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1.
Rev. cir. (Impr.) ; 72(5): 389-394, oct. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138729

ABSTRACT

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.


Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.


Subject(s)
Humans , Biofeedback, Psychology/methods , Constipation/therapy , Defecation , Prospective Studies , Pelvic Floor/physiopathology , Constipation/physiopathology
2.
Arq. gastroenterol ; 57(2): 198-202, Apr.-June 2020.
Article in English | LILACS | ID: biblio-1131655

ABSTRACT

ABSTRACT Pelvic floor rehabilitation aims to address perineal functional and anatomic alterations as well as thoraco-abdominal mechanic dysfunctions leading to procto-urologic diseases like constipation, fecal and urinary incontinence, and pelvic pain. They require a multidimensional approach, with a significant impact on patients quality of life. An exhaustive clinical and instrumental protocol to assess defecation disorders should include clinical and instrumental evaluation as well as several clinical/physiatric parameters. All these parameters must be considered in order to recognize and define any potential factor playing a role in the functional aspects of incontinence, constipation and pelvic pain. After such evaluation, having precisely identified any thoraco-abdomino-perineal anatomic and functional alterations, a pelvi-perineal rehabilitation program can be carried out to correct the abovementioned alterations and to obtain clinical improvement. The success of the rehabilitative process is linked to several factors such as a careful evaluation of the patient, aimed to select the most appropriate and specific targeted rehabilitative therapy, the therapist's scrupulous hard work, especially as regards the patient's emotional and psychic state, and finally the patient's compliance in undertaking the therapy itself, especially at home. These factors may deeply influence the overall outcomes of the rehabilitative therapies, ranging from "real" success to illusion "myth".


RESUMO A reabilitação do assoalho pélvico visa abordar alterações funcionais e anatômicas perineais, bem como disfunções mecânicas torácicas-abdominais que levam a doenças procto-urológicas como prisão de ventre, incontinência fecal e urinária e dor pélvica. Requerem uma abordagem multidimensional, com impacto significativo na qualidade de vida dos pacientes. Um protocolo clínico e instrumental exaustivo para avaliar os transtornos de defecação deve incluir avaliação clínica e instrumental, bem como diversos parâmetros clínicos/fisiátricos. Todos esses parâmetros devem ser considerados para reconhecer e definir qualquer fator potencial desempenhando um papel nos aspectos funcionais da incontinência, prisão de ventre e dor pélvica. Após tal avaliação, tendo identificado com precisão quaisquer alterações anatômicas e funcionais tóraco-abdomino-perineais, um programa de reabilitação pelvi-perineal pode ser realizado para corrigir as alterações acima mencionadas e obter melhora clínica. O sucesso do processo de reabilitação está ligado a diversos fatores, como uma avaliação cuidadosa do paciente, visando selecionar a terapia de reabilitação direcionada mais adequada e específica, além do trabalho árduo e escrupuloso do terapeuta, especialmente no que diz respeito ao estado emocional e psíquico do paciente e, finalmente, a conformidade do paciente em realizar a terapia em si, especialmente em casa. Esses fatores podem influenciar profundamente os resultados globais das terapias de reabilitação, que vão desde o sucesso "real" até o "mito" ilusório.


Subject(s)
Humans , Female , Uterine Prolapse/complications , Pelvic Floor/physiopathology , Constipation/complications , Constipation/rehabilitation , Fecal Incontinence/complications , Fecal Incontinence/rehabilitation , Quality of Life , Constipation/psychology , Fecal Incontinence/psychology
3.
Int. braz. j. urol ; 46(1): 5-14, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1056367

ABSTRACT

ABSTRACT The exact prevalence of pelvic organ prolapse is difficult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic floor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The "Integral theory" of Petros and the "Levels of Support" model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse. The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.


Subject(s)
Humans , Female , Pelvic Organ Prolapse/etiology , Pelvic Organ Prolapse/physiopathology , Parity , Menopause/physiology , Risk Factors , Collagen/physiology , Pelvic Floor/physiopathology , Pelvic Organ Prolapse/therapy , Obesity/complications , Obesity/physiopathology
4.
Int. braz. j. urol ; 45(6): 1196-1203, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056345

ABSTRACT

ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.


Subject(s)
Humans , Male , Aged , Prostatectomy/rehabilitation , Urinary Incontinence/rehabilitation , Pelvic Floor/physiopathology , Perioperative Care/methods , Muscle Stretching Exercises/methods , Erectile Dysfunction/rehabilitation , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Quality of Life , Urinary Incontinence/etiology , Urinary Incontinence/physiopathology , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Neurofeedback , Neoplasm Grading , Erectile Dysfunction/etiology , Erectile Dysfunction/physiopathology , Middle Aged , Muscle Contraction/physiology , Neoplasm Staging
5.
Rev. chil. obstet. ginecol. (En línea) ; 84(2): 158-165, 2019. tab
Article in Spanish | LILACS | ID: biblio-1013827

ABSTRACT

RESUMEN Antecedentes: La incontinencia urinaria (IU) corresponde a la pérdida involuntaria de orina. En la medida en que la población envejece, aumenta su prevalencia y severidad. Objetivo: Describir el impacto de la incontinencia de orina en la población adulto mayor, así como conocer su fisiopatología e implicancias en la calidad de vida. Método: Revisión de la literatura disponible en PubMed, Embase y Medline utilizando los términos "urinary incontinence" y "elderly" entre los años 1990 y 2018. Resultados: La IU en el adulto mayor impacta negativamente en la calidad de vida de esta población, teniendo una multiplicidad de causas subyacentes que implican un tratamiento integral y multidisciplinario de esta patología. Conclusión: Dado el incremento de la edad en la población, conocer y manejar esta patología es importante para el clínico y el especialista para que de esta forma mejore la calidad de vida en este grupo etario.


