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Toto V, Faiola A, Pazzaglia M, de Donato F, Persichetti P. Could Abdominoplasty with Diastasis Recti Abdominis Correction Improve Stress Urinary Symptoms? A 1-Year Follow-up Prospective Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04247-z. [PMID: 39030398 DOI: 10.1007/s00266-024-04247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms. MATERIALS AND METHODS This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery. RESULTS The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire. CONCLUSION The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Vito Toto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Angelo Faiola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Matteo Pazzaglia
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco de Donato
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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An D, Wang J, Zhang F, Jing H, Gao Y, Cong H, Su G, Ye M, Hu C, Wu J, Liao L. Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index. BMC Urol 2024; 24:74. [PMID: 38549067 PMCID: PMC10976754 DOI: 10.1186/s12894-024-01451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI. METHODS Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale. RESULTS In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43. CONCLUSIONS Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control. TRIAL REGISTRATION Date of trial registration: November 27, 2023.
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Affiliation(s)
- Di An
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Jianxia Wang
- Department of Intensive Care Unit, Cancer Hospital Chinese Academy of Medical Science, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Fan Zhang
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huafang Jing
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Yi Gao
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huiling Cong
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Guodong Su
- Department of physiotherapy 3(PT3), China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Miao Ye
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Chunying Hu
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Limin Liao
- China Rehabilitation Research Center (CRRC), Department of Urology of Beijing Boai Hospital, Department of Urology of Capital Medical University, NO 10, Jiaomen Beilu, Beijing, 100068, China.
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Blankensteijn LL, Hockx M, Mullender M, Bouman MB, Melenhorst WBWH. Clinical significance of diastasis recti: Literature review and awareness amongst health care professionals. J Plast Reconstr Aesthet Surg 2023; 84:439-446. [PMID: 37413736 DOI: 10.1016/j.bjps.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND A variety of physical complaints have been related to chronic diastasis recti (DR), including back pain, pelvic pain, and urinary incontinence. However, its clinical significance is still subject of debate, leaving many patients to feel unheard when experiencing symptoms. This study aims to assess current knowledge on DR, its potential treatments, and the awareness of this condition amongst involved health care professionals. METHODS A literature review was performed to analyze current available knowledge on DR and its treatment. Then, a survey was conducted to investigate the awareness on DR amongst general practitioners, midwives, gynecologists, general surgeons, and plastic surgeons. RESULTS Over 500 health care professionals completed our survey, including 46 general practitioners, 39 midwives, 249 gynecologists, 33 general surgeons, and 74 plastic surgeons. Although the majority of respondents (>78% in all groups) reported to encounter DR in daily practice, opinions differed markedly on most significant symptoms, associated physical complaints, best first referral for treatment, and best treatment modality. CONCLUSION Current literature is not unanimous on the relation between DR and physical complaints and on its most suitable treatment. This incongruity is corroborated by the variety of responses from involved health care professionals in our survey. More clinical data are needed to provide clarity on this issue.
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Affiliation(s)
- Louise L Blankensteijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Miriam Hockx
- Mom's Planet Physiotherapy Practice, Planetensingel 71, 2402 AB Alphen aan den Rijn, the Netherlands
| | - Margriet Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Wynand B W H Melenhorst
- Department of Plastic, Reconstructive and Hand Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands
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Cross D, Waheed N, Krake M, Gahreman D. Effectiveness of supervised Kegel exercises using bio-feedback versus unsupervised Kegel exercises on stress urinary incontinence: a quasi-experimental study. Int Urogynecol J 2023; 34:913-920. [PMID: 35802177 PMCID: PMC9266083 DOI: 10.1007/s00192-022-05281-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate and compare the efficacy of supervised Kegel exercises with bio-feedback on stress urinary incontinence (SUI) and pelvic floor muscle strength (PFMS) compared with unsupervised Kegel exercises. METHOD Matched-group quasi-experimental study of 29 female participants divided into two groups (supervised and non-supervised) was conducted over 12 weeks. Baseline measurements of PFMS were undertaken by a women's health physiotherapist and a Kegel exercise regime bespoke designed for each participant. The supervised group visited the physiotherapist monthly for bio-feedback training (BT); the unsupervised group continued at home with their individualised Kegel exercises. Data were collected via a perineometer (Peritron™) and self-reporting responses to questionnaires. All participants received a final PFMS measurement on completion of the study. RESULTS Overall Incontinence Severity index (ISI) score was significantly lower in the supervised group post-intervention. Wilcoxon signed-rank tests indicated that supervised Kegel exercises significantly reduced frequency (p= 0.002) and severity (p= 0.020) of overall ISI. Analysis of PFMS were not significantly different, despite an increase in maximum voluntary contraction or pelvic floor muscle strength (PFMS) (p= 0.032) in the supervised group. Of the questionnaires, results of Wilcoxon signed-rank tests indicated that "total bother" was significantly reduced (p= 0.005) in the supervised group. The correlation analysis between PFMS and ISI did not reveal any significant results. CONCLUSIONS The study confirmed that supervised BT is more effective in reducing SUI than unsupervised Kegel exercises, and that this reduction in ISI score did not correlate with the improvement in PFMS.
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Affiliation(s)
- Donelle Cross
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia.
