpartum women. Methods: This is a randomized controlled trial with the final number of recruited participants of 104. The participants were assigned randomly either to control or intervention groups and were followed up at three and six months. The primary outcome of this study was severity of UI. Adherence to exercises was the secondary outcome. Results: After the intervention, at three months and six months follow-up, there were significant differences between the two groups regarding the practice of PFMEs (p≤ 0.05). Friedman’s analysis of variance showed that there was a significant difference in respect of the exercise adherence rating scale among the intervention group at baseline, at three months and post six months (p≤ 0.05). In the intervention group at baseline the mean (standard deviation, sd) of the International Consultation on Incontinence Questionnaire Short Form was 3.00 (1.94) whereas at three months it decreased to 1.96 (1.69), which decreased further to 1.04 (0.51) at six months. Conclusion: theory-based education delivered through social media is a feasible and effective way of increasing the practice of PFMEs, and can lead to decrease of severity UI.

Analysis of factors affecting the compliance of postpartum pelvic floor muscle training / 预防医学

Objective@#To investigate the difference in behavioral characteristics among different phenotypes of attention deficit hyperactivity disorder (ADHD) using amplitude of low-frequency fluctuation (ALFF), so as to provide insights into clinical differentiation of behavioral characteristics among different phenotypes of ADHD.@*Methods@#The children with ADHD admitted to The Affiliated Hospital of Hangzhou Normal University were enrolled and classified into the inattentive type (ADHD-I), hyperactive/impulsive type (ADHD-HI) and combined type (ADHD-C). The reaction time (RT) was measured using integrated visual and auditory continuous performance test, and the mean (RT-mean) and standard deviation of RT (RT-SD) were estimated. In addition, the ALFF was calculated at 0.010 to 0.027, 0.027 to 0.073, 0.073 to 0.167 Hz, and the difference of ALFF was compared among children with different types of ADHD. @*Results@#A total of 107 children with ADHD were enrolled, including 95 boys and 12 girls, with a mean age of (8.89±1.93) years. There were 69 children with ADHD-I, 8 children with ADHD-HI and 30 children with ADHD-C. The RT-SD was significantly higher among children with ADHD-C than among children with ADHD-I [(126.003±51.619) ms vs. (97.720±45.302) ms; P=0.007]; however, there was no significant difference in RT-mean among children with various ADHD phenotypes (F=1.386, P=0.255). There was an interaction between frequency and ADHD phenotypes (F=2.754, P=0.032), and the ALFF was significantly higher among children with ADHD-C than among children with ADHD-I at 0.010 to 0.027 [(5 590.567±231.595) ms vs. (4 694.001±154.397) ms; P=0.002] and 0.073 to 0.167 Hz [(4 312.609±174.709) ms vs. (3 690.805±116.473) ms; P=0.005].@*Conclusions @#The ALFF varies in ADHD phenotypes, and there is a frequency-specific difference.

Factors affecting postpartum stress urinary incontinence among lying-in women at ages of 35 years and older / 预防医学

Objective@#To investigate the factors affecting postpartum stress urinary incontinence (PSUI) among lying-in women at ages of 35 years and older, so as to provide insights into PSUI prevention. @*Methods@#Lying-in women at ages of 35 years and older receiving postpartum examinations were sampled using a convenient sampling method from Hangzhou Obstetrics and Gynecology Hospital during the period from January 2021 to April 2022. Participants' demographic data, type of delivery, birth weight, diastasis recti abdominis, pelvic floor muscle strength injury, pelvic floor muscle training were collected, and the development of PSUI was evaluated using the International Consultation on Incontinence modular questionnaire. The factors affecting the development of PSUI were identified among lying-in women at ages of 35 years and older using a multivariable logistic regression model. @*Results@#A total of 230 questionnaires were allocated, and 226 valid questionnaires were recovered, with an effective recovery rate of 98.26%. The lying-in women had a mean age of (37.30±2.11) years, and 75.66% had a pre-pregnancy body mass index (BMI) of 18.5 to 24.0 kg/m2. There were 29 women with postpartum BMI of 24.0 kg/m2 and greater (12.83%), 201 women with gestational weeks of 37 weeks and greater at delivery (88.94%), 105 women with vaginal delivery (46.46%), 20 women with neonatal birth weights of 4 000 g and higher (8.85%), 149 women with diastasis recti abdominis (65.93%), 154 women with pelvic floor muscle strength injury (68.14%). The prevalence of PSUI was 25.22% among the study subjects. Multivariable logistic regression analysis showed that vaginal delivery (OR=4.061, 95%CI: 2.124-7.763), postpartum BMI of 24 kg/m2 and higher (OR=1.903, 95%CI: 1.275-3.288), neonatal birth weight of 4 000 g and higher (OR=2.108, 95%CI: 1.420-4.135), diastasis recti abdominis (OR=1.487, 95%CI: 1.110-2.169) and pelvic floor muscle strength injury (OR=2.924, 95%CI: 1.726-4.803) were risk factors for PSUI among lying-in women at ages of 35 years and older, and pelvic floor muscle training was a protective factor for PSUI among lying-in women at ages of 35 years and older (OR=0.410, 95%CI: 0.216-0.780).@*Conclusions@#The development of PSUI correlates with the type of delivery, postpartum BMI, neonatal birth weight, diastasis recti abdominis and pelvic floor muscle strength injury among lying-in women. Reasonable weight control and active pelvic floor muscle training may facilitate the prevention of PSUI.