ABSTRACT Background: Urinary incontinence (UI) is the involuntary loss of urine. The prevalence and severity of this condition increase as population ages. Objective: To describe the impact urinary incontinence in the elderly population, as well as to know its pathophysiology and implications in the quality of life. Method: Review of the literature available in PubMed, Embase and Medline using the keywords "urinary incontinence" and "elderly" between 1990 and 2018. Results: UI in the elderly has a negative impact on their quality of life, having a multiplicity of underlying causes that imply a comprehensive and multidisciplinary treatment of this pathology. Conclusion: Given the age increase in general population, knowing and managing this pathology is important for the clinician and the specialist to improve the quality of life in this age group.


Subject(s)
Humans , Aged , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Quality of Life , Urinary Incontinence/physiopathology , Pelvic Floor/physiopathology
6.
Int. braz. j. urol ; 44(6): 1207-1214, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-975659

ABSTRACT

ABSTRACT Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients. Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children's Continence Society guidelines. Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients. Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Urination/physiology , Vesico-Ureteral Reflux/physiopathology , Pelvic Floor/physiopathology , Lower Urinary Tract Symptoms/physiopathology , Vesico-Ureteral Reflux/complications , Retrospective Studies , Electromyography , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology
7.
Rev. bras. enferm ; 71(5): 2496-2505, Sep.-Oct. 2018. tab
Article in English | LILACS, BDENF | ID: biblio-958705

ABSTRACT

ABSTRACT Objective: Describe the sociodemographic, clinical, and sexual profile, identify profile variables that affect the Health-Related Quality of Life (HRQoL), and evaluate the correlation between two HRQoL questionnaires used in a pelvic floor rehabilitation program. Method: This is an observational, analytical, and cross-sectional study, based on patient records and two questionnaires for HRQoL evaluation. Results: Women presented a mean age of 55.4 years; were married; white; had stress, urge, or mixed urinary incontinence (UI) of moderate to large urine release; and daily or diurnal UI. Only 50.5% had an active sex life and most had sexual complaints. The change in sexual activity and some types of UI affected the HRQoL. The two questionnaires presented a correlation. Conclusion: The profile and correlation between the questionnaires are consistent with the literature. The type of UI and changes in sexual activity affect the HRQoL.


RESUMEN Objetivo: Describir el perfil sociodemográfico, clínico y sexual; identificar variables del perfil que interfieren en la Calidad de Vida Relacionada a la Salud (CVRS) y evaluar correlación entre dos cuestionarios de CVRS usados en un Programa de Rehabilitación del Piso Pélvico. Método: Estudio observacional, analítico, transversal, basado en fichas de atención y en dos cuestionarios de evaluación de CVRS. Resultados: La media etaria de las mujeres era de 55,4 años, casadas, blancas, con incontinencia urinaria (IU) de esfuerzo, de urgencia o mixta, con pérdidas urinarias de moderada a gran cantidad, diarias y diurnas. Solo 50,5% llevaba vida sexual activa. La mayoría expresaba quejas sexuales. El cambio en la actividad sexual y algunos tipos de IU afectaron la CVRS. Los cuestionarios demostraron correlación. Conclusión: El perfil y la correlación entre ambos cuestionarios concuerdan con la literatura. El tipo de UI y los cambios en la actividad sexual afectan la CVRS.


RESUMO Objetivo: Descrever o perfil sociodemográfico, clínico e sexual, identificar variáveis do perfil que interferem na Qualidade de Vida Relacionada à Saúde (QVRS) e avaliar correlação entre dois questionários de QVRS usados em um Programa de Reabilitação do Assoalho Pélvico. Método: Estudo observacional, analítico e transversal, com base em fichas de atendimento e dois questionários de avaliação da QVRS. Resultados: As mulheres possuíam idade média de 55,4 anos, eram casadas, brancas, tinham incontinência urinária (IU) de esforço, de urgência ou mista, com perdas urinárias de moderada a grande quantidade, diárias e diurnas. Apenas 50,5% tinham vida sexual ativa e a maioria apresentava queixas sexuais. A mudança na atividade sexual e alguns tipos de IU afetaram a QVRS. Os dois questionários apresentaram correlação. Conclusão: O perfil e a correlação entre os questionários condizem com a literatura. Tipo de IU e mudança na atividade sexual afetam a QVRS.