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia.
| | - Nasreena Waheed
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
| | | | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
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The Effects of Pelvic Floor Muscle Exercise Combined with Core Stability Exercise on Women with Stress Urinary Incontinence following the Treatment of Nonspecific Chronic Low Back Pain. Adv Urol 2022; 2022:2051374. [PMID: 36105867 PMCID: PMC9467742 DOI: 10.1155/2022/2051374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 01/16/2023] Open
Abstract
Aim. To compare the combined effects of core stability exercise and pelvic floor muscle exercise (PFME) with the effects of PFME alone on women with stress urinary incontinence (SUI) who experience nonspecific chronic low back pain (NSCLBP). Methods. A stratified randomized controlled trial study (RCT) was conducted with 50 women with SUI who experienced LBP, aged 18–60 years and with pad weight ≥2 grams for the one-hour pad test. The respondents were divided into two groups: the intervention group (PFME + core stability exercise) and the control group (PFME). The primary outcomes were the amount and frequency of urine leakage, which were measured using the one-hour pad test and the Bengali-ISI subjective questionnaire. A secondary outcome was quality of life (QoL), which was measured using King’s Health Questionnaire (KHQ). An ITT analysis was conducted using repeated measures ANOVA (2 × 2) with Bonferroni’s post-hoc analysis. Results/Preliminary Findings. The findings illustrated that 72% (n = 18) of the intervention and 28% (n = 7) of the control group participants showed improvement in UI after 12 weeks of intervention. In addition, the amount and frequency of urine leakage significantly decreased in the intervention group compared to the control group (
). Conclusion. The RCT-illustrated improvement of SUI in women with nonspecific chronic low back pain, reduction of frequency, and improvement of the QoL were more evident from PFME with core stability exercise than from PFME alone.
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Barcellini A, Dominoni M, Dal Mas F, Biancuzzi H, Venturini SC, Gardella B, Orlandi E, Bø K. Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training. Front Med (Lausanne) 2022; 8:813352. [PMID: 35186978 PMCID: PMC8852813 DOI: 10.3389/fmed.2021.813352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT. Materials and Methods Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women. Results Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect. Conclusions Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- *Correspondence: Amelia Barcellini
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Dal Mas
- Lincoln International Business School, University of Lincoln, Lincoln, United Kingdom
- Center of Organization and Governance of the Public Administration, University of Pavia, Pavia, Italy
| | - Helena Biancuzzi
- Ipazia, International Observatory on Gender Research, Rome, Italy
| | | | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
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Prieto-Gómez V, Yuste-Sánchez MJ, Bailón-Cerezo J, Romay-Barrero H, de la Rosa-Díaz I, Lirio-Romero C, Torres-Lacomba M. Effectiveness of Therapeutic Exercise and Patient Education on Cancer-Related Fatigue in Breast Cancer Survivors: A Randomised, Single-Blind, Controlled Trial with a 6-Month Follow-Up. J Clin Med 2022; 11:269. [PMID: 35012011 PMCID: PMC8746078 DOI: 10.3390/jcm11010269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors who presented cancer-related fatigue. Women were randomised into a supervised therapeutic exercise group (STE-G) (n = 40) or an unsupervised exercise group (UE-G) (n = 40). Both interventions included patient therapeutic education and were delivered in three sessions per week over eight weeks. The main outcome was perceived fatigue as assessed by the Spanish version of the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F). Other evaluated outcomes were pain measured on a visual analogue scale, and distance measured using the 6-Minute Walk Test. Data were collected at baseline, immediately post-intervention, and at three and six months after baseline. Significantly greater improvements across all variables were observed in the STE-G throughout the entire follow-up period with the exception of pain. Conclusions: A supervised therapeutic exercise program plus patient therapeutic education significantly reduce perceived fatigue and increase functional capacity in breast cancer survivors suffering from cancer-related fatigue compared to an unsupervised physical exercise program based on individual preferences with patient therapeutic education.
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Affiliation(s)
- Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - María José Yuste-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
| | - Javier Bailón-Cerezo
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Centro Superior de Estudios Universitarios La Salle, Department of Physical Therapy, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Helena Romay-Barrero
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Irene de la Rosa-Díaz
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Centro Superior de Estudios Universitarios La Salle, Department of Physical Therapy, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Cristina Lirio-Romero
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
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Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther 2021; 25:664-675. [PMID: 34391661 PMCID: PMC8721086 DOI: 10.1016/j.bjpt.2021.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/28/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. Objective To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum. Methods Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI). Results Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I2 = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA. Conclusion There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum. Trials investigating abdominal and PFM exercises on DRA have mostly been performed on women with mild DRA. The abdominal and PFM exercise programs identified were heterogenous in terms of type of exercises and training dose. We found low quality evidence that TrA and curl-up training are more effective than minimal intervention for treating DRA. There is low to very low evidence that PFM training is not more effective than minimal intervention.
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Affiliation(s)
- Sandra Gluppe
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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Gomes Lopes L, Maia Dutra Balsells M, Teixeira Moreira Vasconcelos C, Leite de Araújo T, Teixeira Lima FE, de Souza Aquino P. Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 157:248-254. [PMID: 34270799 DOI: 10.1002/ijgo.13826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear. OBJECTIVE To investigate the effectiveness of PFMT in the prevention of perineal laceration. SEARCH STRATEGY Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery. SELECTION CRITERIA We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations. DATA COLLECTION AND ANALYSIS We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R. MAIN RESULTS Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration. CONCLUSION Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.
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Affiliation(s)
- Lia Gomes Lopes
- Nursing Department, Federal University of Ceará, Fortaleza, Brazil
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Arbieto ERM, Dos Santos KM, da Luz SCT, Da Roza T. Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non-athletes: A secondary analysis. Neurourol Urodyn 2021; 40:1140-1146. [PMID: 33998052 DOI: 10.1002/nau.24700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
AIMS To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non-athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. METHODS This cross-sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996-2 QUARK). Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire-Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire-Short Form was used to establish the level of physical activity among the non-athletes. RESULTS The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. CONCLUSION FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.
