Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study.

INTRODUCTION AND HYPOTHESIS: The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions. METHODS: A cross-sectional study was conducted between September 2022 and March 2023 using an online questionnaire, which included transgender men over 18 years old who underwent gender-affirming hormone therapy. Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded. The questionnaire employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation. The data were analyzed descriptively and presented as frequencies and prevalence ratios with their respective confidence intervals (95% CI), mean, and standard deviation. RESULTS: A total of 68 transgender men were included. Most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition. CONCLUSIONS: Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%).

Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study.

PURPOSE: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.

Acute Effect of a Half-Marathon over the Muscular Function and Electromyographic Activity of the Pelvic Floor in Female Runners with or without Urinary Incontinence: A Pilot Study.

OBJECTIVE: to verify the acute effect of running a half marathon on pelvic floor muscle (PFM) function and electromyographic (EMG) activity in female runners with and without urinary incontinence. METHODS: This is a cross-sectional pilot study. The sample was divided into two groups: runners with urinary incontinence (with UI) and runners without urinary incontinence (without UI). A semi-structured form and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were used for data collection. The EMG and PFM function were evaluated using the PERFECT method before and immediately after running a half marathon. RESULTS: A total of 14 runners were included (8 with UI; 6 without UI). Runners with and without UI did not show significant differences for EMG and PERFECT. The acute effects of the half marathon on runners without UI were reduced PFM function in terms of strength (p = 0.00), reduced endurance (p = 0.02), and reduced repetition (p = 0.03), and an increase in EMG measured by the median frequency (p = 0.02). Runners with UI showed reduced PFM function in terms of strength (p = 0.05) and repetition (p = 0.01). CONCLUSION: there was no difference in the acute effects of the half marathon on PFM function and EMG in women with and without UI.

What do cochrane systematic reviews say about interventions for enuresis in children and adolescents? An overview of systematic reviews.

OBJECTIVE: To conduct an overview of Cochrane systematic reviews about treatment alternatives for children and/or adolescents with enuresis. SOURCES: An overview of Cochrane systematic reviews about interventions for enuresis in children/adolescents was developed between September/2021 and December/2021. The protocol was registered on PROSPERO and the search was conducted only in the Cochrane Library database without any restriction. Reviews involving any type of intervention for the treatment of enuresis in children/adolescents were included. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and the quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). SUMMARY OF THE FINDINGS: Seven systematic reviews were identified. Based on the ROBIS assessment, all reviews were classified as low risk of bias. According to the AMSTAR-2 assessment, the three oldest systematic reviews were rated as critically low quality, one review was moderate quality, and the three most recent systematic reviews were rated as high quality. No difference was shown between alarm and desmopressin for a complete response to therapy after treatment (RR = 1.30; 95%CI: 0.92 to 1.84), but alarm use is related to a lower risk of adverse events (RR = 0.38; 95%CI: 0.20 to 0.71). There is a moderate certainty that the association between imipramine and oxybutynin is better than placebo to reduce the risk of children who do not achieve 14 consecutive dry nights after treatment (RR = 0.43; 95%CI: 0.23 to 0.78). CONCLUSIONS: There is no difference between alarm and desmopressin for enuresis treatment. However, alarm therapy had fewer adverse events than desmopressin. Moreover, combination therapy between imipramine and oxybutynin is better than placebo.

Prevalence and factors associated with urinary incontinence in female crossfitters: A cross-sectional study.