Subject(s)
Humans , Female , Adult , Aged , Quality of Life/psychology , Pelvic Floor Disorders/rehabilitation , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Retrospective Studies , Pelvic Floor/physiopathology , Pelvic Floor/injuries , Pelvic Floor Disorders/complications , Middle Aged
8.
J. coloproctol. (Rio J., Impr.) ; 38(2): 137-144, Apr.-June 2018. tab, ilus
Article in English | LILACS | ID: biblio-954579

ABSTRACT

ABSTRACT The aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors' experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional intestinal constipation, with surgery reserved for cases in which pharmacologic intervention has failed. The information contained in this review article is subject to the critical evaluation of the medical specialist responsible for determining the action plan to be followed within the context of the conditions and clinical status of each individual patient.


RESUMO O objetivo deste trabalho foi avaliar os consensos de sociedade de especialistas e guidelines publicados sobre o diagnóstico e tratamento da constipação intestinal crônica em adultos, e confrontar com a experiência dos autores, a fim de padronizar condutas que auxiliem o raciocínio e a tomada de conduta do médico. Foi realizada busca na literatura científica, mais precisamente nas bases de dados eletrônicos Medline/Pubmed, Scielo, EMBASE and Cochrane, tendo sido utilizado os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Pode-se concluir que constipação crônica é condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. Identificar com precisão a fisiopatologia presente na constipação crônica funcional é complexo, requerendo a realização de testes funcionais nos casos refratários. O entendimento da motilidade intestinal e do mecanismo defecatório é importante para o manejo da constipação intestinal crônica funcional, sendo o tratamento cirúrgico indicado para casos selecionados, onde à abordagem medicamentosa não surtiu efeito. As informações contidas neste artigo de revisão devem ser submetidas à avaliação e à crítica do médico especialista responsável pela conduta a ser tomada, frente à sua realidade e ao estado clínico de cada paciente.


Subject(s)
Humans , Male , Female , Constipation/surgery , Constipation/diagnosis , Constipation/drug therapy , Pelvic Floor/physiopathology , Constipation/physiopathology , Laxatives/therapeutic use
9.
Rev. argent. urol. (1990) ; 83(2): 60-67, 2018. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-964165

ABSTRACT

Objetivos: Conocer el resultado y el impacto en la calidad de vida en mujeres con IUE antes y después de ser sometidas a nuestro programa de rehabilitación del suelo pélvico (PRSP). Materiales y métodos: Las pacientes con IUE derivadas al PRSP debían cumplimentar el cuestionario de Potenziani antes y después de completar el programa. Se registraron las variables pretratamiento: edad, peso, índice de masa corporal, tipo de IUE, número de compresas y puntuación del cuestionario. Las pacientes eran reevaluadas a los 6 meses de finalizado el PRSP para evaluar el resultado (curación, mejoría o igual) y su grado de afectación en la calidad de vida mediante el cuestionario Potenziani. Resultados: A lo largo del año 2014 fueron derivadas 56 pacientes con IUE para iniciar el PRSP. Finalizaron adecuadamente el programa de rehabilitación 48 pacientes, de las cuales cumplimentaron correctamente los cuestionarios pre y post-rehabilitación 41 pacientes. La puntuación media del cuestionario Potenziani antes de iniciar el PRSP era de 10,15 puntos y la puntuación media a los 6 meses de finalizado el PRSP era de 6,83 puntos, existiendo diferencias significativas. Tras finalizar el PRSP, 22 pacientes referían estar curadas, 15 habían mejorado y 4 continuaban igual. Precisaron de colocación de sling transobturatorio (transobturator tape, TOT) 6 pacientes. Conclusión: La rehabilitación del suelo pélvico es una herramienta muy útil para curar la IUE y mejora la calidad de vida de las pacientes (AU)


Objectives: Determine the outcome and impact of quality of life in women with SUI before and then treated with our program of pelvic floor rehabilitation (PPFR). Materials and methods: Patients with SUI derived to the PPFR should complete the questionnaire Potenziani before and after completing the program. Before starting the rehabilitation treatment, we registered the variables age, weight, body mass index, number of pads, type of incontinence and questionnaire score. Patients were reevaluated at 6 months finalizing the PPFR to evaluate the outcome (cure, improvement or equal) and their level of affectation in the quality of life by Potenziani questionnaire. Results: In the year 2014 were derived 56 patients with SUI to start the PPFR. 48 patients completed correctly the program, and 41 patients completed the questionnaires correctly before and after the rehabilitation program. The score of the questionnaire Potenziani before starting the PPFR was 10.15 points and the score at 6 months of completion of the PPFR was 6.83 points, with significant differences. After finalizing the PPFR, 22 patients reported being cured, 15 had improved and 4 remained the same. Six patients needed surgery to correct the urinary incontinence (transobturator tape, TOT). Conclusion: Pelvic floor rehabilitation is very useful tool to treat SUI and improving the quality of life of patients.(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Quality of Life , Urinary Incontinence, Stress/rehabilitation , Treatment Outcome , Pelvic Floor/physiopathology , Surveys and Questionnaires , Exercise Therapy/methods
10.
Rev. argent. urol. (1990) ; 83(2): 55-59, 2018. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-964162