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Affiliation(s)
- Eliane Regina Mendoza Arbieto
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Keyla Mara Dos Santos
- Department of Physiotherapy, Centro Universitário Estácio de Santa Catarina, São José, Santa Catarina, Brazil
| | - Soraia Cristina Tonon da Luz
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Thuane Da Roza
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
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11
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Moreno-Muñoz MDM, Hita-Contreras F, Estudillo-Martínez MD, Aibar-Almazán A, Castellote-Caballero Y, Bergamin M, Gobbo S, Cruz-Díaz D. The Effects of Abdominal Hypopressive Training on Postural Control and Deep Trunk Muscle Activation: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2741. [PMID: 33800428 PMCID: PMC7967465 DOI: 10.3390/ijerph18052741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abdominal Hypopressive Training (AHT) provides postural improvement, and enhances deep trunk muscle activation. However, until recently, there was a lack of scientific literature supporting these statements. The major purpose of this study was to investigate the effect of AHT on posture control and deep trunk muscle function. METHODS 125 female participants aged 18-60 were randomly allocated to the Experimental Group (EG), consisting of two sessions of 30 min per week for 8 weeks of AHT, or the Control Group (CG), who did not receive any treatment. Postural control was measured with a stabilometric platform to assess the static balance and the activation of deep trunk muscles (specifically the Transverse Abdominal muscle (TrA)), which was measured by real-time ultrasound imaging. RESULTS The groups were homogeneous at baseline. Statistical differences were identified between both groups after intervention in the Surface of the Center of Pressure (CoP) Open-Eyes (S-OE) (p = 0.001, Cohen's d = 0.60) and the Velocity of CoP under both conditions; Open-Eyes (V-OE) (p = 0.001, Cohen´s d = 0.63) and Close-Eyes (V-CE) (p = 0.016, Cohen´s d = 0.016), with the EG achieving substantial improvements. Likewise, there were statistically significant differences between measurements over time for the EG on S-OE (p < 0.001, Cohen´s d = 0.99); V-OE (p = 0.038, Cohen´s d = 0.27); V-CE (p = 0.006, Cohen´s d = 0.39), anteroposterior movements of CoP with Open-Eyes (RMSY-OE) (p = 0.038, Cohen´s d = 0.60) and activity of TrA under contraction conditions (p < 0.001, Cohen´s d = 0.53). CONCLUSIONS The application of eight weeks of AHT leads to positive outcomes in posture control, as well as an improvement in the deep trunk muscle contraction in the female population.
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Affiliation(s)
- María del Mar Moreno-Muñoz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (M.d.M.M.-M.); (F.H.-C.); (A.A.-A.); (D.C.-D.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (M.d.M.M.-M.); (F.H.-C.); (A.A.-A.); (D.C.-D.)
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (M.d.M.M.-M.); (F.H.-C.); (A.A.-A.); (D.C.-D.)
| | - Yolanda Castellote-Caballero
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (M.d.M.M.-M.); (F.H.-C.); (A.A.-A.); (D.C.-D.)
| | - Marco Bergamin
- Department of Medicine, University of Padova Palazzina ex SemeioticaMedica-Via Ospedale Civile, 105 35128 Padova, Italy; (M.B.); (S.G.)
| | - Stefano Gobbo
- Department of Medicine, University of Padova Palazzina ex SemeioticaMedica-Via Ospedale Civile, 105 35128 Padova, Italy; (M.B.); (S.G.)
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (M.d.M.M.-M.); (F.H.-C.); (A.A.-A.); (D.C.-D.)
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12
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Wu L, Gu Y, Gu Y, Wang Y, Lu X, Zhu C, Lu Z, Xu H. Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: Prevalence, risk factors and its impact on life. J Clin Nurs 2020; 30:518-527. [PMID: 33207011 DOI: 10.1111/jocn.15568] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to obtain the incidence of diastasis recti abdominis (DRA) and analyse possible risk factors in adult females. Moreover, the relationships between DRA and lower back pain, pelvic floor function and quality of life were also analysed. BACKGROUND Diastasis recti abdominis is a separation of the abdominal muscles at the linea alba. Currently, studies on the prevalence rates, risk factors and consequences of DRA are varied. In particular, reports on DRA among adult women are lacking. DESIGN A one-sample questionnaire study design is used following the STROBE checklist. METHODS The inter-rectus distance was measured by computed tomography in 644 women. Custom questionnaires, the Oswestry Disability Index, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to investigate personal information, the subjects' back pain, pelvic floor function and quality of life, respectively. RESULTS The incidence of DRA was 28.4%. Age, the number of pregnancies, BMI and diabetes were influencing factors for DRA. After age stratification, pregnancy and diabetes were found to be risk factors for DRA in young women, and obesity and diabetes were risk factors for DRA in older women. This study showed that the association between DRA and low back pain was highly significant. CONCLUSIONS Diastasis recti abdominis is common in adult women. Avoiding multiple pregnancies, preventing diabetes and controlling weight may prevent DRA, which may be beneficial for decreasing low back pain in women. RELEVANCE TO CLINICAL PRACTICE The findings have important implications for the health of adult women which can provide the basis for appropriate nursing implementation for DRA patients. The application of specific prevention and intervention measures for the risk factors may reduce the severity of low back pain.
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Affiliation(s)
- Lina Wu
- School of Nursing, Wenzhou Medical University, Wenzhou, China.,Department of Nursing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yechun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Yanlan Gu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawen Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xueqin Lu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cong Zhu
- Department of Nursing, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China.,Department of Emergency, The First affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongbo Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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13
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Williams AM, Eginyan G, Deegan E, Chow M, Carpenter MG, Lam T. Residual Innervation of the Pelvic Floor Muscles in People with Motor-Complete Spinal Cord Injury. J Neurotrauma 2020; 37:2320-2331. [DOI: 10.1089/neu.2019.6908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alison M.M. Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Emily Deegan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Mason Chow
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Mark G. Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
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14
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Bø K. Physiotherapy management of urinary incontinence in females. J Physiother 2020; 66:147-154. [PMID: 32709588 DOI: 10.1016/j.jphys.2020.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway.
