Efeito de um treinamento de músculos pélvicos em grupo para mulheres com incontinência urinária: um ensaio clínico randomizado / Effect of a training of pelvic muscles in group for women with urinary incontinence: arandomized clinical test

Introdução: A incontinência urinária (IU) é um problema muitas vezes subestimado, não recebendo a devida atenção. Dentre as possibilidades de tratamento conservador da IU, o treinamento dos músculos do assoalho pélvico (TMAP) supervisionado deve ser recomendado como primeira linha de tratamento para as mulheres. O TMAP pode ser desenvolvido em grupos, individualmente e em casa. Objetivos: Ainda há poucos estudos na literatura envolvendo TMAP em grupo com protocolos definidos que possam ser facilmente compreendidos e reproduzidos pelos pacientes. O objetivo deste estudo é demonstrar a eficácia de um protocolo de TMAP em grupo comparado a um protocolo de TMAP domiciliar para mulheres com IU. Métodos: Este foi um estudo experimental controlado randomizado cego que seguiu as recomendações do CONSORT. Os instrumentos de avaliação foram a escala PERFECT, ICIQ-SF e PISQ-12. O principal resultado foi a melhora da função dos músculos do assoalho pélvico (MAP) e os resultados secundários foram a melhora da qualidade de vida (QV) e da função sexual (FS). Resultados: Com doze semanas de tratamento o protocolo do grupo TMAP apresentou-se como uma forma de tratamento mais eficaz para IU, pois apresentou melhora nos itens potência e QV. Ao observar a efetividade dos protocolos, após vinte e quatro semanas, ambos foram efetivos apenas no que se refere aos desfechos secundários, QV e FS. Conclusão: Pode-se supor que a intervenção em grupo, utilizada nesta amostra específica, constitui uma estratégia de intervenção fisioterapêutica factível e viável, capaz de beneficiar muitas mulheres com IU, além de ser uma ferramenta de fácil compreensão e acompanhamento pelos pacientes.

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.

Depression, lower urinary tract symptoms and quality of life in women with multiple sclerosis: a descriptive and correlational study

Introduction: Among the most ordinary clinical manifestations of Multiple Sclerosis (MS) are depression and the presence of Lower Urinary Tract Symptoms (LUTS). Both can compromise a person's quality of life. The objective of this research was to identify the major urinary symptoms and correlate them with quality of life and with depressive symptoms in women with MS. Methods: This was an observatory, descriptive and correlational study, with nonprobabilistic sampling by convenience. This research included women over 18 years old who displayed LUT symptoms and who had been diagnosed with Relapsing-Remitting MS. Assessment consisted of an anamnesis card, the Kurtzke Expanded Disability Status Scale (EDSS), the Incontinence Impact Questionnaire-7 (IIQ-7-BR), the Urogenital Distress Inventory-6 (UDI-6-BR), the Beck Depression Inventory-2 (BDI-II) and the Multiple Sclerosis Quality of Life Questionnaire - Portuguese version (MSQOL-54). Results: 41 women participated in the study, with average age of 50.1 (± 9.45) and average of 4.11 in the EDSS. The most common urinary symptom was urinary urgency (78%). There was no correlation between the severity of the urinary symptom and quality of life. Moderate and significant negative correlation (r = -0.561 p < 0.001) was found between depression and the physical component of quality of life and strong negative correlation (r = -0.729 p < 0.001) was found between depression and the mental component. Conclusions: The most prevalent urinary symptom was urinary urgency. A strong correlation was found between symptoms of depression and quality of life and there was no correlation between urinary symptoms and quality of life.

Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis.

Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords "athlete," "urinary incontinence," and "women" in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.

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.

Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is the most common urinary complaint among women and is defined by the International Continence Society as any involuntary loss of urine due to physical effort, sneezing or coughing. Many women with SUI state that the loss of urine occurs after performing repetitive movements, which may suggest that it is the result of fatigue of the pelvic floor muscles (PFM). Thus, we performed the systematic review of the literature on the influence of PFM fatigue on the development or worsening of the symptoms of SUI in women. METHODS: The PubMed, Scopus, EMBASE, PEDro, LILACS, SciELO, Cochrane Library, Google Scholar, CINAHL and Periódicos CAPES databases were searched for articles using the keywords "fatigue", "pelvic floor", "stress urinary incontinence" and "women", in Portuguese and in English. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed descriptively. RESULTS: Of the 2,010 articles found, five met the inclusion criteria and were analyzed. They were published between 2004 and 2015, and included a total of 30,320 women with ages ranging from 24 to 53.6 years. Of the studies analyzed, three showed an association between fatigue and SUI, and two did not show such an association. CONCLUSIONS: This study confirmed that PFM fatigue can influence the development and/or worsening of SUI.

Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review / Exercícios terapêuticos para dor lombar e pélvica gestacional: uma revisão sistemática

Abstract Introduction: During pregnancy, a woman's body goes through many changes, and lower back and pelvic pain are common and may persist after pregnancy. Although the literature point physical therapy as an effective therapeutic tool, there are few studies on the effects of physical therapy intervention through exercises for this purpose. Objective: To perform a systematic review on the use of Physiotherapy, through therapeutic exercises, for the prevention and treatment of pregnancy low back and pelvic pain. Methods: A systematic search for randomized trials (RCTs) was conducted on the databases PubMed, PEDro, Cochrane, EMBASE, LILACS and Periódicos Capes. There was no date or language restriction. The terms included in the search were: "pregnancy", "low back pain", "pelvic pain", "exercise therapy" and their descriptors in Portuguese. Methodological quality was assessed using the PEDro scale and a descriptive analysis of the studies was performed. Results: Eight studies, including 1781 pregnant women, were selected. Among them, one study addressed the issue of low back pain, two focused on pelvic pain and five on low back and/or pelvic pain. Seven studies presented high methodological quality, and only one study had low methodological quality. Limited evidence on low back pain was found, and conflicting evidence on pelvic pain, and low and/or pelvic pain. Conclusion: RCTs on the subject are scarce and heterogeneous, making it impossible to reach a consensus or any conclusions about which protocol of therapeutic exercise is more effective in the use of physiotherapy for pregnancy low back and pelvic pain.

Resumo Introdução: Na gravidez o organismo materno passa por muitas transformações e a dor lombar e a dor pélvica são frequentes, podendo persistir após a gestação. Embora a literatura venha apontando a Fisioterapia como recurso terapêutico efetivo, existem poucos estudos sobre os efeitos da intervenção fisioterapêutica por meio de exercícios para esse fim. Objetivo: Desenvolver uma revisão sistemática sobre a abordagem da Fisioterapia, por meio de exercícios terapêuticos, na prevenção e no tratamento da dor lombar e pélvica gestacional. Métodos: Realizou-se uma busca sistemática por ensaios clínicos randomizados (ECRs) nas bases de dados PubMed, PEDro, Cochrane, EMBASE, LILACS e Periódicos Capes. Não houve restrição de data e de idioma. Os termos compreendidos na busca foram: "pregnancy", "low back pain", "pelvic pain", "exercise therapy" e seus descritores em português. A qualidade metodológica foi avaliada por meio da escala PEDro, e uma análise descritiva dos estudos foi realizada. Resultados: Oito estudos, incluindo 1781 gestantes, foram selecionados. Dentre eles, um estudo aborda a temática da dor lombar, dois sobre dor pélvica e cinco sobre dor lombar e/ou pélvica. Sete estudos apresentaram alta qualidade metodológica, e somente um estudo apresentou qualidade metodológica baixa. Foram encontradas evidências limitadas para dor lombar e evidências conflitivas para dor pélvica e para dor lombar e/ou pélvica. Conclusão: Os ECRs sobre o tema ainda são escassos e heterogêneos, impossibilitando estabelecer consenso e conclusões sobre qual protocolo de exercícios terapêuticos é mais eficaz no manejo fisioterapêutico da dor lombar e pélvica gestacional.

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI. METHODS: Cochrane's recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group. RESULTS: Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI. CONCLUSION: PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.