Pelvic floor dysfunction as a representative of pelvic frailty / 体力科学

Pelvic floor trauma developing into pelvic frailty is a significant concern in urogynecology or orthopedics. The majority of women who have experienced vaginal childbirth are affected, to a certain extent, by some form of pelvic floor damage, thereby eliciting substantial alterations of functional anatomy in the pelvic cavity which are manifested as urinary incontinence or pelvic organ prolapse (e.g., uterine prolapse). With the above in mind, medical researchers, continence experts, and continence exercise practitioners in the research areas of sports medicine and rehabilitation medicine believe that the coordinated activity of pelvic floor muscles, in association with the abdominal muscles, is a prerequisite for urinary and defecatory continence. Since the pelvic floor forms the base of the abdominal cavity, stronger pelvic floor muscles are crucial in maintaining such capabilities. Opposing action of the abdominal and pelvic floor muscles ensures that exercises for one may also strengthen the other. Appropriate abdominal maneuverability or logical exercise training of the abdominal muscles may thus be beneficial in maintaining not only strength but also coordination, flexibility, and endurance of pelvic floor muscles and abdominal muscles. Such exercises, collectively known as pelvic floor muscle training, may be effective for long-term pelvic cavity care and also in rehabilitating cases of pelvic floor dysfunction. Further research is needed, however, in determining whether pelvic floor muscle function can be truly enhanced or maintained by such exercises in cases of pelvic floor dysfunction and/or decreased urinary continence.

Effectiveness and protocols of pelvic floor muscle exercise for the treatment of urinary incontinence in older people / 体力科学

Urinary incontinence (UI) among older people is a common problem. Several treatments are available for older people with UI including surgery, drug therapies, and behavioral interventions. Recently, much attention has been placed on the behavioral treatments for UI, including pelvic floor muscle (PFM) exercise, weight loss exercise, and thermal therapy, as they have few risks, no side effects, and are effective. These therapies are often recommended as first line treatments for older people with UI. PFM exercise programs often incorporate alternations of fast contractions that are usually held for about two to three seconds interspersed with relaxation intervals of four to five seconds, and sustained contractions, where participants hold the contraction for about eight to ten seconds followed by a relaxation interval of ten to twelve seconds between the contractions. While exercise periods vary between 3 to 24 weeks, 8 to 12 weeks seems to be the most effective length for PFM exercise. The effectiveness of PFM exercise for the improvement of UI has been validated by many studies, with improvement rates ranging widely from 17 to 84%. Also, research has shown that UI is associated with obesity. Increases in body weight cause increases in abdominal wall weight, which in turn increases intra-abdominal pressure and intra-vesicular pressure. Therefore, abdominal fat reduction from exercise may decrease intra-abdominal pressure, perhaps causing improvements in urethral sphincter contraction and, hence, decreasing UI risk. Evidence reveals that PFM exercise and fitness training targeted at reducing modifiable risk factors are effective strategies for treating UI in older people, regardless of UI type.