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15
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Zachovajeviene B, Siupsinskas L, Zachovajevas P, Venclovas Z, Milonas D. Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial. Sci Rep 2019; 9:19192. [PMID: 31844133 PMCID: PMC6915701 DOI: 10.1038/s41598-019-55724-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/24/2019] [Indexed: 11/12/2022] Open
Abstract
Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary incontinence (UI). The effect of training other body muscles on the PFMs is unclear and mostly hypothetical. The objective of our study was to evaluate the effectiveness of postoperative diaphragm muscle, abdominal muscle and PFM training on PFM strength (PFMS) and endurance (PFME) as well as on UI in men after radical prostatectomy (RP). Per-protocol PFMS, PFME and urine loss measurements were performed at 1, 3, and 6 months postoperatively. The primary endpoints were PFMS and PFME differences among the study groups. The secondary endpoint was the correlation between UI and PFMS and PFME. In total, 148 men were randomized to the treatment groups. An increase in PFMS and PFME was observed in all groups compared to baseline (p < 0.001). The greatest difference in PFMS was in the PFM training group, but diaphragm training had the best effect on PFME. The highest (from moderate to strong) correlation between UI and PFME and PFMS (r = -0.61 and r = -0.89, respectively) was observed in the diaphragm training group. Despite different but significant effects on PFMS and PFME, all rehabilitation-training programmes decreased UI in men after RP.
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Affiliation(s)
- B Zachovajeviene
- Lithuanian University of Health Sciences, Medical Academy, Clinic of Sport Medicine, Kaunas, Lithuania
| | - L Siupsinskas
- Lithuanian University of Health Sciences, Medical Academy, Clinic of Sport Medicine, Kaunas, Lithuania
| | - P Zachovajevas
- Lithuanian Sport University, Department of Health Promotion and Rehabilitation, Kaunas, Lithuania
| | - Z Venclovas
- Lithuanian University of Health Sciences, Medical Academy, Department of Urology, Kaunas, Lithuania
| | - D Milonas
- Lithuanian University of Health Sciences, Medical Academy, Department of Urology, Kaunas, Lithuania.
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16
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Caetano AS, Suzuki FS, Lopes MHBDM. URINARY INCONTINENCE AND EXERCISE: KINESIOLOGICAL DESCRIPTION OF AN INTERVENTION PROPOSAL. REV BRAS MED ESPORTE 2019. [DOI: 10.1590/1517-869220192505213379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Research shows that symptoms of urinary incontinence are common among women who engage in physical activity. Objective To conduct a kinesiological analysis of specific exercises for the pelvic floor muscles (PFM), proposing correspondences of these postures through resistance exercises. Methods This research project is of a descriptive nature with level of evidence V. Videos and photos were taken to obtain an image for the collection of data based on the accomplishment of the specific postures. Results The kinesiological study revealed that the muscles involved in the postures of exercises targeting the prevention of urinary incontinence beyond those specific to the pelvic floor were: trunk flexors; spinal erector; adductors and hip extensors. The resistance exercises corresponding to these positions in bodybuilding apparatus were the machine hack squat; sitting adductor exercises; sitting abductor exercises; the smith machine squat and the free squat or machine squat. Conclusion This study showed that it is possible to construct correspondence between exercises for the pelvic floor muscles and resistance exercises with bodybuilding equipment and free weights. A new strategy is suggested for the physical education professional, based on resistance exercises: taking a coadjuvant approach to the treatment and prevention of urinary incontinence during physical and sports exercises. Level of evidence V, Case series.
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17
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Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence. Sex Med 2019; 7:505-513. [PMID: 31563553 PMCID: PMC6963109 DOI: 10.1016/j.esxm.2019.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is often associated with female sexual dysfunction. We investigated which pelvic floor muscle (PFM) parameters (strength, power, and endurance) are associated with improvement of sexual function after 8 weeks of transcutaneous electrical stimulation (TES) training. AIM This study was performed to determine the effects of TES in the seated position on PFM parameters and female sexual function and to identify correlation between improved PFM parameters and sexual function after 8 weeks of TES training in women with SUI. METHODS The present study was performed between August 2018 and November 2018 in women with SUI who were randomized into a TES group (n = 17) or a control group (n = 17). One subject in each of the TES and control groups ultimately withdrew during the intervention due to a lack of time. Both groups were measured at baseline and after 8 weeks of intervention. MAIN OUTCOME MEASURE As outcome measures, PFM parameters (strength, power, and endurance) and female sexual function were assessed using a perineometer and the Female Sexual Function Index (FSFI), respectively. RESULTS The final study population consisted of 32 women with SUI. There were significant differences in PFM strength, power, and endurance and FSFI domain scores (desire, arousal, orgasm, satisfaction, and total score) in both between-group analyses (TES vs control group) and within-group analyses (pre-TES vs post-TSE). Change in PFM endurance had the highest association with change in total FSFI total score (r = 0.437; P = .006), and change in PFM power had the highest association with change in FSFI satisfaction (r = 0.420; P = .008). CONCLUSION TES in a seated position showed a beneficial effect on sexual function in females with SUI. Consideration of PFM parameters associated with FSFI domain scores may be important when developing intervention guidelines to improve female sexual function. Hwang UJ, Lee MS, Jung SH, et al. Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence. Sex Med 2019;7:505-513.
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Affiliation(s)
- Ui-Jae Hwang
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Min-Seok Lee
- Sophie-Marceau Women's Clinic, Daegu, South Korea
| | - Sung-Hoon Jung
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Sun-Hee Ahn
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea.
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18
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Lemos AQ, Brasil CA, Valverde D, Ferreira JDS, Lordêlo P, Sá KN. The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis. J Bodyw Mov Ther 2019; 23:270-277. [PMID: 31103107 DOI: 10.1016/j.jbmt.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/14/2017] [Accepted: 02/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure. OBJECTIVES To evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women. SEARCH METHODS The following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication. SELECTION CRITERIA Randomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included. DATA COLLECTION AND ANALYSIS Two reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles. RESULTS 4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32). CONCLUSIONS No evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.
