Adherence to pelvic floor muscle training with or without vaginal spheres in women with urinary incontinence: a secondary analysis from a randomized trial.

INTRODUCTION AND HYPOTHESIS: Pelvic floor muscle training (PFMT) is widely recommended as first-line therapy for women with urinary incontinence. However, adherence to PFMT decreases over time, and information regarding barriers to PFMT is scarce. The primary aim of our study was to investigate whether a vaginal spheres device helped improve adherence to PFMT. The secondary aim was to assess determinants of adherence and the association with treatment outcome. METHODS: This was a secondary analysis of a randomized trial with a 6-month follow-up in women with urinary incontinence (UI) in whom we evaluated adherence to PFMT, performed either with (spheres group) or without (control group) vaginal spheres. The Morisky-Green Questionnaire (MGQ) was used to assess adherence, defined as the extent to which participants corresponded to the agreed recommendations; participants were classified as adherent or nonadherent according to their responses. Efficacy of PFMT was assessed using the International Consultation on Incontinence Questionnaire Short Form scale (ICIQ-SF). RESULTS: Seventy women were enrolled and data from 65 (35 treated and 30 controls) were suitable for analysis. There were no significant differences in adherence to treatment between groups at the end of follow-up (33.3 % in controls and 42.9 % in spheres). The largest group of nonadherent women in both arms were those who mainly forgot to do the exercises. ICIQ-SF results between adherent and nonadherent women did not differ significantly [mean 0.55, 95 % confidence interval (CI) 1.13-2.25]. No significant difference was observed between women who attained greater and lesser improvement in UI after treatment (4.5 %; 95 % CI -11.7 to 20.6). CONCLUSIONS: In patients with UI, vaginal spheres as an adjunct to PFMT did not increase adherence to pelvic muscle exercises. Lack of persistence appeared to be due to forgetfulness and did not seem to be influenced by the efficacy of PFMT.

Lactobacillus fermentum CECT 5716 Reduces Staphylococcus Load in the Breastmilk of Lactating Mothers Suffering Breast Pain: A Randomized Controlled Trial.

INTRODUCTION: Recent results indicate that human mastitis and painful breastfeeding may be characterized by a mammary bacterial dysbiosis, a process in which the population of potential pathogens increases at the expense of the normal mammary microbiota. The objective of the present study is the evaluation of three different doses of Lactobacillus fermentum CECT5716 to reduce the load of Staphylococcus in the breastmilk of women suffering from painful breastfeeding. MATERIALS AND METHODS: A randomized double-blinded controlled study with four study groups was performed. Three groups received the probiotic strain for 3 weeks at doses of 3×10(9) colony-forming units (CFU)/day, 6×10(9) CFU/day, or 9×10(9) CFU/day. The fourth group received a placebo of maltodextrin. The main outcome of the study was Staphylococcus counts in breastmilk. The secondary outcomes were Streptococcus, Lactobacillus, and total bacteria counts in breastmilk, immunoglobulin A and interleukin 8 concentrations in breastmilk, and breast pain scores. RESULTS: At the end of the study, a significant decrease in the Staphylococcus load was observed in the probiotic groups compared with the baseline loads (p=0.045), whereas the control group maintained similar levels over time. A significant difference in the pain score was observed among the groups receiving the three probiotic doses compared with the control group (p=0.035, p=0.000, and p=0.028, respectively). A dose-response effect could not be observed because the three doses tested induced similar effects, and no significant differences were detected. CONCLUSIONS: We conclude that L. fermentum CECT5716 is an efficient treatment for breast pain during lactation associated with a high level of Staphylococcus in breastmilk.

Effect of vaginal spheres and pelvic floor muscle training in women with urinary incontinence: a randomized, controlled trial.

AIMS: To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence. METHODS: Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test. RESULTS: Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group (P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group. CONCLUSIONS: Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe.

Cistitis intersticial como causa de dolor pélvico crónico en ginecología / Interstitial cystitis as a cause of chronic pelvis pain in gynecology

La cistitis intersticial es un complejo síndrome crónico inflamatorio vesical, más común de lo que podría imaginarse, en cuya patogenia subyace una alteración de la permeabilidad del urotelio como fracaso de su función protectora de barrera. Sus síntomas más comunes son: frecuencia (incremento del número de micciones), urgencia miccional, dolor abdominal, uretral o genital, dispareunia y otros síntomas variados. Su diagnóstico es generalmente difícil de realizar; en muchas ocasiones se plantea por exclusión y, otras veces, con la mejoría clínica que suponen ciertas maniobras terapéuticas, como la sobredistensión. La cistoscopia desempeña un importante papel diagnóstico, que permite detectar la clásica úlcera de Hunner; también contribuyen a establecer el diagnóstico, entre otras pruebas, la biopsia vesical y el test de sensibilidad al potasio. Su tratamiento es empírico y sintomático, e incluye tratamientos físicos (distensión vesical, estimulación eléctrica), fármacos de uso intravesical (principalmente, el dimetilsulfóxido), diversos fármacos de uso sistémico (antidepresivos tricíclicos, antihistamínicos, pentosanpolisulfato, analgésicos, corticoides, etc.) y, en algunos casos, técnicas quirúrgicas. El ginecólogo siempre debe tener presente la cistitis intersticial como una de las posibles causas de dolor pélvico crónico en la mujer

Interstitial cystitis is a complex chronic inflammatory syndrome of the bladder that is more frequent than is commonly believed. The pathogenesis of this entity involves an alteration of the permeability of the urothelium, leading to a failure of its protective function of providing a barrier. The most common symptoms are frequency (an increase in the number of micturitions), voiding urgency, abdominal, urethral or genital pain, dyspareunia and a variety of other symptoms. Diagnosis of interstitial cystitis is generally difficult and is often made by exclusion or on the basis of clinical improvement produced by therapeutic maneuvers such as overdistension. Cystoscopy plays an important role in diagnosis, a classical finding being Hunner ulcer; among other tests, bladder biopsy and the potassium sensitivity test are also useful. Treatment of this entity is empirical and symptomatic, and includes physical treatments (bladder distension, electrical stimulation), intravesical drugs (mainly dimethyl sulfoxide), diverse systemic drugs (tricyclic antidepressants, antihistamines, pentosan polysulfate, analgesics, corticosteroids) and, in some cases, surgical techniques. Gynecologists should be alert to interstitial cystitis as one of the possible causes of chronic pelvic pain in women