Pelvic floor muscle exercise for prevention of pelvic floor disorders at each life stage in women / 体力科学

Pelvic floor muscles play an important role in inner unit functioning related to excretion, reproduction, support of pelvic organs, posture, and respiration, while their weakening is a characteristic health problem for many women. The pelvic floor is closely related to women’s life events, and protection and strengthening of the pelvic floor in accordance with life stages will lead to the prevention of pelvic floor disorders (pelvic frailty). Pelvic floor muscle exercises may be the first choice for prevention, improvement, and/or conservative treatment of pelvic organ prolapse caused by weakening of pelvic floor muscle groups. Also, pelvic floor muscle exercises can be done on a daily and continuous basis as a fitness activity; but proper assessment and practice with appropriate methods are important. In addition, an integrated program that includes lifestyle modification can enhance its effectiveness. In order to realize the lifelong well-being of women, there is a need to further develop effective pelvic floor exercises in creating a more comprehensive prevention-care health system for society.

Pelvic floor muscle training for pelvic organ prolapse ~Pelvic floor rehabilitation in our hospital~ / 体力科学

Pelvic organ prolapse (POP) is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). This is a female specific illness and is one of the women’s health problems that negatively impacts quality of life (QOL). The causes of prolapse are multifactorial. However, it is primarily associated with vaginal delivery, which leads to pelvic floor muscle and connective tissue injury. POP presents with various symptoms that may include urinary, bowel, and/or sexual dysfunction. Available POP treatments vary according to the degree of the prolapse symptoms. Pelvic floor muscle training (PFMT) is the treatment of first choice for mild POP (evidence level Ⅰ, recommended grade A). In Japan, it is not yet covered by health insurance, so patients have limited opportunities to learn about correct PFMT under the diagnosis from a specialist physician in pelvic floor disorder. In this article, the PFMT for POP provided in our hospital is reported.

Fundamentals and practices for pelvic floor muscle training / 体力科学

Recently, pelvic floor muscle training has become popular not only in health magazines but also in women’s magazines, on television and on social networking services. The pelvic floor muscles are difficult to visually confirm movement of in a clothed situation, making it difficult to get a sense of muscle contraction; and, thus, there are many cases of incorrect training leading to pelvic floor dysfunction, including urinary incontinence and pelvic organ prolapse, and significant reduction of quality of life and healthy life expectancy. Therefore, the ability of instructors to teach appropriate pelvic floor muscle training is an important key to the prevention and improvement of pelvic floor dysfunction. The purpose of this review is to understand the functional anatomy and motor function of the pelvic floor muscles and to disseminate evaluation and training practices for preventing and improving pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse.

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study / O treinamento por meio de gameterapia pode aliviar os sintomas de incontinência urinária em mulheres climatéricas? Um estudo de viabilidade

Abstract Objective To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress ormixed urinary incontinence (UI). Methods Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. Results The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p<0.001; r=0.8), as well an increase in PFM power (p=0.027, r=0.2) and endurance (p=0.033; r=0.3) in G_Game. Conclusion The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

Resumo Objetivo Investigar a viabilidade do treinamento dos músculos do assoalho pélvico (TMAP) por meio de gameterapia no alívio de sintomas urinários em mulheres climatéricas com incontinência urinária (IU) de esforço ou mista. Métodos Ensaio clínico randomizado, dividido em dois grupos: Gameterapia (G_Game) e Controle (G_Controle). Ambos os grupos receberam recomendações sobre TMAP não supervisionado, e G_Gametambém recebeu TMAP supervisionado por meio de gameterapia. Após 5 semanas consecutivas, a viabilidade foi investigada considerando a aderência das participantes, sintomas urinários (avaliados pelo questionário International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) e função do assoalho pélvico (esquema PERFECT: power, endurance, repetition, fast). Os testes exatos de Fisher, Kruskal-Wallis, sinal de Wilcoxon pareado e Mann-Whitney U foram usados pela análise de intenção de tratar, usando o software STATA 15.1 (StataCorp, College Station, TX, EUA). Resultados O presente estudo incluiu 20 mulheres por grupo e observou uma maior adesão no G_Game. Na análise intragrupo, foi observada diminuição no escore do ICIQUI- SF emambos os grupos (de 14,0 para 10,0; de 13,5 para 0), associada ao aumento da resistência (de 2,5 para 3,5; de 2,5 para 4,0) em G_Control e G_Game, respectivamente. Além disso, houve um aumento concomitante no power (de 2,0 para 3,0), repetition (de 3,0 para 5,0) e fast (de 10,0 para 10,0) dosmúsculos do assoalho pélvico (MAPs) no G_Game. Na análise intergrupos, foi observada redução da IU (p<0,001; r=0,8), assim como do power (p=0,027; r=0,2) e da endurance (p=0,033; r=0,3) dos MAPs no G_Game. Conclusão A viabilidade do TMAP supervisionado por meio de gameterapia foi identificada pela observação da aderência das participantes, pelo alívio dos sintomas urinários e pela melhora da função dos MAPs.

