Atuação da fisioterapia no tratamento de incontinência urinaria de esforço / Role of physical therapy in the treatment of urinary incontinence of effort

A incontinência urinária de esforço é caracterizada por toda perda involuntária de urina causada por uma força excessiva sobre a musculatura do assoalho pélvico. A fisioterapia urológica tem como objetivo reabilitar essa musculatura através de exercícios do assoalho pélvico, biofeedback, eletroestimulação e cones vaginais. O objetivo desta pesquisa foi revisar e apontar a importância da reabilitação fisioterapêutica em paciente com incontinência urinaria de esforço. Este estudo foi realizado com base na revisão literária, obedecendo aos critérios de inclusão. Verificou-se a importância da fisioterapia urológica em pacientes com incontinência urinaria de esforço, pelos métodos utilizados nessa reabilitação, assim proporcionando ao paciente uma melhor opção de tratamento.(AU)

Stress urinary incontinence is characterized by involuntary loss of urine caused by excessive force on the muscles of the pelvic floor. Neurological physiotherapy aims to rehabilitate the musculature through pelvic floor exercises, biofeedback, electrical stimulation and vaginal cones. The objective of this research is to review and point out the importance of Physiotherapeutic Rehabilitation in patients with Stress urinary incontinence. This study was conducted as a literary review, obeying the criteria of inclusion. It was observed the importance of neurological physiotherapy in patients with urinary incontinence of effort, by methods used in rehabilitation, thus giving the patient a better treatment option.(AU)

Neural regulation of the stress response: glucocorticoid feedback mechanisms

The mammalian stress response is an integrated physiological and psychological reaction to real or perceived adversity. Glucocorticoids are an important component of this response, acting to redistribute energy resources to both optimize survival in the face of challenge and to restore homeostasis after the immediate challenge has subsided. Release of glucocorticoids is mediated by the hypothalamo-pituitary-adrenal (HPA) axis, driven by a neural signal originating in the paraventricular nucleus (PVN). Stress levels of glucocorticoids bind to glucocorticoid receptors in multiple body compartments, including the brain, and consequently have wide-reaching actions. For this reason, glucocorticoids serve a vital function in negative feedback inhibition of their own secretion. Negative feedback inhibition is mediated by a diverse collection of mechanisms, including fast, non-genomic feedback at the level of the PVN, stress-shut-off at the level of the limbic system, and attenuation of ascending excitatory input through destabilization of mRNAs encoding neuropeptide drivers of the HPA axis. In addition, there is evidence that glucocorticoids participate in stress activation via feed-forward mechanisms at the level of the amygdala. Feedback deficits are associated with numerous disease states, underscoring the necessity for adequate control of glucocorticoid homeostasis. Thus, rather than having a single, defined feedback ‘switch’, control of the stress response requires a wide-reaching feedback ‘network’ that coordinates HPA activity to suit the overall needs of multiple body systems.