OBJECTIVE: To determine the prevalence and factors associated with urinary incontinence (UI) in female crossfitters. METHODS: This is a cross-sectional study. Data were collected using assessment forms: Knowledge, Attitude and Practice survey for young female athletes; Incontinence Severity Index; and International Consultation on Incontinence Questionnaire for UI. Descriptive analysis was conducted to obtain absolute and relative frequencies, means and 95% confidence intervals (95% CI). Multivariate analysis was carried out to determine the association between UI and sociodemographic, gynecological-obstetric, and anthropometric variables, associated morbidities, previous history and physical activity. RESULTS: Prevalence of UI, in the 189 included volunteers, was 38.6% and the most frequent type was stress UI (69.9%). A total of 72.6% of incontinent women reported urine loss during CrossFit training. Knowledge (53.4%) and attitude (86.2%) regarding UI were generally adequate, while prevention, management and treatment were inadequate (96.3%). The predominant characteristics of UI were frequency of once a week or less (74.0%), in small amounts (86.3%), mild intensity (57.5%) and slight impact on quality of life (64.3%). In multivariate analysis, no variable was significantly associated with UI. CONCLUSIONS: The prevalence of UI in female crossfitters was 38.6%. The factors investigated did not contribute to the development of UI.

Assessment of the strength and electrical activity of the pelvic floor muscles of male-to-female transgender patients submitted to gender-affirming surgery: A case series.

AIMS: To assess the strength and electrical activity of the pelvic floor muscles (PFMs) of male-to-female transgender individuals submitted to gender-affirming surgery (GAS). METHODS: A case series study was conducted from October 2016 to August 2018. Transgender women, who were scheduled for GAS, participated in the study. The volunteers were submitted to a clinical evaluation of the PFM followed by digital palpation (PERFECT method) and electromyography in the preoperative, 15, and 30 days after GAS. They responded to the International Consultation on Incontinence Questionnaire-Urinary Incontinence (UI)-Short Form to evaluate the effect of UI on quality of life and to questions related to the urinary, anorectal, and sexual symptoms. Fifteen days after the GAS, patients were instructed to perform perineal exercises at home, twice a day. RESULTS: The study sample consisted of 15 transgender women with an average age of 30.6 (SD = 6.7) years. There was a decline in median strength and sustained muscle contraction duration (PERFECT), in the electrical muscle activity (RMSmean and RMSmax) between pre-GAS and 15 days after GAS (p < 0.05). However, there was an increase in these parameters between 15 and 30 days after GAS (p < 0.05). Moreover, six patients exhibited pre-GAS UI, which continued after surgery, with a worsening of urgency symptoms and improvement in nocturia and postmicturition leakage. CONCLUSION: Strength, sustained muscle contraction duration, and PFM electrical activity may decline 15 days after GAS, returning to pre-GAS values in the first month after surgery.

Frequência de incontinência urinária em mulheres praticantes de crossfit: um estudo transversal / Frecuencia de incontinencia urinaria en mujeres que practican crossfit: un estudio transversal / Frequency of urinary incontinence in women who practice crossfit: a cross-sectional study

RESUMO O objetivo deste estudo foi verificar a frequência de Incontinência Urinaria (IU) em mulheres praticantes de Crossfit. Realizou-se um estudo de corte transversal com mulheres que praticavam Crossfit há, pelo menos, 6 meses ininterruptos, com idade entre 18 a 35 anos e frequência de treino de, no mínimo, três vezes por semana. Foram aplicados questionários de avaliação individual compostos por dados sociodemográficas, antropométricos e esportivos, além do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF), para identificar a presença de IU. Também por meio do ICIQ-IU-SF foram identificados a frequência e quantidade de perda de urina e interferência da IU na qualidade de vida (QV) das mulheres incontinentes. Essas mulheres também responderam a um questionário acerca da gravidade da IU. A amostra total do estudo foi de 50 mulheres, das quais 10 (20%) apresentaram IU. A maioria das mulheres incontinentes apresentou IU de gravidade moderada e de interferência leve na QV. Ademais, observou-se associação entre ter histórico de IU e apresentar IU (RP=5,33; IC95%=1,41 a 20,10). Diante do exposto, conclui-se que a frequência de IU em mulheres praticantes de Crossfit foi de 20%, sendo a IU, em sua maioria, de gravidade moderada e de leve interferência na QV.

