Fecal incontinence or pelvic organ prolapse among women with premature ovarian insufficiency

Objectives: To assess the status of the pelvic floor muscle (PFM) of premature ovarian insufficiency women (POI women) and the incidence of fecal incontinence (FI) and pelvic organ prolapse (POP). Methods: A secondary analysis of a cross-sectional study with 150 women with POI was performed. Pelvic floor muscle assessment was performed with the PERFECT scale. The subscales POPDI-6 and CRADI-8 of the questionnaire Pelvic Floor Distress Inventory-20 (PFDI-20) were used for pelvic floor symptoms focused on FI and POP. Moreover, FI and POP were also assessed as dichotomous variables (yes/no). Results: Women with FI and POP did not present differences in the PFM assessment across P (p = 0.61), E (p = 0.78), R (p = 0.22), and F (p = 0.79) variables when compared with women with POI; no differences were also seen between women with and without POP according the pelvic muscles: P (p = 0.91), E (p = 0.99), R (p = 0.62), and F (p = 0.10). Women with FI and POP presented higher scores in all PFDI-20 subscales and total score when compared with the control group (p < 0.05). Conclusions Pelvic floor muscle assessment within POI women with or without FI or POP did not differ. However, PF symptoms are more severe in the FI or POP groups. (AU)

Efeitos do fortalecimento muscular do assoalho pélvico em pacientes pós-acidente vascular encefálico com incontinência urinária / Effects of pelvic floor muscle strengthening in post-stroke patients with urinary incontinence

Introdução: Pacientes pós-acidente vascular encefálico (AVE) apresentam alterações motoras, causando perda de força muscular, que afeta inclusive os músculos do assoalho pélvico. Essa perda de força pode levar a incontinência urinária que consiste na perda involuntária de urina. A Sociedade Internacional de Incontinência Urinária (SIC) indicou a fisioterapia como tratamento de primeira linha para a incontinência urinária, mas ainda não foram encontradas revisões sistemáticas da literatura que avalie o efeito do fortalecimento muscular do assoalho pélvico em pacientes pós-AVE com IU. Objetivo: Realizar uma revisão sistemática da literatura sobre os efeitos do fortalecimento do assoalho pélvico em pacientes pós-AVE com IU. Métodos: Buscas nas bases Medline, Lilacs, Scielo, PEDro, sem restrição de data ou idioma de publicação. Foram utilizadas combinações de palavras-chave, tais como: acidente vascular encefálico, reabilitação, incontinência urinária, fisioterapia, assoalho pélvico, além de seus respectivos termos em inglês. Os estudos foram analisados por dois avaliadores independentes. A qualidade metodológica dos estudos incluídos foi avaliada de acordo com a escala PEDro. Resultados: A estratégia de busca resultou em 693 artigos, e após a análise de títulos, resumos e textos completos, realizados por dois avaliadores independentes, foram excluídos 688, restando cinco artigos selecionados para a presente revisão sistemática. Em geral, os estudos mostraram que os pacientes pós-AVE obtiveram melhora em todas as medidas de desfecho investigadas (força, resistência e atividade dos músculos do assoalho pélvico, frequência de micção, número de episódios de incontinência, número de absorventes usados, quantidade da perda de urina, função do trato urinário inferior, sintomas da bexiga hiperativa e independência funcional), exceto na qualidade de vida e impacto da incontinência, tanto a curto como a longo prazo. Conclusão: Os resultados parecem promissores em relação à eficácia do fortalecimento muscular do assoalho pélvico como uma intervenção para a reabilitação de indivíduos com IU pós-AVE. No entanto, tais conclusões se baseiam em apenas cinco estudos, de qualidade metodológica moderada, necessitando de mais estudos sobre o assunto. (AU)

Introduction: Post-stroke patients present motor impairments, such as muscle weakness, which also affects the pelvic floor muscles. This loss of strength can lead to urinary incontinence (UI), which consists of involuntary loss of urine. The International Society for Urinary Incontinence has indicated physical therapy as a first-line treatment for UI, but no systematic reviews of the literature have yet found that evaluates the effects of pelvic floor muscle training in post-stroke patients with UI. Objective: To perform a systematic review of the literature investigating the effects of pelvic floor strengthening in post-stroke patients with UI. Methods: Searches in Medline, Lilacs, Scielo, PEDro, without restriction of date or language of publication were performed. The terms included the following descriptors: stroke, rehabilitation, urinary incontinence, physical therapy, pelvic floor, as well as these terms in Portuguese, with strategies specific to each base. The studies were analyzed by two independent evaluators. The methodological quality of the included studies was evaluated according to the PEDro scale. Results: The search strategy resulted in 693 articles, and after the analysis of titles, abstracts and full texts, 688 were excluded, resulting in five articles selected for the present systematic review. In general, studies have shown that post-stroke patients improved all investigated outcome measures (strength, endurance and pelvic floor muscle activity, urinary frequency, number of incontinence episodes, number of absorbents used, amount of loss of urine, lower urinary tract function, overactive bladder symptoms and functional independence), except for the quality of life and impact of incontinence, both short-term and long-term. Conclusion: As observed, the results seem promising regarding the efficacy of pelvic floor muscle training as an intervention for the rehabilitation of individuals with UI post-stroke. However, these conclusions are based on only five studies, of moderate methodological quality, requiring further studies. (AU)