Effect of moxibustion on postpartum urodynamics and pelvic floor function in puerperal women / 中国针灸

OBJECTIVE@#To observe the effect of moxibustion on postpartum urodynamics and recovery of pelvic floor function based on the pelvic floor muscle function training.@*METHODS@#A total of 150 puerperal women were randomly divided into an observation group (75 cases, 15 cases dropped off) and a control group (75 cases, 15 cases dropped off). The control group was treated with pelvic floor muscle function training, twice a day. Based on the treatment in the control group, the observation group was treated with @*RESULTS@#Compared before treatment, the levels of FUL, MUCP, BC, Pdet Qmax and SLPP in the observation group after treatment were increased (@*CONCLUSION@#The moxibustion combined with pelvic floor muscle function training could improve postpartum urodynamics and pelvic floor muscle strength.

Effect of Pelvic Floor Muscle Training on Neurogenic Detrusor Overactivity / 中国康复理论与实践

Objective:To investigate the effect of pelvic floor muscle training on detrusor overactivity in patients with spinal cord injury. Methods:From August, 2019 to August, 2020, 17 patients with incomplete spinal cord injury were randomly divided into control group (n = 8) and experimental group (n = 9). Both groups accepted tolterodine tartrate 4 mg a day orally for twelve weeks, while the experimental group accepted pelvic floor muscle training. They were measured urodynamic indexes, and assessed with Neurogenic Bladder Symptom Scale and Patient Perception of Bladder Condition before and after treatment. Results:All the urodynamic indexes and scores of the scales improved in both groups after treatment (t > 3.674, |Z| > 2.646, P < 0.05), while the indexes of maximum bladder volume, first contraction pressure volume of detrusor, leakage point pressure of detrusor, maximum contraction pressure of detrusor and neurogenic bladder symptom score improved more in the experimental group than in the control group (|t| > 2.194, P < 0.05). Conclusion:Pelvic floor muscle training based on medicine can release the detrusor overactivity in patients with spinal cord injury.

Activation of pelvic floor, lumbar and abdominal musculature during a simulated manual material handling task: a cross-sectional study / Ativação do assoalho pélvico, musculatura lombar e abdominal durante uma tarefa simulada de manuseio de material: um estudo transversal / Activación del diafragma pélvico, de la musculatura lumbar y abdominal durante una actividad simulada de manejo de material: un estudio transversal

ABSTRACT Pelvic floor muscles act synergistically with the abdominal and lumbar muscles contributing to spine and pelvic control. These muscles are activated during activities that increase intra-abdominal pressure, such as manual material handling. The aim of our study was to assess the electrical activity of the lumbar, abdominal and pelvic floor muscles during manual material handling with different loads. This is a cross-sectional study with sixteen nulliparous continent women aged between 18 and 35 years. An electromyographic system was used to evaluate the activation of the multifidus, erector spinal (iliocostal) and abdominal rectus muscles bilaterally (Trigno Wireless®, DelSys®, Boston, USA) and another for the pelvic floor muscles (Thought Technology Ltd, Canadá). Electromyographic data were collected during manual handling of three loads: light (1.5 kg), medium (4.5 kg) and heavy (11.3 kg). Repeated measures ANOVA was applied to compare the activation among loads at a 5% level of significance (α = 0.05). There was a significant increase in the activation of the lumbar and abdominal musculature as the load increases. No difference among loads was found for the pelvic floor muscle activation. Pelvic floor muscles did not increase their activation in function of the load, as occur for the lumbar and abdominal muscles in nulliparous continent women. These findings need to be confirmed for incontinent woman, since it could have clinical implications for designing both occupational tasks and pelvic floor rehabilitation.

