Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence: Comparison Within and Between Nonhomebound and Homebound Older Adults.

PURPOSE: To compare the effectiveness of a biofeedback-taught pelvic floor muscle training (PFMT) intervention in reducing urinary incontinence (UI) and improving general health-related and UI-specific quality of life in homebound and nonhomebound older adults. We also compared adherence rates to the prescribed PFM exercises and strategies (urge and/or stress) in the 2 groups of subjects. DESIGN: Secondary data analysis of initial 6-week PFMT intervention data from a randomized controlled trial designed to examine the efficacy of a relapse prevention intervention in sustaining improvements in UI following PFMT. SUBJECTS AND SETTING: The sample comprised 93 homebound and 185 nonhomebound community-dwelling men and women 60 years and older with urge, stress, or mixed UI at least twice a week for a minimum of 3 months. METHODS: The intervention consisted of 6 weekly in-home visits during which biofeedback via transcutaneous electromyographic patches was used to teach subjects pelvic floor muscle exercises and, as indicated, stress and/or urge suppression strategies to prevent involuntary urine loss. Incontinence severity was measured by a 1-week bladder diary at baseline and at the end of the 6-week intervention. Health-related quality of life was measured at baseline and postintervention using the Medical Outcomes Study Short Form-36 (MOS SF-36) (general health-related quality of life), and the Modified Incontinence Impact Questionnaire (MIIQ). Self-reported adherence data were collected at each intervention visit. RESULTS: At baseline, homebound subjects had significantly more severe UI, more comorbid conditions, and higher levels of functional impairment than nonhomebound subjects. Following the intervention, there was a significant reduction in the number of incontinent episodes in both homebound and nonhomebound subjects, with no significant group differences (P = .25) in the median percent reduction in UI (64.5% in homebound vs 70.4% in nonhomebound subjects). UI-specific quality of life (MIIQ total scores) improved significantly in both groups without any significant between-group differences (P = .83). There were no significant changes in health-related quality of life in either group. Pelvic floor muscle adherence rates were higher than adherence rates to strategies in both groups, with no significant group differences. CONCLUSIONS: The biofeedback-guided PFMT intervention was equally effective in reducing UI and improving UI-specific quality of life in homebound and nonhomebound community-dwelling older adults.

EPI-NO más que un dispositivo favorecedor de la elasticidad perineal para el parto / Epi-No: more than a flattering deviceto improve perineal elasticity in childbirth

En la actualidad, las principales causas de lesión de las estructuras del suelo pélvico están asociadas a cambios hormonales y mecánicos que se producen durante la gestación, así como al efecto de la expulsión fetal durante el parto. Estas alteraciones pueden afectar gravemente la calidad de la vida de la mujer, por lo que se hace imprescindible su abordaje precoz. Este abordaje debe comenzar desde la prevención y llevarse a cabo por un equipo multidisciplinar que conozca las diferentes terapias o dispositivos diseñados para el manejo de cada alteración. El EPI-NO es un dispositivo vaginal diseñado a finales de los años noventa con el objetivo de ejercitar la musculatura del suelo pélvico de cara al parto y restaurar el tono muscular en el posparto. Su uso es sencillo y no resulta lesivo para la gestante o su futuro bebé; asimismo, aporta numerosos beneficios para la gestante, entre los que se encuentran: reducción en el número de episiotomías y desgarros de 2.º y 3.er grado, aumento de la incidencia de periné intacto y prevención de la incontinencia urinaria en el embarazo y posparto, entre otros. Conociendo las necesidades de la mujer y los recursos disponibles a su alcance, los profesionales podrán orientar a la gestante en el uso del EPI-NO durante su proceso de embarazo, parto y posparto, y disminuir así la morbilidad asociada al parto (AU)