ABSTRACT

Objetivos: Evaluar el impacto en la calidad de vida de mujeres con diversos tipos de incontinencia urinaria, en quienes se realizó un programa de entrenamiento de la musculatura del piso pelviano (EMPP). Materiales y métodos: Se llevó a cabo un estudio retrospectivo, descriptivo y analítico que evaluó a mujeres con incontinencia urinaria derivadas al Centro Urológico Profesor Bengió para realizar rehabilitación del piso pelviano entre enero de 2014 y diciembre de 2015. Todas las pacientes recibieron EMPP como primera línea de tratamiento. La calidad de vida fue evaluada mediante cuestionarios validados, entre los que se realizó UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) versión corta e IQoL (Incontinence Quality of Life). Las variables continuas fueron comparadas a través de pruebas pareadas de T test y las categóricas por el método de chi cuadrado (X2 ). Las puntuaciones fueron evaluadas previo y posterior al EMPP. Se definió una p<0,05 como estadísticamente significativa. Resultados: La población en estudio se remitió a 82 pacientes. La mejoría subjetiva expresada por las pacientes en una escala de 0-10 fue de 6,33 (desvío estándar [DE]=2,42) con una mediana de 7. En la población general existe una declinación en el cuestionario UDI-6 (-2,6; p<0,0001), IIQ-7 (-2,4; p=0,0001) y un aumento en IQoL (11,35; p<0,0001). En los diferentes tipos de incontinencia urinaria (esfuerzo, urgencia y mixta) también se observó una mejoría individual en todos los cuestionarios en cada tipo de incontinencia urinaria, excepto en el cuestionario IQoL (p=0,34) en pacientes con incontinencia de orina de esfuerzo. Conclusiones: El EMPP representa una terapia no invasiva efectiva en el tratamiento de diversas formas de incontinencia de orina, produciendo un impacto favorable en la calidad de vida de mujeres que padecen esta patología.(AU)


Objectives: To assess the impact on the quality of life in women with different types of urinary incontinence, who was a training of the musculature of the pelvic floor muscle (TMPP) program. Materials and methods: Was a retrospective, descriptive and analytical study evaluated women with urinary incontinence derived for rehabilitation of pelvic floor between January 2014 and December 2015. All patients received TMPP as first line treatment. Quality of life was evaluated performing validated questionnaires, which was carried out: UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) short version and IQoL (Incontinence Quality of Life). Continuous variables were compared through the categorical and paired T test tests by chi square (X2 ) method. Scores were assessed pre and post the TMPP. Defined a p<0.05 as statistically significant. Results: The study population was referred to 82 patients. Subjective improvement expressed by patients on a scale of 0-10 was 6.33 (standard deviation [SD]=2.42) with a median of 7. In the general population, there is a decline in the UDI-6 questionnaire (-2.6; p<0.0001), IIQ-7 (-2.4; p=0.0001) and an increase in the IQoL (11.35; p<0.0001). In the different types of urinary incontinence (stress, urgency and mixed) also find an individual improvement in all the questionnaires in each type of urinary incontinence, except in questionnaire IQoL (p=0.34) in patients who are stress urinary incontinence. Conclusions: The TMPP represents a therapy effective non-invasive in the treatment of various forms of urinary incontinence producing a positive impact on the quality of life of women living with this disease.(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Urinary Incontinence/rehabilitation , Pelvic Floor/physiopathology , Exercise Therapy/methods , Surveys and Questionnaires , Retrospective Studies
11.
Rev. Assoc. Med. Bras. (1992) ; 63(12): 1032-1038, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-896331

ABSTRACT

Summary Introduction: Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. Objective: To verify the effects of isolated PFMT on the symptoms of OAB. Method: Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. Results: There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. Conclusion: The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.


Resumo Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) envolve a contração dos músculos puborretal, esfíncteres anal e uretral externo, inibindo a contração do detrusor, o que justifica sua utilização no tratamento dos sintomas da bexiga hiperativa (BH). Objetivo: Verificar os efeitos do TMAP isolado sobre a sintomatologia da BH. Método: Ensaio clínico prospectivo com 27 mulheres com incontinência urinária mista (IUM), com predomínio de sintomas de BH e perda ≥ 2 g no pad test. Avaliaram-se: função dos músculos do assoalho pélvico (MAP) (palpação digital e manometria); sintomas urinários (noctúria, frequência e perda urinária); grau de incômodo dos sintomas de BH (Overactive Bladder Questionnaire [OAB-V8]); e qualidade de vida (Incontinence Quality-of-Life Questionnaire [I-QoL]). O programa de TMAP consistiu em 24 sessões ambulatoriais (2x/semana + TMAP domiciliar). Os testes de Mann-Whitney e Wilcoxon (com nível de significância de 5%) foram utilizados para analisar os dados. Resultados: Observou-se melhora significativa dos sintomas urinários ao pad test (5,8±9,7; p<0,001); ao diário miccional (perda urinária [0,7±1,1; p=0,005] e noctúria [0,8±0,9; p=0,011]). Foram observados redução do grau de incômodo dos sintomas urinários conforme questionário OAB-V8 (10,0±7,7; p=0,001) e significativos resultados na função dos MAP: Oxford (3,6±0,9; p=0,001), Endurance (5,2±1,8; p<0,001), Fast (8,9±1,5; p<0,001) e manometria (26,6±15,8; p=0,003). No mais, a qualidade de vida teve significativa melhora nos três domínios avaliados pelo I-QoL. Conclusão: O TMAP sem quaisquer orientações adicionais melhora a sintomatologia, a função dos MAP e a qualidade de vida de mulheres com sintomas de BH.