RESUMO Os músculos do assoalho pélvico agem sinergicamente com os músculos abdominais e lombares, contribuindo para o controle da coluna e da pelve. Esses músculos são ativados durante atividades que aumentam a pressão intra-abdominal, como o manuseio manual do material. O objetivo deste estudo foi avaliar a atividade elétrica dos músculos do assoalho pélvico, coluna lombar e abdominais durante o manuseio manual do material com diferentes cargas. Trata-se de um estudo transversal com 16 mulheres nulíparas do continente com idade entre 18 e 35 anos. Utilizou-se um sistema eletromiográfico para avaliar a ativação dos músculos multífidos, eretor da coluna (iliocostal) e reto abdominal, bilateralmente (Trigno Wireless®, DelSys®, Boston, EUA) e outro sistema para os músculos do assoalho pélvico (Thought Technology Ltd, Canadá). Os dados eletromiográficos foram coletados durante o manuseio manual de três cargas: leve (1,5kg), média (4,5kg) e pesada (11,3kg). Medidas repetidas Anova foram aplicadas para comparar a ativação entre cargas e o nível de significância foi estabelecido em 5% (α=0,05). Houve um aumento significativo na ativação da musculatura lombar e abdominal à medida que a carga aumentou. Não foi encontrada diferença entre as cargas para a ativação dos músculos do assoalho pélvico. Os músculos do assoalho pélvico não aumentaram sua ativação de acordo com a carga manuseada, como ocorre nos músculos lombar e abdominal em mulheres continentes e nulíparas. Esses achados precisam ser confirmados para mulheres incontinentes, pois podem ter implicações clínicas para o planejamento de tarefas ocupacionais e para a reabilitação do assoalho pélvico.

RESUMEN Los músculos del piso pélvico actúan sinérgicamente con los músculos abdominales y lumbares contribuyendo al control de la columna y la pelvis. Estos músculos se activan durante actividades que aumentan la presión intraabdominal, como el manejo manual de material. El objetivo de este estudio fue evaluar la actividad eléctrica de los músculos del piso lumbar, abdominal y pélvico durante el manejo manual del material con diferentes cargas. Este es un estudio transversal con dieciséis mujeres continentes nulíparas de edades comprendidas entre 18 y 35 años. Se usó un sistema electromiográfico para evaluar la activación de los músculos multifido, erector espinal (iliocostal) y recto abdominal bilateralmente (Trigno Wireless®, DelSys®, Boston, EE. UU.) y otro para los músculos del piso pélvico (Thought Technology Ltd, Canadá). Los datos electromiográficos fueron recolectados durante el manejo manual de tres cargas: ligera (1.5 kg), mediana (4.5 kg) y pesada (11.3 kg). Se aplicaron medidas repetidas ANOVA para comparar la activación entre cargas y el nivel de significancia se estableció en 5% (α = 0.05). Hubo un aumento significativo en la activación de la musculatura lumbar y abdominal a medida que aumenta la carga. No se encontraron diferencias entre las cargas para la activación de los músculos del piso pélvico. Los músculos del piso pélvico no aumentaron su activación de acuerdo con la carga manejada, como ocurre con los músculos lumbares y abdominales en las mujeres continentes nulíparas. Estos hallazgos deben confirmarse para la mujer incontinente, ya que podría tener implicaciones clínicas para el diseño de tareas ocupacionales y la rehabilitación del piso pélvico.

Treinamento do assoalho pélvico na retenção urinária decorrente de encefalomielite aguda disseminada / Pelvic floor muscle training in neurogenic bladder due to acute disseminated encephalomyelitis syndrome

A dengue pode desencadear manifestações neurológicas como a Síndrome de Encefalomielite Aguda Disseminada (ADEM), de caráter inflamatório, desmielinizante, que pode ter dentre as consequências déficits motores e sensitivos, neurite ótica e disfunções vesicais, como a retenção urinária, tornando o indivíduo dependente da realização do cateterismo vesical intermitente (CVI). Desta forma, o objetivo deste estudo é descrever o tratamento fisioterapêutico de uma paciente com retenção urinária, decorrente de Síndrome de ADEM pós-dengue. Paciente do sexo feminino, 52 anos, internada em hospital de média complexidade com diagnóstico de ADEM. Na avaliação inicial apresentava grau de força muscular 3 de membros inferiores e 4 de membros superiores, 2 de musculatura do assoalho pélvico (MAP) e retenção urinária, necessitando realizar CVI. Foram realizados 32 atendimentos com duração de uma hora, incluindo o treinamento do assoalho pélvico em diferentes posturas e eletroestimulação de superfície da MAP com equipamento da marca Ibramed. Paciente recebeu alta hospitalar com evidente melhora da força muscular global e sem necessidade de CVI, apresentando micção voluntária e sem resíduo pós-miccional, favorecendo a prevenção de agravos do trato urinário inferior e superior. (AU)