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Affiliation(s)
- Amanda Queiroz Lemos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Metropolitan Union for the Development of Education and Culture (UNIME), Lauro de Freitas, Bahia, Brazil.
| | - Cristina Aires Brasil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Metropolitan Union for the Development of Education and Culture (UNIME), Lauro de Freitas, Bahia, Brazil
| | - Danielle Valverde
- Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Janine Dos Santos Ferreira
- Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Patrícia Lordêlo
- Postgraduate Program at the Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Postgraduate Program at the Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Ammendolia A, d’Esposito O, Inzitari MT, Manti F, Caridi AD, Iocco M. Original kinesio tape application for temporary diastasis recti reduction: a single case study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The person in this case study was a man with prostatic cancer and diastasis rectus abdominis. Perineal rehabilitation was needed to prevent urinary incontinence, before and after a radical prostatectomy. This study reports on an original application of kinesio tape to reduce the diastasis rectus abdominis so that he could carry out the rehabilitation programme. Methods Three green-coloured Y-type tapes (width 5 cm and length 15 cm) were positioned to form an X, orthogonally at the linea alba, separating the tape half in width and two-thirds of a grid in length into 2 ends, under 75% pulling force (above and below the navel), and two green-coloured I-type tapes (width 5 cm and length 30 cm) positioned in parallel at the rectus abdominis, from the external face of the 5th, 6th and 7th costal cartilage and by the xiphoid process to the upper part of the pubis tubercle and pubic symphysis under 50% pulling force. Kinesio tapes were applied daily before every session of the perineum rehabilitation. Findings A significant reduction of the diastasis was observed by ultrasound, after the kinesio tape was applied. Conclusions This case demonstrates that it was possible to perform a pre- and post-operative perineal rehabilitation programme after the application of kinesio tape, which efficiently reduced the diastasis rectus while performing exercises, with the aim to prevent urinary incontinence.
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Affiliation(s)
- Antonio Ammendolia
- Associate Professor, Department of Medical and Surgical Sciences, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
| | - Oriana d’Esposito
- Doctor, Department of Medical and Surgical Sciences, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
| | - Maria Teresa Inzitari
- Physiotherapist, Department of Medical and Surgical Sciences, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
| | - Francesco Manti
- Radiologist, Department of Clinical and Experimental Medicine, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
| | - Adele De Caridi
- Doctor, Department of Clinical and Experimental Medicine, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
| | - Maurizio Iocco
- Professor, Department of Medical and Surgical Sciences, University of Catanzaro, “Magna Græcia”, Catanzaro, Italy
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20
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Werner LA, Dayan M. Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor. CURRENT WOMENS HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180222152952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.
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Affiliation(s)
- Laura Anne Werner
- Shelbourne Physiotherapy 100B-3200 Shelbourne V8P 5G8, Victoria, BC, Canada
| | - Marcy Dayan
- Dayan Physiotherapy and Pelvic Floor Clinic 909-750 W Broadway V5Z 1H8 Vancouver, BC, Canada
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21
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Vesentini G, El Dib R, Righesso LAR, Piculo F, Marini G, Ferraz GAR, Calderon IDMP, Barbosa AMP, Rudge MVC. Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis. Clinics (Sao Paulo) 2019; 74:e1319. [PMID: 31778432 PMCID: PMC6862713 DOI: 10.6061/clinics/2019/e1319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022] Open
Abstract
There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) -1.02 [95% confidence interval (CI) -1.90 to -0.14], P=0.02; I2= not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], P<0.0001; I2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD.
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Affiliation(s)
- Giovana Vesentini
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
- *Corresponding author. E-mail:
| | - Regina El Dib
- Departamento de Biociencias e Diagnostico Bucal, Instituto de Ciencia e Tecnologia, Universidade Estadual Paulista (UNESP), Sao Jose dos Campos, SP, BR
- McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Fernanda Piculo
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
| | - Gabriela Marini
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
- Departamento de Ciencias da Saude, Universidade Sagrado Coracao, Bauru, SP, BR
| | - Guilherme Augusto Rago Ferraz
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
| | | | | | - Marilza Vieira Cunha Rudge
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
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Ruiz de Viñaspre Hernández R. Efficacy of hypopressive abdominal gymnastics in rehabilitating the pelvic floor of women: A systematic review. Actas Urol Esp 2018; 42:557-566. [PMID: 29248338 DOI: 10.1016/j.acuro.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. OBJECTIVE To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. METHODS We consulted the databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Trip Database and Web of Science. We selected systematic reviews, clinical trials and analytical studies that assessed the efficacy of hypopressive abdominal gymnastics in women. The measured outcomes were the strengthening of the pelvic floor muscles, the incidence of urine incontinence or prolapse and symptom remission. We included 4 clinical trials, whose quality was measured with the PEDro scale. RESULTS Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance. PRACTICAL IMPLICATION The evidence reviewed does not support the recommendation for hypopressive abdominal gymnastics for strengthening the pelvic floor either during the postpartum period or outside that period. Pelvic floor muscle training remains the first-line treatment for pelvic floor dysfunction. CONCLUSION There is a lack of quality clinical trials that have evaluated the efficacy of hypopressive abdominal gymnastics.
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Rocha F, Carvalho J, Jorge Natal R, Viana R. Evaluation of the pelvic floor muscles training in older women with urinary incontinence: a systematic review. Porto Biomed J 2018; 3:e9. [PMID: 31595241 PMCID: PMC6726312 DOI: 10.1016/j.pbj.0000000000000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Urinary incontinence (UI) is defined as any involuntary urine loss that predominantly affects older women. There is evidence that pelvic floor muscles training (PFMT) program is effective on the treatment of pelvic floor (PF) dysfunctions and is considered to be first-line treatment. The evaluation of pelvic floor muscles (PFM) function and strength is central to validate the effectiveness of the training protocol in UI decrease. The Oxford Grading Scale and manometry are fundamental to evaluate the PFM function and strength. Objective: The aim of the study was to systematize the scientific evidence about the effects of PFMT in older women, assessing the PF function and strength through Oxford Grading Scale and manometry. Methods: The research of randomized controlled clinical trials was performed through B-on, EBSCO, PEDro, Pubmed, and SciELO data carried out from 2003 to 2016. Results: A total of 35 studies were identified, 26 of these were selected and fully analyzed. From the analyzed studies (n = 26), 20 were excluded for not meeting the criteria for inclusion, and only 6 studies were classified as high methodological quality, scoring an overall 4 points according the PEDro scale. Conclusion: The PFMT seems to be effective in treating UI in older women; the Oxford Grading Scale and manometry are considered the most reliable in the random and controlled clinical trials results. However, future investigations with high methodological quality with older women are necessary to support these results.