Subject(s)
Humans , Female , Adult , Aged , Pelvic Floor/innervation , Exercise Therapy/methods , Urinary Bladder, Overactive , Quality of Life , Syndrome , Electric Stimulation Therapy , Prospective Studies , Surveys and Questionnaires , Physical Therapy Modalities , Treatment Outcome , Pelvic Floor/physiopathology , Urinary Bladder, Overactive/physiopathology , Nocturia/physiopathology , Nocturia/therapy , Middle Aged
12.
Rev. bras. enferm ; 70(1): 231-235, jan.-fev. 2017.
Article in Portuguese | LILACS, BDENF | ID: biblio-843608

ABSTRACT

RESUMO Objetivo: relatar a criação, experiência de implantação e atendimento realizado no Programa de Reabilitação do Assoalho Pélvico (PRAP), um projeto da Faculdade de Enfermagem da Universidade Estadual de Campinas (UNICAMP), desenvolvido em um centro de saúde de Campinas, São Paulo, Brasil. Resultados: este Programa surgiu devido à elevada demanda de pacientes com incontinência urinária (IU) e necessidade de formação ou capacitação de profissionais para atender esta clientela e multiplicar as ações em outras unidades de saúde. Atualmente o PRAP encontra-se em seu décimo ano de funcionamento, tendo, até o momento, atendido 102 pacientes com IU e outras disfunções do assoalho pélvico e do trato urinário inferior, formado 480 alunos, capacitado oito profissionais de saúde e estimulado pesquisas. Conclusão: as atividades preventivas e de reabilitação do assoalho pélvico constituem-se áreas de importante atuação do enfermeiro e iniciativas como a relatada contribuem para a formação profissional e prática baseada em evidências.


RESUMEN Objetivo: relatar la creación, experiencia de implantación y atendimiento realizado en el Programa de Rehabilitación del Piso Pélvico (en portugués, PRAP1), un proyecto de la Facultad de Enfermería de la Universidad Estadual de Campinas (UNICAMP), desarrollado en un centro de salud de Campinas, San Pablo, Brasil. Resultados: este Programa surgió debido a la elevada demanda de pacientes que sufren de incontinencia urinaria (IU) y necesidad de formación o capacitación de profesionales para atender a esta clientela y multiplicar las acciones en otras unidades de salud. Actualmente el PRAP está en su décimo año de funcionamiento, y ha atendido, hasta este momento, a 102 pacientes con IU y otras disfunciones del suelo pélvico y del tracto urinario inferior, además de haber formado 480 alumnos, capacitado ocho profesionales de la salud y estimulado investigaciones. Conclusión: las actividades preventivas y de rehabilitación del piso pélvico constituyen áreas de importante actuación del enfermero e iniciativas como la relatada, y contribuyen para la formación profesional y práctica basada en evidencias.


ABSTRACT Objective: to relate the creation, experience of establishment and service performed in the Pelvic Floor Rehabilitation Program [(PRAP)], a project of the School of Nursing of University of Campinas (UNICAMP), developed at a health unity in Campinas, São Paulo, Brazil. Results: this Program appeared due to the high demand of patients with urinary incontinence (UI) and need of formation or qualification of professionals to serve those customers and multiply the actions at other health unities. Nowadays, the PRAP is in its tenth year, and it has served 102 patients with UI and other dysfunctions of the pelvic floor and lower urinary tract, qualified 480 health professionals and stimulated researches. Conclusion: the preventive actions of pelvic floor rehabilitation are important areas of the nurse’s performance and initiatives as the related ones contribute for the professional formation and practice based on evidences.


Subject(s)
Humans , Female , Aged , Urinary Incontinence/therapy , Pelvic Floor/physiopathology , Rehabilitation Nursing/methods , Urinary Incontinence/complications , Brazil , Program Development , Rehabilitation Nursing/standards , Education, Nursing/methods , Middle Aged
13.
Int. braz. j. urol ; 43(1): 121-126, Jan.-Feb. 2017. tab
Article in English | LILACS | ID: biblio-840811

ABSTRACT

ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.


Subject(s)
Humans , Female , Adult , Aged , Tibial Nerve/physiopathology , Transcutaneous Electric Nerve Stimulation/methods , Pelvic Floor/physiopathology , Exercise Therapy/methods , Urinary Bladder, Overactive/physiopathology , Urinary Bladder, Overactive/therapy , Syndrome , Time Factors , Urination/physiology , Surveys and Questionnaires , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Muscle Strength/physiology , Middle Aged
14.
Femina ; 44(4): 270-275, 20161230.
Article in Portuguese | LILACS | ID: biblio-1050874