Efeitos agudos e subagudos de uma sessão de montaria a cavalo sobre variáveis cardiovasculares de indivíduos jovens e saudáveis / Acute and subacute effects of a horseback riding session on cardiovascular variables in young healthy subjects

A Equoterapia utiliza o cavalo como instrumento terapêutico que proporciona diversos benefícios terapêuticos, porém as alterações fisiológicas oriundas da montaria ainda não estão bem esclarecidas e pesquisas existentes apresentam resultados divergentes. Este estudo teve como objetivo verificar os efeitos agudos e subagudos de uma sessão de montaria a cavalo na frequência cardíaca (FC) e pressão arterial (PA). Tratou-se de uma pesquisa quantitativa experimental com 20 indivíduos jovens saudáveis (22,4 ± 2,7 anos) que realizaram uma sessão de montaria. Avaliaram-se os desfechos FC e PA pré e pós-intervenção e dez minutos após o seu término. A FC aumentou após a intervenção ao passo e ao trote (p < 0,001) e retornou aos valores iniciais dez minutos após o seu término. A PA não apresentou diferença significativa imediatamente após a montaria; entretanto a PA sistólica reduziu-se dez minutos após o término da intervenção (p < 0,05) e apresentou efeito hipotensor nos homens quando comparado aos valores iniciais (p < 0,05). As mulheres apresentaram valores de FC mais altos e de PA mais baixos do que os homens em todos os momentos avaliados (p < 0,05). Conclui-se que uma sessão de montaria a cavalo ao passo e ao trote é capaz de gerar efeitos sobre o sistema cardiovascular de indivíduos jovens saudáveis. (AU)

Therapeutic horseback riding uses the horse as a therapeutic tool which provides many therapeutic benefits; however the physiological changes resulting from the horse riding are not well understood yet and existing researches show divergent results. The aim of this study was to investigate the acute and subacute effects of a horseback riding session in heart rate (HR) and blood pressure (BP). This was an experimental quantitative research with 20 young healthy subjects (22.4 ± 2.7 years old) who held a horseback riding session. The HR and BP outcomes were assessed pre- and post-intervention and 10 minutes after the end of the intervention. HR increased after the intervention while walk and trot (p < 0.001) and returned to baseline 10 minutes after its completion. BP showed no significant difference immediately after the horse riding; however, systolic BP was reduced 10 minutes after the end of the intervention (p < 0.05) and showed hypotensive effect in men when compared to baseline (p < 0.05). Women had higher values of HR and lower BP than men in all evaluated moments (p < 0.05). It was concluded that a horseback riding session (walk and trot) is able to inducing effects on the cardiovascular system of young healthy subjects.(AU)

Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies / Sinergismo da musculatura abdomino-pélvica em mulheres hígidas: uma revisão sistemática

Abstract Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.

Resumo Introdução: O treinamento dos músculos do assoalho pélvico é amplamente utilizado no tratamento de disfunções do assoalho pélvico, como a incontinência urinária, e durante sua execução evita-se a contração abdominal, entretanto vários estudos defendem a utilização do sinergismo entre estes grupos musculares. Objetivo: Revisar sistematicamente os estudos que buscam identificar a presença de sinergismo entre os músculos do abdômen e do assoalho pélvico e sua funcionalidade em mulheres sem disfunções do assoalho pélvico. Metodologia: Para a realização da revisão, foram seguidas as recomendações propostas pela Colaboração Cochrane para revisões sistemáticas. A busca na literatura incluiu as bases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL e EMBASE, além de busca manual, do início das bases até agosto de 2013. Foram incluídos estudos observacionais transversais com mulheres saudáveis que foram avaliadas quanto à presença de sinergismo entre os músculos abdominais e do assoalho pélvico. Resultados: Foram incluídos 10 artigos e todos demonstraram a existência de sinergismo entre os músculos abdominais e músculos do assoalho pélvico em mulheres saudáveis nas posturas supina, sentada e em ortostase. Conclusão: Dessa forma, pode-se concluir que há sinergismo entre os músculos do abdômen e do assoalho pélvico em mulheres saudáveis. Conhecer melhor o comportamento dessas musculaturas e do sinergismo pode favorecer a elaboração de estratégias de prevenção e tratamento das disfunções dos músculos do assoalho pélvico feminino.

Association between the Functionality of Pelvic Floor Muscles and Sexual Satisfaction in Young Women.