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Affiliation(s)
| | - Joana Carvalho
- Faculty of Sports, University of Porto.,Research Centre in Physical Activity, Health and Leisure CIAFEL
| | - Renato Jorge Natal
- Faculty of Engineering.,Institute of Science and Innovation in Mechanical and Industrial Engineering INEGI
| | - Rui Viana
- Faculty of Health Sciences, University of Fernando Pessoa.,Physical Medicine and Rehabilitation Department, Centro Hospitalar São João EPE, Porto, Portugal
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Fidale TM, Borges FFR, Roever L, Souza GDC, Gonçalves A, Chacur EP, Pimenta C, Haddad EG, de Agostini GG, Gregório FC, Guimarães FCR, Arantes FJ, dos Santos LA, Pereira AA, Antunes HKM, Puga GM, Lizardo FB. Eletromyography of abdominal muscles in different physical exercises: An update protocol for systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0395. [PMID: 29702987 PMCID: PMC5944552 DOI: 10.1097/md.0000000000010395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The abdominal muscles are extremely important because they are directly involved in the functions of support, containment of viscera, and help in the process of expiration, defecation, urination, vomiting, and also at the time of childbirth. Many exercises and equipment are used to strengthen the abdominal muscles, and the workouts are proposed for a variety of purposes, such as preventing and rehabilitating low back pain, improving sports performance, achieving aesthetic standards, among others. Exercises that potentiate the electromyographic activity promote a greater recruitment of muscle fibers and are more effective to improve or maintain of the force. The electromyographic activity analysis allows us to reflect on the quality of the exercises proposed, consequently, to choose and order the exercises properly in a training session. METHODS Our systematic review protocol will developed following the reporting items for the systematic review. To identify relevant studies, we sought articles on the following bases: MEDLINE, PubMed, Europubmed, SciELO, Physiotherapy Evidences Data Base (PEDro), Cochrane, and Google Scholar. The methodological quality of the studies included in the review will evaluated using a checklist and quality assessment. For intervention studies, risk of bias will estimated using the Cochrane Collaboration tool. RESULTS The results of this study will show the electromyographic activation of the abdomen in the different types of exercises. CONCLUSION Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086172.
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Affiliation(s)
- Thiago Montes Fidale
- Electromyography Laboratory of Institute of Biomedical Sciences
- Laboratory of Experimental Medicine, Federal University of Uberlândia, Uberlândia
- UNIPAC College of Uberlândia, Uberlândia
| | | | - Leonardo Roever
- Laboratory of Experimental Medicine, Federal University of Uberlândia, Uberlândia
| | | | - Alexandre Gonçalves
- Laboratory of Experimental Medicine, Federal University of Uberlândia, Uberlândia
- Atenas College Morphofunctional Department, Paracatu
| | | | | | - Eduardo Gasparetto Haddad
- Laboratory of Experimental Medicine, Federal University of Uberlândia, Uberlândia
- UNIPAC College of Uberlândia, Uberlândia
| | | | | | | | | | - Lázaro Antônio dos Santos
- Electromyography Laboratory of Institute of Biomedical Sciences
- UNIPAC College of Uberlândia, Uberlândia
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Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther 2018; 98:260-268. [PMID: 29351646 PMCID: PMC5963302 DOI: 10.1093/ptj/pzy008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Diastasis recti abdominis affects a significant number of women during the prenatal and postnatal period. OBJECTIVE The objective was to evaluate the effect of a postpartum training program on the prevalence of diastasis recti abdominis. DESIGN The design was a secondary analysis of an assessor-masked randomized controlled trial. METHODS One hundred seventy-five primiparous women (mean age = 29.8 ± 4.1 years) were randomized to an exercise or control group. The interrectus distance was palpated using finger widths, with a cutoff point for diastasis as ≥2 finger widths. Measures were taken 4.5 cm above, at, and 4.5 cm below the umbilicus. The 4-month intervention started 6 weeks postpartum and consisted of a weekly, supervised exercise class focusing on strength training of the pelvic floor muscles. In addition, the women were asked to perform daily pelvic floor muscle training at home. The control group received no intervention. Analyses were based on intention to treat. The Mantel-Haenszel test (relative risk [RR] ratio) and the chi-square test for independence were used to evaluate between-group differences on categorical data. RESULTS At 6 weeks postpartum, 55.2% and 54.5% of the participants were diagnosed with diastasis in the intervention and control groups, respectively. No significant differences between groups in prevalence were found at baseline (RR: 1.01 [0.77-1.32]), at 6 months postpartum (RR: 0.99 [0.71-1.38]), or at 12 months postpartum (RR: 1.04 [0.73-1.49]). LIMITATIONS The interrecti distance was palpated using finger widths, and the sample included women with and without diastasis. CONCLUSIONS A weekly, postpartum, supervised exercise program, including strength training of the pelvic floor and abdominal muscles, in addition to daily home training of the pelvic floor muscles, did not reduce the prevalence of diastasis.