ABSTRACT

O enfraquecimento da musculatura do assoalho pélvico pode prejudicar a função urinária e sexual das mulheres. A perda de alguma função fisiológica, mesmo que temporária, causa alterações no cotidiano das pacientes, provocando impacto psicossocial e na sua qualidade de vida. O presente estudo busca quantificar o impacto da incontinência urinária (IU) na qualidade de vida sexual das mulheres através de uma revisão da literatura atual disponível, publicada entre 2000 e 2015. Apesar dos dados serem ainda inconsistentes, comprovou-se que a incontinência urinária afeta de maneira importante a sexualidade e a qualidade de vida de parte importante das mulheres acometidas.(AU)


The pelvic floor muscles weakness can impair urinary and sexual function of women. The loss of some physiological function, even if temporary, causes changes in the daily lives of patients, causing psychosocial impact and affecting their quality of life. This study seeks to quantify the impact of urinary incontinence (UI) in the quality of sexual life of women through a review of the currently avaiable data, publishe between 2000-2015. Even data are still inconsistent it was demonstrated that urinary incontinence significantly affects sexuality and important part of quality of life of affected women.(AU)


Subject(s)
Humans , Female , Quality of Life , Urinary Incontinence , Psychosocial Impact , Sexual Behavior , Pelvic Floor/physiopathology , Sexuality
15.
Rev. Assoc. Med. Bras. (1992) ; 62(7): 635-640, Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-829521

ABSTRACT

Summary 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.


Resumo Introdução: a palpação digital e a manometria são métodos capazes de fornecer informações sobre contração voluntária máxima (CVM) e endurance da musculatura do assoalho pélvico (MAP), e pode-se esperar uma forte correlação entre essas variáveis. Objetivo: investigar a correlação entre CVM e endurance, avaliados por palpação digital e manometria. Método: incluíram-se 42 mulheres, com idade média de 58,1 anos (±10,2) e sintomas predominantes de incontinência urinária de esforço (IUE). Realizou-se primeiramente o exame digital, seguido pela manometria (Peritron®). Mensuraram-se a CVM de acordo com a escala de Oxford (0-5 pontos) e o endurance pelo esquema PERFECT. Resultados: encontrou-se correlação positiva entre CVM mensurada por palpação digital e pressão manométrica de pico (r=0,579; p<0,001), e entre as medições do endurance avaliado pelo Peritron e o esquema PERFECT (r=0,559; p<0,001). Conclusão: os resultados revelaram correlação positiva e significativa entre a capacidade e a manutenção de contração dos MAP por meio das avaliações digital e manométrica em mulheres com IUE.


Subject(s)
Humans , Female , Aged , Palpation/methods , Urinary Incontinence, Stress/physiopathology , Pelvic Floor/physiopathology , Pelvic Floor/innervation , Manometry/methods , Muscle Contraction/physiology , Physical Endurance/physiology , Pressure , Reference Values , Vagina/physiology , Middle Aged
16.
Clin. biomed. res ; 36(3): 135-141, 2016. tab, graf
Article in Portuguese | LILACS | ID: biblio-831704

ABSTRACT

Introdução: A incontinência urinária (IU) é a perda involuntária de urina e pode ser classificada de acordo com os sintomas, sendo os tipos mais comuns: IU de esforço (IUE), IU de urgência (IUU) e IU mista (IUM). Ela causa impacto físico e psicológico negativo, piorando a qualidade de vida. A fisioterapia pélvica é importante no tratamento conservador da IU, pois é segura, não invasiva e com mínimos efeitos colaterais. Objetivos: Descrever o perfil das mulheres avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com relação à IU e qualidade de vida. Métodos: Estudo descritivo, transversal e retrospectivo, realizado a partir de informações dos prontuários das pacientes avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do HCPA, de agosto de 2013 a dezembro de 2014. Resultados: Dos 164 prontuários analisados, a média de idade das pacientes foi de 58,07 anos (±10,98), 55% realizaram parto normal, 51% fizeram episiotomia, todas eram multíparas, 60,4% apresentavam prolapso de órgão pélvico e a IUM foi a mais prevalente, sendo que 71,3% perdiam urina em jato. Quanto à força dos músculos do assoalho pélvico, 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 acessória. O International Consultation on Incontinence Questionnaire - Short Form (ICIS-SF) mostrou que o impacto da IU foi grave em 62,8%. Conclusão: Este estudo permitiu identificar as principais demandas da população feminina com IU, facilitando o delineamento de estratégias de reabilitação eficazes e compatíveis com a prática clínica (AU)


Introduction: Urinary incontinence (UI) is an involuntary loss of urine and can be classified according to its symptoms. The most common types are the following: stress UI (SUI), urge UI (UUI), and mixed UI (MUI). It causes negative physical and psychological impact and consequent deterioration in quality of life. Pelvic physical therapy plays an important role in the conservative treatment of UI, since it is noninvasive, safe, and with minimal side effects. Objectives: To describe the profile of female patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of Porto Alegre Clinical Hospital (HCPA) regarding urinary incontinence and quality of life. Methods: A descriptive, cross-sectional, retrospective, documentary study that used information from the medical records of patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of HCPA, from August 2013 to December 2014. Results: Of the 164 medical records analyzed, patients' average age was 58.07 years (±10.98), 55% of them underwent vaginal delivery, 51% received episiotomy, all were multiparous, 60.4% had pelvic organ prolapse, and 71.3% had urinary leakage in jets. MUI was the most prevalent type of IU. Regarding the strength of pelvic floor muscles, most patients had grade 2 (31.1%), followed by grade 1 (28%) and grade 3 (24.4%), according to the modified Oxford Grading Scale. 75.6% of the patients used some accessory musculature. Quality of life was measured by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which showed that the impact of UI was severe in 62.8% of the patients. Conclusion: The present study identified the main demands of the female population with symptoms of UI, facilitating the design of effective rehabilitation strategies which are compatible with clinical practice (AU)