Objective The objective of this study is to associate the results obtained while assessing the pelvic floor muscles (PFM) functionality with the score of sexual satisfaction of young adult women. Methods This is an observational and cross-sectional study. The inclusion criteria were women aged between 20 and 40 years who have had sexual intercourse, nulliparous, BMI lower than 25 kg/m(2), and absence of pelvic floor dysfunction. The evaluation consisted of both the medical history and assessment of the PFM functionality using the Perina pressure biofeedback and Oxford Scale. We measured sexual satisfaction using the Female Sexual Quotient questionnaire and used the Kolmogorov-Smirnov test to verify the normality of the data. We analyzed non-parametric variables using the Spearman correlation test. The significance level was 5%. Results A total of 80 women with a median age of 26 years and median BMI of 21.64 kg/m(2) participated in this study. We divided the subjects into two groups, best and worse PFM functionality, according to median Perina pressure biofeedback and Oxford scale. We found no difference between the groups when comparing the sexual satisfaction scores. There was only a slight significant correlation between the Contraction Voluntary Average obtained using the pressure biofeedback and the primary domain (r = 0.27; p = 0.01). Conclusion This study found a slight correlation between PFM functionality and the functionality of the primary domain of the Female Sexual Quotient questionnaire. Therefore, it is not possible to state whether there is an association between the PFM functionality and female sexual satisfaction in young adults.

Association between the Functionality of Pelvic Floor Muscles and Sexual Satisfaction in Young Women / Associação entre a funcionalidade dos músculos do assoalho pélvico e a satisfação sexual em mulheres adultas jovens

Abstract Objective The objective of this study is to associate the results obtained while assessing the pelvic floor muscles (PFM) functionality with the score of sexual satisfaction of young adult women. Methods This is an observational and cross-sectional study. The inclusion criteria were women aged between 20 and 40 years who have had sexual intercourse, nulliparous, BMI lower than 25 kg/m2, and absence of pelvic floor dysfunction. The evaluation consisted of both the medical history and assessment of the PFM functionality using the Perina pressure biofeedback and Oxford Scale. We measured sexual satisfaction using the Female Sexual Quotient questionnaire and used the KolmogorovSmirnov test to verify the normality of the data. We analyzed non-parametric variables using the Spearman correlation test. The significance level was 5 %. Results A total of 80 women with a median age of 26 years and median BMI of 21.64 kg/m2 participated in this study. We divided the subjects into two groups, best and worse PFM functionality, according to median Perina pressure biofeedback and Oxford scale. We found no difference between the groups when comparing the sexual satisfaction scores. There was only a slight significant correlation between the Contraction Voluntary Average obtained using the pressure biofeedback and the primary domain (r = 0.27; p = 0.01). Conclusion This study found a slight correlation between PFM functionality and the functionality of the primary domain of the Female Sexual Quotient questionnaire. Therefore, it is not possible to state whether there is an association between the PFM functionality and female sexual satisfaction in young adults.

Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study.

INTRODUCTION AND HYPOTHESIS: The Pilates method is a form of physical exercise that improves the control of the core muscles, improving the conditioning of all the muscle groups that comprise the core, including the pelvic floor muscles (PFM). Thus, this study had the goal of verifying the existence of differences in the functioning of the PFM in women who practice the Pilates method and sedentary women. METHODS: This was an observational, cross-sectional pilot study. A sample size calculation was performed using preliminary data and it determined that the sample should have at least 24 individuals in each group. The participants were 60 women aged 20 to 40 years; 30 women practiced the Pilates method (PMG) and 30 were sedentary (SG). An anamnesis file was used to collect personal data and assess the knowledge and perception of the PFM. The Perina perineometer and vaginal palpation were used to determine the functionality of the PFM. RESULTS: There was no significant difference between the PMG and the SG in any of the variables analyzed. CONCLUSIONS: We concluded that the functionality of the PFM in younger women who practice the Pilates method is not different from that of sedentary women.

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)

Perfil de usuários que buscam atendimento fisioterapêutico para incontinência urinária em um centro de saúde do município de Porto Alegre / Profile of users seeking physical therapy for urinary incontinence in a health center in the city of Porto Alegre