RESUMEN El objetivo de este estudio fue evaluar la frecuencia de incontinencia urinaria (IU) en mujeres que practican crossfit. Se realizó un estudio transversal con mujeres que habían practicado crossfit, como mínimo, durante 6 meses ininterrumpidos, con edades entre 18 y 35 años y una frecuencia de entrenamiento de al menos tres veces por semana. Se aplicaron cuestionarios de evaluación individual que constó de datos sociodemográficos, antropométricos y deportivos, además del International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) para identificar la presencia de IU. También se identificaron la frecuencia y cantidad de pérdida de orina y la interferencia de la IU en la calidad de vida (CV) de las mujeres con incontinencia utilizando el ICIQ-IU-SF. Esas mujeres también respondieron a un cuestionario sobre la gravedad de la IU. La muestra total del estudio se compuso de 50 mujeres, de las cuales 10 (20%) tenían IU. La mayoría de las mujeres con incontinencia presentaban IU de gravedad moderada e interferencia mínima en la CV. Además, se observó una asociación entre haber presentado antecedentes de IU y tener IU (RP=5,33; IC95%=1,41 a 20,10). Se concluye que la frecuencia de IU en mujeres que practican crossfit fue del 20%, y que la IU se presentó, en su mayoría, de gravedad moderada y de interferencia mínima en la CV de ellas.

ABSTRACT The aim of this study was to determine the frequency of urinary incontinence (UI) in women who practice crossfit. This was a cross-sectional study with women aged between 18 and 35 years, who had been practicing crossfit for at least six months without interruption, and at least three times a week. Individual assessment questionnaires were used, composed of sociodemographic, anthropometric and exercise data, as well as the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) to identify the presence of UI. The frequency and amount of urine loss and UI interference in quality of life (QoL) were also identified via ICIQ-IU-SF. These women also responded to a questionnaire about the severity of UI. The total sample of the study was 50 women, of whom 10 (20%) had UI. Most incontinent women had moderate UI and mild interference in QoL. Moreover, we observed an association between having UI history and presenting UI (PR=5.33, 95% CI=1.41 to 20.10). Given the above, we concluded that the frequency of UI in female crossfit athletes was 20%, with UI being mostly of moderate severity and mild interference in QoL.

"Posterior Tibial Nerve" or "Tibial Nerve"? Improving the reporting in health papers.

AIMS: The primary objective of this study is to identify which term is the most appropriate to use according to anatomical nomenclature: "posterior tibial nerve" or "tibial nerve." Furthermore, this paper intends to show how the use of these terms in papers indexed in important health databases is numerous and to describe the anatomical characteristics of such nerve, to improve future scientific publications. METHODS: This is a descriptive study about the importance of standardizing the use of the terms "posterior tibial nerve" and "tibial nerve" and its anatomy. It comprises three phases: the first is a search in the main databases to identify the use of the terms "posterior tibial nerve" and "tibial nerve." The second phase refers to the consultation of international anatomical terminology to identify the most appropriate term to refer to the nerve, while the third phase is related to the study of the anatomy of this nerve. RESULTS: The term "tibial nerve" is more commonly used, but the use of the term "posterior tibial nerve" is still very substantial. According to international anatomical terminology, the correct term is "tibial nerve," which is a branch of the sciatic nerve. CONCLUSIONS: "Tibial nerve" is the term standardized by international anatomical terminology. The use of terms in accordance with Terminologia Anatomica is important to facilitate the process of teaching and learning, as well as to improve the reporting and interpretation of papers regarding health, and the evidence-based clinical practice.

Factors associated with pain in the pelvic girdle in pregnant adolescents: A case-control study.