Subject(s)
Humans , Female , Middle Aged , Aged , Quality of Life , Urinary Incontinence/epidemiology , Exercise Therapy , Pelvic Floor/physiopathology , Urinary Incontinence/rehabilitation
17.
Femina ; 43(6): 257-264, nov.-dez. 2015. tab
Article in Portuguese | LILACS | ID: lil-771224

ABSTRACT

A Vulvodínia Localizada Provocada (VLP) é um tipo de dor crônica limitante e de interesse clínico, cuja etiologia ainda é obscura e para a qual parece não haver consenso a respeito da terapêutica. O objetivo desta pesquisa foi descrever o papel da fisioterapia pélvica no tratamento da VLP. Para tanto, foi realizada uma Revisão sistemática das bases de dados PubMed, LILACS, PEDro e SciELO a partir das palavras-chave vulvodínia, vestibulodínia e dor vulvar, bem como suas variáveis em inglês, em busca de ensaios clínicos que tratassem de técnicas fisioterapêuticas para esse fim. Foram incluídos ensaios clínicos e estudos observacionais e excluídos os que tratassem de estudos em homens ou cobaias e os que versavam unicamente de tratamento cirúrgico ou medicamentoso. Todos foram analisados e qualificados pelos graus de evidência da Associação Médica Brasileira (AMB). Os resultados mostraram que de um um total de 14 artigos, quatro foram estudos de caso, cinco, ensaios randomizados controlados e os demais, estudos observacionais de coorte, transversais e retrospectivos. Foram descritos tratamentos por eletroestimulação, terapia comportamental e fisioterapia pélvica focada nos exercícios do assoalho pélvico, particularmente de propriocepção e coordenação motora visando à recuperação da capacidade ativa de relaxamento. Houve forte evidência suportando a eficácia da fisioterapia pélvica no alívio do quadro clínico da VLP. Não houve consenso a respeito de qual técnica, dentro do arsenal fisioterapêutico, é a mais eficiente para essas pacientes. Concluiu-se que a fisioterapia pélvica é segura e eficiente no tratamento da VLP e deve encabeçar o algoritmo terapêutico desse tipo de paciente.(AU)


Localized Provoked Vulvodynia (LPV) is a limiting chronic pain of clinical interest, whose etiology is still unclear and for which there is no consensus on the therapy. The aim of this paper was to describe the role of pelvic physiotherapy in the treatment of VLP. It was necessary a systematic review of databases PubMed, LILACS, PEDro and SciELO with the keywords vulvodynia, vestibulodínia and vulvar pain in Portuguese and in English, searching for clinical trials upon the physical therapy techniques for this purpose. It was included clinical trials and excluded those that concerned men or mice or only surgical or drug treatment. All of them were analyzed and qualified by the Associação Médica Brasileira (AMB) evidence scale. The results showed that on a total of 14 articles, four were case reports, five, randomized controlled trials, and the others, retrospective study and cross-sectional study studies. They described electrical stimulation treatments, behavioral therapy and pelvic physical therapy focused on pelvic floor exercises, particularly of proprioception and coordination aimed the recovery of active capacity of relaxation. There was strong evidence supporting the effectiveness of pelvic physiotherapy in relieving the clinical symptoms of LPV. There was no consensus about which technique on the physical therapy arsenal is the most effective. Concludes that pelvic physical therapy is safe and effective in the treatment of LPV, and should be considered as first line therapeutic in the algorithm of this kind of patient.(AU)


Subject(s)
Humans , Female , Physical Therapy Modalities , Pelvic Floor/physiopathology , Vulvodynia/therapy , Chronic Pain/therapy , Behavior Therapy/methods , Electric Stimulation Therapy/methods , Databases, Bibliographic , Exercise Therapy/methods , Pulsed Radiofrequency Treatment/methods , Hyperthermia, Induced/methods
18.
Int. braz. j. urol ; 41(3): 521-526, May-June 2015. tab, ilus
Article in English | LILACS | ID: lil-755868

ABSTRACT

ABSTRACT

To evaluate different flowmetry/EMG patterns in patients with proven detrusor overactivity (DO) and compare them with that of a group of patients with lower urinary tract symptoms (LUTS) but without DO.

Materials and Methods

We retrospectively evaluated the records of 100 patients with frequent urinary tract infection or any kind of storage or voiding symptoms that had undergone urodynamic testing: 50 cases with proven DO on cystometry who had a good quality flowmetry/EMG and 50 patients without DO. EMG lag time (the time distance between pelvic floor EMG inactivation and the start of urine flow) and different flow curve pattern were recorded and compared.