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

Effects of Sling Exercise Therapy on Muscle Strength of Pelvic Floor for Patients with Postpartum Stress Urinary Incontinence / 中国康复理论与实践

Objective:To observe the effects of sling exercise therapy on muscle strength of pelvic floor in patients with postpartum stress urinary incontinence. Methods:From February, 2018 to February, 2019, 90 patients diagnosed as postpartum stress urinary incontinence 42 days after delivery were randomly divided into control group (n = 45) and observation group (n = 45). The control group received Kegel training, and the observation group received sling exercise therapy, for a month. The electromyogram of pelvic floor was measured before and after treatment, and the clinical efficacy was evaluated at the end of the treatment. Results:The electromyogram of pelvic floor increased in both groups after treatment (t > 3.879, P < 0.01), and increased more in the observation group than in the control group (P < 0.05). The rate of improvement was 93.33% in the observation group, which was more than 75.56% in the control group (χ2 = 13.83, P < 0.05). Conclusion:Sling exercise therapy can more effectively improve the muscle strength of pelvic floor for patients with postpartum stress urinary incontinence, and relieve the symptoms of overfall.

Association between the Functionality of Pelvic Floor Muscles and Sexual Satisfaction in Young Women / Associação entre a funcionalidade dos músculos do assoalho pélvico e a satisfação sexual em mulheres adultas jovens

Abstract 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/m2, 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 KolmogorovSmirnov 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/m2 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.

Effects of Acupuncture in Different Stages on Pelvic Floor Muscles and Urinary Function in Patients with Spinal Cord Injury / 中国康复理论与实践

Objective To investigate the therapeutic effects of acupuncture on pelvic floor muscles and urinary function in patients with spinal cord injury. Methods From March, 2012 to March, 2015, 23 patients with spinal cord injury were divided into control group (n=8), early intervention group (n=8) and later intervention group (n=7). The control group received routine rehabilitation, the intervention groups received acupuncture at Baliao (BL-31, BL-32, BL-33 BL-34), Yanglingquan (GB-34), Sanyinjiao (SP-6) and Taichong (LR-3) acupoints in addition. The early intervention group was acupunctured one week before removal of catheter, and the later intervention group adopted inter-mittent catheterization after removal of catheter, and then received acupuncture. The pelvic floor muscles strength, the urine function and quality of life were recorded before and six weeks after intervention. Results There was no significant difference in all the indices before in-tervention (P>0.05). After intervention, the pelvic floor muscles strength improved in the intervention groups compared with the control group (P0.05). The quality of life improved in all the groups after inter-vention (F>0.864, P<0.05), however, no significant difference was found among three groups (F=1.558, P<0.05). Conclusion Acupuncture, especially early acupuncture, could improve the pelvic floor muscle strength and bladder function in spinal cord injury patients.

DTI and DTT in evaluation of effect of childbearing history on female pelvic floor muscles / 实用医学杂志

Objective To investigates the feasibility of diffusion tensor imaging (DTI) and diffusion tensor tracking (DTT) for evaluation of the effect of childbearing history on female pelvic floor muscles. Methods Forty-six healthy females were divided into two groups: nulliparous and primiparous. MR conventional sequences and DTI were acquired. The optimized FA threshold value was obtained by regulating the FA to fiber tracking. The two groups were compared in terms of ADC, FA, VRA and T2-WT. Results (1)The DTT of FA 0.18 got the highest score in fiber tracking . ( 2 ) The ADC of nulliparous subjects and the subjects who had given birth were (1.24 ± 0.11) ×10-3 mm2/s, (1.33 ± 0.11) ×10-3 mm2/s (P = 0.017). There were no statistical differences in FA, VRA and T2-WT between the two groups (P > 0.05). Conclusions The optimized FA threshold of fiber tracking in pelvic floor muscles is 0.18. DTI and DTT may be used to evaluate the effect of childbearing history on female pelvic floor muscles.