BACKGROUND: Due to biological immaturity and unfavorable psychosocial conditions, it is conjectured that teenage pregnancy may be associated with disorders such as pelvic girdle pain. The evidence for risk factors for pelvic girdle pain in pregnant adolescents remains unclear. OBJECTIVES: To evaluate the factors associated with pelvic girdle pain related to pregnancy in adolescents. DESIGN: Case-control study. METHOD: Seventy three pregnant women with presence of pelvic girdle pain (case group) and 331 pregnant women without pelvic girdle pain (control group) aged between 10 and 19 years, with gestational age between 28 and 40 weeks were included. RESULTS/FINDINGS: A logistic regression model was used to identify factors associated with the occurrence of pelvic girdle pain. The following aspects were considered for the model: sociodemographic, anthropometric, gynecological and obstetrical, related to lifestyle, musculoskeletal and psychosocial factors. The results showed that suspected common mental disorder (OR: 2.27; 95% CI: 1.23 to 4.18), low back pain during menstruation (OR: 2.10; 95% CI: 1.16 to 3.80) and strenuous work (OR: 1.95; 95% CI: 1.13 to 3.35) were associated with pelvic girdle pain among pregnant adolescents. CONCLUSIONS: Attention must be given to pregnant adolescents with suspected common mental disorder, low back pain during menstruation and strenuous work in order to ensure referral to the appropriate healthcare professional for early prevention of pelvic girdle pain.

Multiparity, age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Multiparity, age and high body mass index (BMI) are the most widely investigated factors associated with urinary incontinence (UI) during pregnancy. We hypothesized that multiparity, age 35 years or older and high BMI (prepregnancy and during pregnancy) are risk factors for the occurrence of UI in pregnant women. METHODS: Searches were done on MEDLINE/PubMed (1966-2017), LILACS/BIREME (1982-2017), CINAHL/Ebsco (1981-2017) and Scopus/Elsevier (1950-2017). The following criteria were used for study eligibility: (1) population: low-risk pregnant women in any trimester and without age restriction; (2) exposure factors: multiparity (≥ 2 deliveries), age 35 years or older and high BMI (overweight and obesity); (3) outcome: UI during pregnancy; (4) study design: cohort, case-control or cross-sectional studies that used multivariate logistic analysis. Two independent reviewers performed the entire systematic review process. Data extraction of each article was done and, when possible, included in a meta-analysis. Risk of study bias was assessed by NOS and quality of evidence by GRADE. A significance level of p ≤ 0.05 was adopted. The PROSPERO registration number was CRD42014013193. RESULTS: Of 1176 articles identified through searches, 13 were included after screening and application of eligibility criteria. Very low quality of evidence shows that multiparity (OR = 2.09; 95% CI: 1.07 to 4.08), age 35 years or older (OR = 1.53; 95% CI: 1.45 to 1.62) and overweight and obesity during pregnancy (OR = 1.53; 95% CI: 1.28 to 1.83) are risk factors for UI in pregnancy. CONCLUSIONS: The exposure factors investigated are risk factors for UI in pregnancy based on a very low quality of evidence.

Factors Associated with Urinary Incontinence in Pregnant Adolescents: A Case-Control Study.

STUDY OBJECTIVE: To evaluate the factors associated with urinary incontinence (UI) in pregnant adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A case-control study was conducted in 3 Brazilian public hospitals. Adolescents between the ages of 10 and 19 years with gestational age of 27 weeks or more were included. The sample size was calculated using the Open-epi (http://www.openepi.com/Menu/OE_Menu.htm) 3.01 program considering gestational obesity as an associated factor. The resulting sample consisted of 658 volunteers, 329 in the case group (with UI) and 329 in the control group (without UI). The subjects responded to the evaluation form containing information about the outcome of interest and possible associated factors. Stata 14.0 software (StataCorp) was used to perform multivariate logistic analysis. RESULTS: The variables age between 10 and 14 years (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.13-5.35; P = .023), previous UI (OR, 1.9; 95% CI, 1.36-2.75; P < .001), and constipation (OR, 1.7; 95% CI, 1.23-2.42; P = .002) were associated with UI in pregnant adolescents. Multigravida was not a factor associated (OR, 0.5; 95% CI, 0.31-0.66; P < .001) for UI in pregnant adolescents. CONCLUSION: Attention must be given to primigravidae between the ages of 10 and 14 years who report previous UI and/or constipation to ensure referral to the appropriate health care professional for early prevention of UI.

Urinary incontinence in pregnant adolescents: A case series.

