Prevalence of urinary incontinence in Brazilian para athletes.

OBJECTIVE: To describe the prevalence of urinary incontinence (UI) in para athletes in Brazil. METHODS: This is a cross-sectional study with Brazilian para athletes with physical impairments from all para sports. The data from 86 participants of both sexes (60 males and 26 females) were collected through an online survey that gathered sociodemographic data and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, from March to July 2023. RESULTS: The prevalence of UI was 45.3% (n=39), with the average impact on quality of life scored at 6.1±3.5 on a scale of 0-10. Most para athletes reported moderate (43.5%) or severe (38.4%) symptoms. The most common type was mixed UI (46.1%), with an average of 3±1.9 episodes of urinary loss per athlete in the last 4 weeks. Adjusted Poisson regression (controlling for sex, age and level of competition) revealed that para athletes with orthopaedic impairments had a 58% lower prevalence of UI (prevalence ratio=0.42; 95% CI 0.24, 0.83) compared with those with neurological impairments. Furthermore, ordinal regression indicated that para athletes with neurological impairments were 147% more likely to experience a progression from 'severe' to 'very severe' UI (OR=2.47; 95% CI 1.59, 3.93). CONCLUSIONS: UI is highly prevalent among para athletes, particularly those with neurological impairments, underscoring the need for specialised genitourinary healthcare and the need for further treatment and monitoring of the condition. There is a critical need to raise awareness among coaches, healthcare providers and the athletes themselves about UI and its impact to foster the comprehensive well-being of these athletes.

What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females?

INTRODUCTION AND HYPOTHESIS: The objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms. METHODS: Pelvic morphology and LAM function were evaluated using ultrasound imaging and manual palpation using the elements of the PERFECT Scheme (Power, Endurance, Repetitions, Fast contractions, Elevation, Co-contraction and Timing) before and after women with SUI underwent a 12-week PFMT intervention. SUI severity was determined subjectively (ICIQ-FLUTS-UI) and objectively (30-min pad test [30MPT]). RESULTS: At baseline (n = 97), less leakage on the 30MPT was weakly associated with higher bladder neck position (ρs = -0.209,p = 0.044), yet with lower LAM function based on the PERFECT Scheme (overall score: ρs = 0.206, p = 0.043; repeated maximum voluntary contractions (MVCs): ρs = 0.203, p = 0.046; power/motor control: ρs = 0.214, p = 0.035). Lower symptom severity (ICIQ-FLUTS-UI) was associated with observed perineal lift during coughing (U = 34.000; p = 0.042). All measures of SUI severity and LAM function were significantly improved after PFMT intervention. Greater improvements in bladder neck elevation during MVC (ρs = -0.261, p = 0.027) and greater reductions in levator plate length during MVC (ρs = 0.292, p = 0.016) were weakly associated with greater reductions in leakage (30MPT), the latter also being associated with more improvement symptoms (ICIQ-FLUTS-UI; ρs = 0.238, p = 0.041). Greater improvement in the ability to repeat MVCs (ρs = 0.303, p = 0.009) was weakly associated with smaller improvements in symptoms (ICIQ-FLUTS-UI). CONCLUSION: Improvements in bladder neck support and elevation show weak associations with improvement in SUI signs and symptoms. LAM function as measured by the PERFECT Scheme is not associated with SUI severity in women, and improvements in LAM function when measured by the PERFECT Scheme are not associated with improvements in SUI signs and symptoms.

Can the inability to contract the pelvic floor muscles influence the severity of urinary incontinence symptoms in females?

INTRODUCTION AND HYPOTHESIS: The objective was to analyze if the inability to perform a maximal voluntary contraction (MVC) of the pelvic floor muscles (PFMs) in a first assessment can influence the severity of urinary incontinence symptoms in women. METHODS: A cross-sectional study was carried out using the medical records of women with UI who were referred for pelvic floor physiotherapy after undergoing a gynecological evaluation between May 2013 and December 2019. Records included data referring to age, body mass index (BMI), obstetric history, Modified Oxford Scale (MOS), and the final score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) from a baseline assessment. Data were divided into women who were unable and those who were able to voluntarily perform an MVC of the PFMs. Statistical analysis was conducted using SPSS version 21. RESULTS: A total of 498 medical records were analyzed and 36.3% of those women were not able to perform a PFM MVC after verbal command and digital stimulus. Homogeneity was observed among groups and no significant difference was found regarding the severity of UI symptoms when the groups were compared. CONCLUSIONS: No association was found between the inability to contract the PFMs and the severity of UI symptoms. Other studies should be developed to better understand why some women are incapable of performing a voluntary PFM contraction. Also, it would be relevant to compare women with PFM dysfunction who are not able to contract the PFMs with healthy women with the same PFM condition to analyze whether this muscle condition could be related to dysfunctions such as UI or pelvic organ prolapse.

Vibratory perineal stimulation for the treatment of female stress urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: The pelvic floor muscles (PFM) play an important part in the urinary continence mechanism. Changes in their structure and functionality may lead to a predisposition to pelvic floor dysfunction such as urinary incontinence (UI), which is the involuntary loss of urine. Some techniques for conservative treatment of UI are already well documented. However, new approaches have been found that require scientific proof of their effectiveness, such as vibratory stimulation (VS). Thus, we performed a systematic review of studies that investigated the use of perineal VS (PVS) for the treatment of stress UI. MATERIALS AND METHODS: This study followed the recommendations of the Cochrane Collaboration for systematic reviews. Studies that used PVS for the treatment of female UI were eligible. RESULTS: A total of 56 studies were found, of which ten were duplicates and were excluded. Analysis of the titles and abstracts led to the exclusion of 30 studies, leaving 16 for detailed analysis. Of these, only three were included as they fulfilled all the eligibility criteria previously established for the present study. In spite of the heterogeneity of the protocols, all the studies had the goal of assessing the effects of vibration on the PFM, and the stimulation was found to be effective in reducing urinary leakage, improving muscle strength and consequently the patients' quality of life. CONCLUSIONS: Because of the heterogeneity and the small number of studies, it is not possible to draw a conclusion as to the effectiveness of PVS for the treatment of stress UI, and further studies are needed to provide scientific support for its use.

Perfil das pacientes do ambulatório de uroginecologia de um hospital público de Porto Alegre com relação à incontinência urinária e à qualidade de vida / Profile of female patients in the urogynecology ambulatory care of a public hospital in southern Brazil regarding urinary incontinence and quality of life

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)