Dengue can trigger neurological manifestations such as Acute Disseminated Encephalomyelitis (ADEM), with inflammatory, demyelinating condition, which may have, among the consequences, motor and sensory deficits, optic neuritis and bladder dysfunctions, such as urinary retention, making the individual dependent on intermittent bladder catheterization (IBC). Therefore, the objective of this study was to describe the physiotherapeutic treatment of a patient with urinary retention, due to ADEM syndrome after dengue. A 52-year-old female patient admitted to a hospital of medium complexity with a diagnosis of ADEM. In the initial evaluation, she presented a degree 3 of muscular strength in the lower limbs and 4 in the upper limbs, 2 in pelvic floor musculature (PFM) and urinary retention, requiring IBC. We performed 32 one hour sessions, including pelvic floor muscle training in different positions and surface electrostimulation of PFM with Ibramed brand equipment. Patient was discharged with evident improvement of global muscle strength and without IBC, presenting voluntary voiding and without post void residual, favoring the prevention of lower and upper urinary tract injuries. (AU)

Pelvic Floor Muscle Exercise Education and Factors Associated with Implementation among Antenatal Women in Hospital Universiti Sains Malaysia / 가정의학회지

BACKGROUND: Pelvic floor muscle exercise is effective for pelvic floor muscle dysfunction. Despite the high prevalence of pelvic floor muscle dysfunction in women in the community, pelvic floor muscle exercise recognition is low in Malaysian society; thus, this intervention is not frequently used . This study assessed the knowledge of, attitudes towards, and use of pelvic floor muscle exercise among antenatal women before and after educational classes. The study also determined factors associated with exercise practice. METHODS: An interventional study was conducted in 121 antenatal women selected through systematic random sampling between June and December 2010. Baseline knowledge of, attitude towards, and practice of pelvic floor muscle exercise were assessed using self-administered validated questionnaires at first visit and at 2 months postpartum. All participants attended two exercise education classes on their next two visits before delivery. A paired t-test and multivariate analysis were used for data evaluation. RESULTS: The mean pre-intervention scores for knowledge, attitudes, and practice were 24.98, 24.25, and 3.51, respectively, with statistically significant mean score increments after intervention (P < 0.001). The mean differences were 4.67 (95% confidence interval [CI], 3.86–5.49), 3.77 (95% CI, 3.05–4.50) and 3.45 (95% CI, 2.90–4.00) for knowledge, attitudes, and practice, respectively. Lack of baseline information on pelvic floor muscle exercise was significantly associated with practice change following an educational class. CONCLUSION: Education is effective in improving knowledge of, attitude towards, and practice of pelvic floor muscle exercise. There is a need for greater effort to increase exercise awareness in our community, especially during antenatal class.

The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: A meta-analysis / 亚洲男科学杂志(英文版)

Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). However, whether the PFME guided by a therapist (G-PFME) can contribute to the recovery of urinary continence for patients after RP is still controversial. We performed this meta-analysis to investigate the effectiveness of G-PFME on UI after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone. Literature search was conducted on Cochrane Library, Embase, Web of Science, and PubMed, to obtain all relevant randomized controlled trials published before March 1, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the continence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME. Twenty-two articles with 2647 patients were included. The continence rates of G-PFME were all superior to control at different follow-up time points, with the odds ratio (OR) (95% confidence interval [CI]) of 2.79 (1.53-5.07), 2.80 (1.87-4.19), 2.93 (1.19-7.22), 4.11 (2.24-7.55), and 2.41 (1.33-4.36) at 1 month, 3 months, 4 months, 6 months, and 12 months after surgery, respectively. However, there was no difference between additional preoperative G-PFME and postoperative G-PFME, with the OR (95% CI) of 1.70 (0.56-5.11) and 1.35 (0.41-4.40) at 1 month and 3 months after RP, respectively. G-PFME could improve the recovery of urinary continence at both early and long-term stages. Starting the PFME preoperatively might not produce extra benefits for patients at early stage, compared with postoperative PFME.