The effect of electrical stimulation of the pelvic floor combined with acupuncture on urinary dysfunction in spinal cord injury patients / 中华物理医学与康复杂志

Objective To observe the effect of electrical stimulation of the pelvic floor muscles (PES) combined with acupuncture on urinary dysfunction in patients with spinal cord injury (SCI). Methods Sixty-two patients with SCI were randomly divided into a treatment group ( n =31 ) and a control group ( n =31 ).All subjects received routine bladder function training and a drinking water schedule for 8 weeks.In addition,the treatment group was given PES 30-40 min/d 6 times/week and acupuncture for 30 min/d,6 times/week for the 8 weeks.Residual volume of urine was evaluated using ultrasound and a daily voiding diary.Uurodynamic examinations and catheter extraction were used to assess the urinary function pre- and post-treatment. Results No significant difference was found between the two groups before treatment,but after 8 weeks of treatment the residual volume of urine detected by ultrasound and voiding frequency were significantly lower in the treatment group than in the control group.First desire to urinate and maximal urinary bladder capacities in the treatment group were also significant higher than in the control group.The efficacy of treatment was also sustained significantly longer in the treatment group. Conclusion PES combined with acupuncture therapy is more effective than routine bladder function training for SCI patients with urinary dysfunction.

Características anatómicas y fisiológicas de los músculos pélvicos en la coneja doméstica (Oryctolagus cuniculus) / Anatomical and physiological characteristics of pelvic muscles in the female rabbit (Oryctolagus cuniculus)

In mammals, the pelvic striated muscles have been linked to the regulation of urinary functions and little is known about the involvement of this muscle in reproductive functions. The objective of this study was to use surgical and electrophysiological techniques to determine the anatomical features and innervation of iliococcygeus and pubococcygeus muscles in adult female rabbits and characterize the reflex electromyographic (EMG) activity in response to genital stimulation. Results show that the iliococcygeus and pubococcygeus are long bilateral muscles with fibers attached to the ilium bone. The muscle fibers are not attached to the pelvic viscera but they run adjacent to the vagina and rectum to be inserted into the sacral vertebrae. The iliococcygeus and pubococcygeus muscles are innervated by branches arising from S3 and S4. The reflex EMG activity was obtained during stimulation of the vaginal orifice skin and the perineal and pelvic vagina. Abdominal vaginal stimulation did not cause an EMG response. Cervical stimulation produced a temporary inhibition in the activity of the iliococcygeus and pubococcygeus. These findings extend the poor descriptions of innervation and anatomy of the striated pelvic musculature shown in the textbooks and atlas of rabbits. They also suggest that the iliococcygeus and pubococcygeous muscles can be activated by reflex action during reproductive processes such as mating and parturition.

En mamíferos, la musculatura estriada pélvica se ha relacionado con la regulación de funciones urinarias y poco se sabe de su participación en funciones reproductivas. Los objetivos del presente estudio fueron determinar las características anatómicas y la inervación de los músculos iliococcígeo y pubococcígeo de la coneja adulta, y caracterizar la actividad electromiográfica (EMG) refleja en respuesta a la estimulación genital. Para ello se utilizaron técnicas quirúrgicas y electrofisiológicas. Los resultados muestran que el iliococcígeo y pubococcígeo son músculos bilaterales que se originan en el hueso iliaco; están inervados por ramas que emergen de S3 y S4; sus fibras musculares no se adhieren a las vísceras pélvicas, sino que discurren lateral a la vagina y al recto y se insertan en las vértebras sacras. Durante la estimulación de la piel del orificio vaginal y la vagina pélvica y perineal se presentó actividad EMG refleja en ambos músculos. La estimulación de la vagina abdominal no indujo respuesta EMG. La estimulación cervical produjo inhibición temporal en la actividad del iliococcígeo y pubococcígeo. Estos resultados contribuyen a las escasas descripciones anatómicas de la musculatura pélvica de la coneja que se encuentran en libros de texto y atlas; también sugieren que los músculos pélvicos iliococcígeo y pubococcígeo podrían activarse reflejamente durante procesos reproductivos, como la cópula y el parto.

Effectiveness of electrical stimulation of pelvic floor muscles in the treatment of urinary incontinence in patients with incomplete spinal cord injury / 中华物理医学与康复杂志

Objective To observe the therapeutic effects of electrical stimulation of pelvic floor muscles on urinary incontinence (UI) in patients with incomplete spinal cord injury (ISCI). Methods Seven patients (5 males and 2 females; average age: 32.5 years; average duration after injury: 7.5 months) with ISCI were treated with ESPFM applied on rectum (for male) or vagina (for female) for 30～45 min,once a day, 5 days a week for (2～3) months. The rate of success on stopping using catheters and the frequency and amount of urination were observed during treatment. Results Catheters were taken out successfully from all patients 2～3 weeks after treatment. Five out of the 7 patients had more self-control of urination than incontinence after 8 weeks of treatment though there was no significant difference in the amount of the urination. Conclusion ESPFM might improve the function of urinary bladder in patients with incomplete spinal cord injury.