Results

The age and gender distribution were not statistically significant between the two groups. A negative lag time (≤ 0 sec) and an obstructive pattern were the only parameters that were more commonly seen in the DO group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a lag times <2 sec for diagnosing DO were 70%, 96%, 96% and 72%, respectively. For a negative lag time, they were 52%, 100%, 100% and 63%, respectively.

Conclusions

A lag time < 2 sec is a useful flowmetric finding that effectively rules out patients with LUTS that do not have DO (specificity and PPV=96%). With the cutoff of zero or less, specificity and PPV will be 100%. It has lower sensitivity and NPV, however, and is not measurable in a considerable population of patients with DO that have concomitant DV.

.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Electromyography/methods , Rheology/methods , Urinary Bladder, Overactive/physiopathology , Age Distribution , Lower Urinary Tract Symptoms/physiopathology , Pelvic Floor/physiopathology , Reference Values , Retrospective Studies , Sensitivity and Specificity , Time Factors , Urodynamics/physiology
19.
Rev. argent. coloproctología ; 26(1): 1-7, mar. 2015. ilus, tab
Article in Spanish | LILACS | ID: biblio-973142

ABSTRACT

Objetivo: Evaluar el grado de concordancia entre la manometría anorrectal y la ecografía dinámica del piso pelviano (ecodefecografía) mediante la medición del índice kappa, en la detección de la contracción paradojal del haz puborrectal en pacientes que presentan dificultad evacuatoria (DE) ocasionada por pujo disinergico. Material y Método: Se efectuaron manometría anorrectal y ecodefecografía, en 89 pacientes (9 hombres y 80 mujeres) en un centro ambulatorio de coloproctología, a pacientes que presentaban síntomas de obstrucción defecatoria en el período comprendido entre mayo 2011 y mayo 2014. Se reportó la presencia de contracción paradojal del haz puborrectal durante el pujo en las manometrías. En la ecodefecografía se analizó el movimiento del músculo puborrectal, comparando el ángulo anorrectal. durante el reposo y pujo. En caso de constatarse una disminución del mismo durante el esfuerzo evacuatorio se interpreto como contracción paradojal del haz puborrectal. Resultados:. Se obtuvo un índice kappa de 0.87 (IC 95% 0,73-0,97), dando un muy buen grado de acuerdo entre los resultados de ambos estudios, con resultados estadísticamente significativos (p=0,05). Conclusión: La ecodefecografía es una herramienta útil que puede confirmar casos de disinergia demostrada por manometría, pero si bien ambos métodos presentan muy buen grado de acuerdo entre sí, ningún estudio puede reemplazar al otro ya que ambos métodos tienen sus resultados falsos positivos.


Objective: To assess the degree of agreement between anorectal manometry and dynamic pelvic floor ultrasound (echodefecography) by calculating kappa index in patients with symptoms of obstructed defecation. Material and Methods: Anorectal manometry and echodefecography were performed in patients with obstructed defecation symtpoms between May 2011 and May 2014. When the anorectal manometry was performed, the pressures during attempted defecation were recorded. Dyssinergic pattern was defined if a rise in pressures was noted. When the echodefecography was performed, the angle between the internal edges of the puborectalis with a vertical line according to the anal canal axis was calcultated at rest and during straining. Results: Anorectal manometry and echodefecography was performed in 89 patients with defecatory disturbances symptoms. Male:female 9male, the mean age of patients was 57 years old (range 25-78). The assessment of the degree of agreement or concordance between dynamic ultrasound and anorectal manometry yielded a kappa index of 0.87 (very good agreement) with statistically significant results (p=0.05). Conclusion: Ultrasonography may be used to assess patients with obstructed defecation, as it is able to detect the same anorrectal dysfuntions found by another pelvic floor studies. It is a minimally invasive, well tolerated method, and avoids exposure to radiation. Although both methods shows very good agreement with each other, they cannot replace them since both methods have false positive results.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Manometry/methods , Defecography/methods , Constipation/diagnosis , Constipation/physiopathology , Anal Canal/diagnostic imaging , Anal Canal/physiopathology , Rectum/physiopathology , Pelvic Floor/physiopathology
20.
Rev. Hosp. Clin. Univ. Chile ; 26(3): 215-221, 2015. tab, ilus
Article in Spanish | LILACS | ID: lil-786574

ABSTRACT

Pelvic floor dysfunctions are highly prevalent in our population significantly affecting the quality of life of women. Pregnancy and childbirth are well recognized risk factors. It has recently become clear that pelvic floor trauma encompass more than perineal trauma or “what one could see in the delivery room.” The levator ani muscle may be affected at birth with the loss of the integral structure of the pelvic floor support, secondarily triggering the descent of the pelvic organs. The overdistension of the urogenital hiatus and anal sphincter injuries can also be consequences of a vaginal birth. An episiotomy is an intervention that seeks to facilitate the expulsion of the fetus expanding the perineum preventing tissue distension and perineal tear. However, this claim raised by its developer has no scientific basis. Today the restrictive practice of this procedure is recommended, given the potential complications that may arise when it is systematically performe. Despite this recommendation, there are no conclusive studies that explore the role that episiotomy has in obstetric pelvic floor trauma...


Subject(s)
Humans , Female , Pelvic Floor/surgery , Pelvic Floor/physiopathology , Pelvic Floor/injuries , Episiotomy
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