The clinical application of biological feedback therapyand the characteristicsof pelvic floor surface electro-myography in elderly patients with functional constipation / 实用医学杂志

Objective To evaluate the therapeutic effect of biofeedbackand thecharacteristics of pelvic floor surface electromyography in elderly patients with functional constipation. Methods Analysis 258 cases of functional constipation patients with 12 index of five steps of the pelvic floor surface electromyographic. Of these, 74 patients(50 older age-group and 24 control group)with functional constipation were treated with biofeedback. Use constipation patient symptomself-assessment scale,before and after treatment,compared two groups with the scord and clinical effect,analysis 12 index of the pelvic floor surface electromyographic in older age-group. Results Compared to control group,the older age-group had a lower amplitude during pre-baseline step,flick step,tonic step,endurance step and pos-baseline step.The older age-group had a higher CV(coefficient of vari-ance)during pre-baseline step and endurance step,median frequency during tonic step and endurance step. Onset time during flick step,CV during tonic step andpos-baseline step in the older age-group is as well as control group. The maximal contraction amplitude,continuous contraction and prolonged contraction amplitude were all increased in the elderly group after biofeedback treatment. The variation coefficient of the prebaseline and the duration of the endurance contraction was decreased. The value frequency of the durable contraction decreases. Conclusion The characteristics of pelvic floor surface electromyography in elderly patients:had a lower ampli-tude duringpre-baseline step,flick step,tonic step,endurance step and pos-baseline step,had a higher CV during pre-baseline step and endurance step,median frequency during tonic step and endurance step.Biofeedback therapy can improve pelvic floor muscle tension and the coordination of sports.

Progress in maternal pelvic floor muscle training / 中国实用护理杂志

Pelvic floor muscle training is an important means for preventing and treating pelvic floor dysfunction.This article reviews the impact of gestational delivery on pelvic floor function,the role of pelvic floor muscle training,the current status of maternal pelvic floor muscle training,influencing factors,and the progress of interventions.It is suggested that medical staff should strengthen the health education of the pelvic floor muscle training for pregnant women and the compliance and standardization of maternal pelvic floor muscle training,so as to reduce the incidence of female pelvic floor dysfunction diseases and protect women's health.

Clinical Observation of Moxibustion plus Pelvic Floor Muscle Exercises for Postpartum Stress Urinary Incontinence / 上海针灸杂志

Objective To compare the clinical efficacy among moxibustion plus pelvic floor muscle exercises, pelvic floor muscle exercises, and Western medication in treating postpartum stress urinary incontinence. Method Fifty-eight eligible patients were divided by the random number table into an integration group (19 cases), an exercise group (19 cases) and a Western medication group (20 cases). The integration group was intervened by pelvic floor muscle exercises plus moxibustion, 3 times of exercises a day, 5 min each time, and moxibustion at Zusanli (ST36), Sanyinjiao (SP6), Guanyuan (CV4), Zhongji (CV3) and Qihai (CV6), once a day, 30 min each session. The exercise group was intervened by muscle force exercises to train the pelvic floor muscle, 3 times a day, 5 min each time. The Western medication group was intervened by oral administration of Duloxetine hydrochloride, 80 mg a day (40 mg per dose, twice a day). For the above methods, 6 d was taken as a course of treatment. Four treatment courses were observed, with a 1-month follow-up study. The 1-hour pad test was used to record the volume of urine leak. Before and after the treatment, as well as in the 1-month follow-up, the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score was evaluated and compared among the groups, and the short-term and long-term therapeutic efficacies were also compared. Result The short-term and long-term therapeutic efficacies of the integration group were superior to those of the exercise group and Western medication group (P<0.05). The integration group showed significant improvement after the treatment and in the follow-up study compared to the pre-treatment state (P<0.01); after the intervention, the integration group was better than the exercise group and Western medication group in comparing the urine leak volume by the 1 h pad test and ICIQ-UI-SF score (P<0.01,P<0.05). Conclusion Moxibustion plus pelvic floor muscle exercises can improve the short-term quality of life of patients with postpartum stress urinary incontinence. This method can produce a better effect in improving the quality of life compared to pelvic floor muscle exercises alone.