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Affiliation(s)
- Sandra L Gluppe
- Department of Sports Medicine, Norwegian School of Sports Sciences, PO Box 4014, Ullevål Stadion 0806, Oslo, Norway. She was a Master candidate at the time this manuscript was accepted,Address all correspondence to Ms Gluppe at:
| | - Gunvor Hilde
- Department of Sports Medicine, Norwegian School of Sports Sciences, and Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | | | - Marie E Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, and Department of Obstetrics and Gynaecology, Akershus University Hospital
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High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor. Clin Biomech (Bristol, Avon) 2017; 47:53-60. [PMID: 28600995 DOI: 10.1016/j.clinbiomech.2017.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. METHODS This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and "waveform" pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10×10 matrix of capacitive transducers. FINDINGS Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P=0.04). During the "waveform" contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P=0.05) and decreased rates of contraction (small effect, P=0.04) and relaxation (large effect, P=0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. INTERPRETATION Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.
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de Souza Abreu N, de Castro Villas Boas B, Netto JMB, Figueiredo AA. Dynamic lumbopelvic stabilization for treatment of stress urinary incontinence in women: Controlled and randomized clinical trial. Neurourol Urodyn 2017; 36:2160-2168. [PMID: 28346721 DOI: 10.1002/nau.23261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/11/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the results of the dynamic lumbopelvic stabilization (DLS) exercises with exercises for the pelvic floor muscles (PFM) in women with stress urinary incontinence. METHODS Randomized controlled clinical trial comparing 17 women submitted to the DLS with 16 women submitted to the exercises for the PFM. The evaluated outcomes were incontinence severity, quality of life (QoL), and impression of improvement in three moments. Significance was set at 5%. RESULTS For socio-demographic and clinical variables, only climacteric was more prevalent in the DLS group (82% vs. 44%, P = 0.02). Soon after the intervention, there was no difference between the groups in relation to the outcomes evaluated. In the evaluation after 90 days, the DLS group presented better values for the severity of the losses (4.1 ± 2.6 vs. 5.7 ± 2.4, P = 0.006, d = 0.64), daytime frequency (4.6 ± 0.4 vs. 6.2 ± 0.6, P < 0.001, d = 2.67), and nighttime frequency (0.4 ± 0.3 vs. 1.4 ± 0.5, P < 0.001, d = 2.50), QoL and impression of improvement (P < 0.001). CONCLUSIONS After treatment, the DLS plus PFM exercise patients had results similar to those performing PFM exercises alone. However, the DLS plus PFM exercises were superior in the outcomes of incontinence severity, QoL, and impression of improvement in the post-90-day evaluation, showing longer lasting effect.
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Affiliation(s)
- Nathalia de Souza Abreu
- Physical Therapy Course, Faculty of Medical Sciences and Health of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Physical Therapy Sector, Hospital and Maternity Terezinha de Jesus, Juiz de Fora, Minas Gerais, Brazil.,Physiotherapy Course, Salgado de Oliveira University, Juiz de Fora, Minas Gerais, Brazil
| | | | - José Murilo Bastos Netto
- Faculty of Medicine, Department of Surgery, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - André Avarese Figueiredo
- Faculty of Medicine, Department of Surgery, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Martins LA, Santos KMD, Dorcínio MBA, Alves JO, Roza TD, Luz SCTD. A PERDA DE URINA É INFLUENCIADA PELA MODALIDADE ESPORTIVA OU PELA CARGA DE TREINO? UMA REVISÃO SISTEMÁTICA. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172301163216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Atualmente, diversos estudos relatam incontinência urinária (IU) entre mulheres jovens nulíparas e fisicamente ativas. Contudo, alguns investigam a prevalência da IU de acordo com as modalidades esportivas, enquanto outros investigam a carga de treino. A finalidade do presente estudo foi verificar se a modalidade esportiva é mais determinante na prevalência de IU do que a carga de treino entre mulheres jovens nulíparas. Para esta revisão sistemática, três revisores independentes realizaram uma busca de publicações originais nas bases de dados PubMed, LILACS e SciELO, entre 1994 e 2015. Foram utilizadas como estratégia de busca as palavras-chave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas na MeSH e no DeCS. Foram incluídos apenas estudos originais publicados nas línguas português, inglês e espanhol, que verificaram a IU em mulheres nulíparas, atletas ou praticantes de atividade física. Foram selecionados 873 estudos, mas somente dez artigos satisfizeram os critérios de inclusão e exclusão. Todos os artigos foram do tipo transversal, dos quais quatro relacionaram a IU com as modalidades esportivas, cinco verificaram a carga de treino com a perda de urina e um estudo verificou ambos os aspectos. Foi encontrada uma alta taxa de prevalência de IU entre atletas. Parece haver evidência de que as atividades que exigem salto, aterrissagem longa e corrida são as mais propensas a provocar perda de urina. Além disso, a maior carga de treino parece estar associada com a quantidade de urina perdida. Esta revisão evidencia as altas taxas de IU em praticantes de grandes cargas de treinamento associadas a esportes com salto, especialmente entre atletas. Contudo, ainda não há resposta para qual fator esportivo é mais determinante para a perda de urina entre mulheres nulíparas.
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Affiliation(s)
| | | | | | | | - Thuane da Roza
- Universidade do Estado de Santa Catarina (UDESC), Brazil; Universidade do Porto, Portugal
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Halski T, Ptaszkowski K, Słupska L, Dymarek R, Paprocka-Borowicz M. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study. Clin Interv Aging 2017; 12:75-83. [PMID: 28115836 PMCID: PMC5221554 DOI: 10.2147/cia.s121467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.
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Affiliation(s)
- Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders
| | - Lucyna Słupska
- Department of Physiotherapy, Opole Medical School, Opole
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Ki C, Heo M, Kim HY, Kim EJ. The effects of forced breathing exercise on the lumbar stabilization in chronic low back pain patients. J Phys Ther Sci 2016; 28:3380-3383. [PMID: 28174456 PMCID: PMC5276765 DOI: 10.1589/jpts.28.3380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was conducted to investigate the effects of forced breathing exercise on the trunk functions of chronic low back pain patients. [Subjects and Methods] Twenty-four patients with chronic low back pain were randomly divided into groups of respiratory effort and trunk stabilization exercises. The exercises were performed for 45 minutes, 3 times per week for 6 weeks. Spinal stabilization was measured as the compensation of thesagittal angle joint in relation to the lumbar external load. [Results] After the intervention, the forced breathing and stabilization exercise groups showed a significant difference in lumbar spine stabilization between the first and second stress tests and the control group also showed a significant difference after the intervention. The M1 and M2 tests of lumbar spine stabilization revealed no significant differences between the groups. [Conclusion] The results of this research demonstrate that forced breathing exercise therapy is effective at improving the trunk stability and daily living activities of chronic low back pain patients.