A Incontinência Urinária, definida como qualquer perda involuntária de urina, é reconhecida como um problema de saúde pública multifatorial e que tem a opção terapêutica da Fisioterapia. Este trabalho objetiva descrever o perfil de usuários da atenção básica do Sistema Único de Saúde que buscaram atendimento fisioterapêutico para Incontinência Urinária em um Centro de Saúde de Porto Alegre, entre março de 2012 e abril de 2014. Trata-se de um estudo transversal, documental e retrospectivo, de abordagem quantitativa. Foram analisadas as anamneses de 95 pacientes (84 mulheres e 11 homens). A média de idade das mulheres foi 63 anos e 65,5 anos para os homens. O tempo desde o início dos sintomas obteve média de 25 anos entre as mulheres e 11 meses entre os homens. Entre as mulheres, 13,2% apresentam Diabete Mellitus, 48,8% relatam Hipertensão Arterial Sistêmica e 48,8% realizaram cirurgia pélvica. A média de partos foi 6,5 (59,5% parto normal - 30,9% com fórceps e 64,3% com episiotomia -, 9,5% cesariana e 26,2% ambos). Entre os homens, 36,3% apresentam Diabete Mellitus, 54,5% Hipertensão Arterial Sistêmica e 72,7% realizaram prostatectomia. O perfil de pacientes demonstrado nesse estudo foram adultos e idosos com mais de 40 anos, sobretudo mulheres que realizaram parto normal ou cirurgias pélvicas. No sexo masculino, observou-se alta incidência de pacientes que realizaram prostatectomia. Os pacientes avaliados apresentaram elevado percentual de Hipertensão Arterial Sistêmica. Verificou-se o elevado tempo de convívio com a Incontinência Urinária, principalmente entre as mulheres, por considerarem parte do envelhecimento, demonstrando a necessidade de maior esclarecimento da população acerca do tema.

The Urinary Incontinence (UI), defined as any involuntary loss of urine, is recognized as a multifactorial problem of public health and has therapeutic option physiotherapy. This paper aims to describe the user's profile of primary care of the Sistema Único de Saúde who sought physical therapy for UI in a Porto Alegre Health Centre and were attended by students of the Physical Therapy School of the Universidade Federal do Rio Grande do Sul, between March 2012 and April 2014. It is a documentary study with descriptive analysis of the variables. The case histories of 95 patients (84 women and 11 men) were analyzed. The average age of women was 63 years and 65.5 years for men. The time from onset of symptoms had an average of 25 years for women and 11 months among men. Among women, 13.2% have Diabetes Mellitus (DM), 48.8% reported systemic arterial hypertension (SAH) and 48.8% had pelvic surgery. The average number of births was 6.5 (59.5% vaginal delivery - 30.9% to 64.3% with forceps and episiotomy - 9.5% caesarean section and 26.2% both). Among men, 36.3% had DM, hypertension 54.5% and 72.7% underwent prostatectomy. The results show that the UI may be related to obstetric history, pelvic surgery and hypertension. There was the high convivial time with the UI, especially among women, because they consider part of aging, demonstrating the need for further clarification of the population on the subject.

Reflexões sobre menopausa, incontinência urinária, sexualidade e envelhecimento / Refletions on menopause, urinary incontinence, sexuality and aging

O presente estudo buscou compreender as relações estabelecidas entre menopausa, incontinência urinária, sexualidade e envelhecimento com base na percepção de idosas participantes da Fisioterapia para o Assoalho Pélvico. Apresenta um delineamento qualitativo, transversal e exploratório. Participaram o estudo doze mulheres idosas, na faixa etária dos 60 aos 79 anos. As informações foram coletadas por meio de uma entrevista semiestruturada e interpretadas e categorizadas de acordo com a Análise de Conteúdo de Bardin. Para as participantes, falar sobre a menopausa, incontinência urinária, as mudanças percebidas e sua vida sexual foi um resgate de sentimentos. Em suas histórias de vida, o corpo e o envelhecimento se entrecruzam e se misturam, assumindo novos contornos e configurando inúmeras possibilidades de viver, envelhecer e cuidar de si.

This present study sought to understand the relation between menopause, urinary incontinence, sexuality and aging. The study used a qualitative design with a cross-sectional and exploratory approach. The study’s participants were twelve elderly women, aged from 60 to 79 years, who participated in treatment groups of physiotherapy for the pelvic floor. Data was collected using a semi-structured interview and it was interpreted and categorized according to the Content Analysis based on the Bardin’s approach. Talking about menopause, urinary incontinence, perceived changes by them and their sexuality life was a rescue of feelings for the participants. Body and aging have intermingled and combined among themselves in their life stories. They present several forms and possibilities of living, aging and self-care.