AIMS: Determine the severity of urinary incontinence (UI) and its effect on the quality of life (QoL) of pregnant adolescents, as well as explore the strategies used to manage UI and the reporting/investigation of this condition by healthcare professionals. METHODS: A case series was conducted in three Brazilian public hospitals that offer prenatal care. Inclusion criteria were: age between 10 and 19 years, gestational age of 27 weeks or more, and reported UI in the third trimester of pregnancy. All volunteers responded to the Incontinence Severity Index (to assess severity of UI) and the International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (to evaluate the effect of UI on QoL). A descriptive analysis of data were done. RESULTS: A total of 329 incontinent pregnant adolescents with mean age of 17.09 years (95%CI 16.92-17.26), who reported voiding urgency (72.0%), increased daytime urinary frequency (75.1%), nocturia (96.7%), and mixed UI (44.1%) were included in the study. UI was considered moderate to severe (79.3%) and had a moderate effect on QoL (mean 9.84; 95%CI 9.40-10.28). The volunteers used UI management strategies (66.6%), with bladder emptying prior to activities (56.8%) and the use of sanitary pads (29.5%) most frequently reported. UI is not disclosed voluntarily (89.1%) or explored by healthcare professionals (91.2%). CONCLUSION: UI can be moderate to severe and has a moderate effect on QoL in incontinent pregnant adolescents, who use strategies to manage this condition. Healthcare professionals do not identify this urinary symptom during prenatal care.

The effectiveness of biofeedback in treatment of women with stress urinary incontinence: a systematic review / Eficácia do biofeedback no tratamento de mulheres com incontinência urinária de esforço: revisão sistemática

OBJECTIVES: to assess whether pelvic-floor muscle training associated with biofeedback is more effective in the treatment of women with stress urinary incontinence, when compared to exercise alone. METHODS: a research of articles published in the last 20 years in Lilacs, PubMed and SCIRUS databases, using the descriptors urinary incontinence, stress and biofeedback was conducted. Randomized clinical trials comparing pelvic-floor muscle training with and without biofeedback were included. RESULTS: the study involved three randomized clinical trials involving 169 patients. A physical therapist was responsible for conducting the treatment using electromyographic or pressure biofeedback, and exercises were performed in the clinic or at home. The assessment methods, treatment times and protocols used were heterogeneous. Statistical analysis and rates of cure/improvement were similar between the groups of articles analyzed. Two studies had a score 8, and the third had 6 points according to PEDro's Scale. CONCLUSIONS: examination of the studies found suggests that adding biofeedback to pelvic-floor muscle training appears not to bring about a significant difference in terms of the success of treatment, when compared to perineal exercises performed in isolation.

OBJETIVOS: verificar se os exercícios para a musculatura do assoalho pélvico (MAP) associados ao biofeedback promovem maior eficácia no tratamento da incontinência urinária de esforço em mulheres, quando comparados a cinesioterapia de forma isolada. MÉTODOS: foi realizada uma pesquisa dos artigos publicados nos últimos 20 anos, nas bases de dados Lilacs, PubMed e SCIRUS, através dos descritores urinary incontinence, stress e biofeedback. Foram incluídos ensaios clínicos aleatorizados que utilizaram como intervenção exercícios para a MAP isolados e associados ao biofeedback, de forma comparativa. RESULTADOS: foram incluídos três ensaios clínicos randomizados envolvendo 169 pacientes. O fisioterapeuta foi responsável por conduzir o tratamento utilizando biofeedback eletromiográfico ou pressórico, e os exercícios foram realizados no ambulatório ou orientados para casa. Verificou-se heterogeneidade quanto ao método de avaliação, tempo de tratamento e protocolos utilizados. As análises estatísticas e os índices de cura/melhora foram semelhantes entre os grupos dos artigos analisados. Dois estudos obtiveram pontuação igual a oito e o terceiro alcançou seis pontos de acordo com a Escala PEDro. CONCLUSÕES: a análise dos estudos encontrados sugere que a adição do biofeedback aos exercícios perineais parece não promover diferença significativa para o sucesso do tratamento, quando comparado aos exercícios perineais realizados de forma isolada.