Currently, the main causes of damage to the pelvic floor structures are associated with hormonal and mechanical changes occurring during pregnancy, as well as the effect of fetal expulsion during delivery. These changes can severely affect the quality of life of women, so it is essential to his early approach. This approach should start from prevention and be carried out by a multidisciplinary team who knows the different therapies or devices designed for handling each alteration. The EPI-NO is a vaginal device designed in the late 90s with the aim of exercising the muscles of the pelvic floor facing the delivery and restore muscle tone postpartum. Its use is simple and not harmful to the pregnant woman or her unborn child; likewise, brings numerous benefits to the pregnant among which are: reduction in the number of episiotomies and tears 2nd and 3rd grade, increased incidence of intact perineum and prevention of urinary incontinence in pregnancy and postpartum, among others. Knowing the needs of women and the resources available to them, professionals can guide the mother in using the EPI-NO during their pregnancy, childbirth and postpartum, decreasing the morbidity associated with childbirth (AU)

The role of cell death in sexually dimorphic muscle development: male-specific muscles are retained in female bax/bak knockout mice.

The bulbocavernosus (BC) and levator ani (LA) muscles are present in males but absent or severely reduced in females, and the fate of these muscles controls the survival of motoneurons in the sexually dimorphic spinal nucleus of the bulbocavernosus. However, the mechanism underlying the sex difference in BC and LA development has been controversial. We examined the role of cell death in sexual differentiation of the bulbocavernosus BC/LA muscles in mice. Muscle development was mapped from embryonic day 16 (E16) to postnatal day 5 (P5). A sex difference (male>female) first arose on E17 (BC) or E18 (LA), and increased in magnitude postnatally. TUNEL labeling revealed dying cells in the BC and LA muscles of both sexes perinatally. However, females had a significantly higher density of TUNEL-positive cells than did males. A role for the proapoptotic factors, Bax and Bak, in BC/LA development was tested by examining mice lacking one or both of these proteins. In females lacking either Bax or Bak, the BC was absent and the LA rudimentary. Deletion of both bax and bak genes, however, rescued the BC, increased LA size approximately 20-fold relative to controls, and virtually eliminated TUNEL-positive cells in both muscles. We conclude that cell death plays an essential role in sexual differentiation of the BC/LA muscles. The presence of either Bax or Bak is sufficient for cell death in the BC/LA, whereas the absence of both prevents sexually dimorphic muscle cell death.

Early postnatal response of the spinal nucleus of the bulbocavernosus and target muscles to testosterone in male gerbils.

This study examined the response of the spinal nucleus of the bulbocavernosus (SNB) and the bulbocavernosus (BC) muscle, to testosterone in male Mongolian gerbils (Meriones unguiculatus) during the early postnatal period. Male gerbil pups were given testosterone propionate (TP) or vehicle for 2 days, then perfused on postnatal day (PND) 3, 5, 10 or 15. The BC and levator ani (LA) muscles were removed, weighed, and sectioned. Cross-sections of BC muscle fibers were measured and muscle fiber morphology examined. Spinal cords were removed and coronally sectioned in order to count and measure the SNB motoneurons. Following TP treatment, male pups of all ages had significantly heavier BC-LA muscles and larger fibers in the BC muscle compared to age-matched controls. The increase in muscle weight following TP treatment was greatest at PND10, while fiber size increased to a similar degree at all ages suggesting that hyperplasia as well as hypertrophy was responsible for the increase in muscle mass at this time. SNB motoneurons increased significantly in number and size with age and TP treatment. We hypothesize that the increase in SNB motoneuron number during normal ontogeny that can be augmented by TP treatment and represents an unusual means of establishing sexual dimorphism in the nervous system of a mammal through cell recruitment to the motor pool of a postnatal animal.

Ciliary neurotrophic factor increases muscle fiber number in the developing levator ani muscle of female rats.

In addition to its well characterized neurotrophic properties, ciliary neurotrophic factor (CNTF) also has myotrophic effects in several experimental paradigms. We have previously observed that the volume of the levator ani (LA) muscle is increased in female rats treated with CNTF during the perinatal period. In order to determine the cellular basis for the effect of CNTF on LA muscle volume, female rat pups were given daily perineal injections of CNTF or a control solution from postnatal day 1 through 6. Mean cross-sectional area of LA muscle fibers and LA fiber number were assessed on postnatal day 7. CNTF treatment increased LA muscle fiber number more than 300% while having no effect on LA fiber size. We conclude that CNTF prevents muscle fiber degeneration and/or increases myogenesis in the developing LA muscle.