Reflexões sobre menopausa, incontinência urinária, sexualidade e envelhecimento / Refletions on menopause, urinary incontinence, sexuality and aging

O presente estudo buscou compreender as relações estabelecidas entre menopausa, incontinência urinária, sexualidade e envelhecimento com base na percepção de idosas participantes da Fisioterapia para o Assoalho Pélvico. Apresenta um delineamento qualitativo, transversal e exploratório. Participaram o estudo doze mulheres idosas, na faixa etária dos 60 aos 79 anos. As informações foram coletadas por meio de uma entrevista semiestruturada e interpretadas e categorizadas de acordo com a Análise de Conteúdo de Bardin. Para as participantes, falar sobre a menopausa, incontinência urinária, as mudanças percebidas e sua vida sexual foi um resgate de sentimentos. Em suas histórias de vida, o corpo e o envelhecimento se entrecruzam e se misturam, assumindo novos contornos e configurando inúmeras possibilidades de viver, envelhecer e cuidar de si. (AU)

This present study sought to understand the relation between menopause, urinary incontinence, sexuality and aging. The study used a qualitative design with a cross-sectional and exploratory approach. The study’s participants were twelve elderly women, aged from 60 to 79 years, who participated in treatment groups of physiotherapy for the pelvic floor. Data was collected using a semi-structured interview and it was interpreted and categorized according to the Content Analysis based on the Bardin’s approach. Talking about menopause, urinary incontinence, perceived changes by them and their sexuality life was a rescue of feelings for the participants. Body and aging have intermingled and combined among themselves in their life stories. They present several forms and possibilities of living, aging and self-care. (AU)

Reinventando a vida: um estudo qualitativo sobre os significados culturais atribuídos à reconstrução corporal de amputados mediante a protetização / Re-inventando la vida: un estudio cualitativo sobre los significados culturales atribuidos a la reconstrucción corporal de amputados mediante prótesis / Reinventing life: a qualitative study on the cultural meanings attributed by amputees to body reconstruction through implantation of prosthetics

Analisaram-se os significados culturais que os indivíduos amputados atribuem aos seus corpos e às suas vidas cotidianas após uso de prótese. Foram utilizados, como pressupostos teóricos, os estudos culturais e sóciohistóricos sobre o corpo humano. Participaram da pesquisa nove pacientes, sendo seis homens e três mulheres, com idades variando de 18 a 82 anos, além do protesista e do fisioterapeuta. As entrevistas foram analisadas por meio da técnica de análise de conteúdo, sendo identificadas quatro categorias temáticas: "Tornar-se outro: o corpo amputado"; "Familiarizar-se com um outro corpo"; "A imperfeição vista pelos outros" e "O corpo protetizado: um outro de si mesmo". A análise por categorias revelou que a prótese foi observada como uma forma de resgatar a funcionalidade perdida e também a estética corporal na medida em que os pacientes viram seus corpos novamente como completos. O uso da prótese significou uma forma de manter-se humano mesmo que sustentado por um objeto artificial.

The cultural meanings that amputees attribute to their bodies and their daily lives following the use of prosthetics were analyzed. Cultural and sociohistorical studies on the human body were used as theoretical presuppositions. Nine patients (six men and three women) aged 18 to 82 years participated in the study, along with a prosthetician and a physical therapist. The interviews were analyzed using the content analysis technique, and four thematic categories were identified: "Becoming different: the amputated body"; "Getting accustomed to a different body"; "Imperfection as seen by others"; "The prosthetized body: another version of oneself". Analysis according to categories revealed that prostheses were seen as a way of recovering body aesthetics as well as lost functions, such that the patients came to see their bodies as whole again. Using a prosthesis signified a way to remain human, even if sustained by an artificial object.

Se analizan los significados culturales que los individuos amputados atribuyen a sus cuerpos y a sus vidas cotidianas tras el uso de prótesis. Se utilizaron como presupuestos teóricos los estudios culturales y socio-históricos sobre el cuerpo humano. Participaron de la pesquisa nueve pacientes, siendo seis hombres y tres mujeres, con edades variando de 18 a 82 años, además del protésico y del fisioterapeuta. Las entrevistas se analizaron por medio de la técnica de análisis de contenido, identificándose cuatro categorías temáticas: "Tornarse otro: el cuerpo amputado"; "Familiarizarse con otro cuerpo"; "La imperfección vista por los otros" y "El cuerpo en prótesis: otro de sí mismo". El análisis por categorías reveló que la prótesis se observó como una forma de rescatar la función perdida y también la estética corporal en la medida en que los pacientes han visto sus cuerpos nuevamente como completos. El uso de la prótesis ha significado una forma de mantenerse humano aunque sustentado por un objeto artificial.