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Affiliation(s)
- Chul Ki
- Department of Physical Therapy, Dongshin University, Republic of Korea
| | - Myoung Heo
- Department of Occupational Therapy, Gwangju University, Republic of Korea
| | - Hwang-Yong Kim
- Department of Occupational Therapy, Gwangju University, Republic of Korea
| | - Eun-Jeong Kim
- Department of Physical Therapy, Dongshin University, Republic of Korea
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Multimodal Physical Therapy Intervention for Urinary Incontinence and Overactive Bladder in the Older Adult. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ghaderi F, Mohammadi K, Amir Sasan R, Niko Kheslat S, Oskouei AE. Effects of Stabilization Exercises Focusing on Pelvic Floor Muscles on Low Back Pain and Urinary Incontinence in Women. Urology 2016; 93:50-4. [DOI: 10.1016/j.urology.2016.03.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
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Ferla L, Darski C, Paiva LL, Sbruzzi G, Vieira A. Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.002.ao19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Lia Ferla
- Universidade Federal do Rio Grande do Sul, Brazil
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Bø K, Hilde G, Tennfjord MK, Sperstad JB, Engh ME. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn 2016; 36:716-721. [PMID: 27037746 DOI: 10.1002/nau.23005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/15/2016] [Indexed: 11/06/2022]
Abstract
AIMS Compare vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength, and endurance in women with and without diastasis recti abdominis at gestational week 21 and at 6 weeks, 6 months, and 12 months postpartum. Furthermore, to compare prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) in the two groups at the same assessment points. METHODS This is a prospective cohort study following 300 nulliparous pregnant women giving birth at a public university hospital. VRP, PFM strength, and endurance were measured with vaginal manometry. ICIQ-UI-SF questionnaire and POP-Q were used to assess UI and POP. Diastasis recti abdominis was diagnosed with palpation of ≥2 fingerbreadths 4.5 cm above, at, or 4.5 cm below the umbilicus. RESULTS At gestational week 21 women with diastasis recti abdominis had statistically significant greater VRP (mean difference 3.06 cm H2 O [95%CI: 0.70; 5.42]), PFM strength (mean difference 5.09 cm H2 O [95%CI: 0.76; 9.42]) and PFM muscle endurance (mean difference 47.08 cm H2 O sec [95%CI: 15.18; 78.99]) than women with no diastasis. There were no statistically significant differences between women with and without diastasis in any PFM variables at 6 weeks, 6 months, and 12 months postpartum. No significant difference was found in prevalence of UI in women with and without diastasis at any assessment points. Six weeks postpartum 15.9% of women without diastasis had POP versus 4.1% in the group with diastasis (P = 0.001). CONCLUSIONS Women with diastasis were not more likely to have weaker PFM or more UI or POP. Neurourol. Urodynam. 36:716-721, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | - Gunvor Hilde
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | | | | | - Marie Ellstrøm Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, and Akershus University Hospital, Oslo, Norway
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Ferla L, Paiva LL, Darki C, Vieira A. Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study. Int Urogynecol J 2015; 27:123-8. [DOI: 10.1007/s00192-015-2801-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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Lehmann C, Zipponi I, Baumann MU, Radlinger L, Mueller MD, Kuhn A. Standardized pelvic floor exercises improve stress urinary incontinence in women with intrinsic sphincter deficiency. Neurourol Urodyn 2015; 35:711-6. [DOI: 10.1002/nau.22779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/16/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Corinne Lehmann
- Institute for Physiotherapy; Department of Physiotherapy; Bern Switzerland
| | - Ingrid Zipponi
- Departments of Obstetrics and Gynaecology; Urogynaecology Inselspital; University Hospital and University of Bern; Bern Switzerland
| | - Marc U. Baumann
- Departments of Obstetrics and Gynaecology; Urogynaecology Inselspital; University Hospital and University of Bern; Bern Switzerland
| | | | - Michael D. Mueller
- Departments of Obstetrics and Gynaecology; Urogynaecology Inselspital; University Hospital and University of Bern; Bern Switzerland
| | - Annette Kuhn
- Departments of Obstetrics and Gynaecology; Urogynaecology Inselspital; University Hospital and University of Bern; Bern Switzerland
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Celiker Tosun O, Kaya Mutlu E, Ergenoglu AM, Yeniel AO, Tosun G, Malkoc M, Askar N, Itil IM. Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial. Clin Rehabil 2014; 29:525-37. [PMID: 25142280 DOI: 10.1177/0269215514546768] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 07/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether symptoms of urinary incontinence is reduced by pelvic floor muscle training, to determine whether urinary incontinence can be totally eliminated by strengthening the pelvic floor muscle to grade 5 on the Oxford scale. DESIGN Prospective randomized controlled clinical trial. SETTING Outpatient urogynecology department. SUBJECTS One hundred thirty cases with stress and mixed urinary incontinence. INTERVENTION All participants were randomly allocated to the pelvic floor muscle training group or control group. A 12-week home based exercise program, prescribed individually, was performed by the pelvic floor muscle training group. MAIN MEASURES Urinary incontinence symptoms (Incontinence Impact Questionnaire-7, Urogenital Distress Inventory-6, bladder diary, stop test and pad test) were assessed, and the pelvic floor muscle strength was measured for (PERFECT testing, perineometric and ultrasound) all participants before and after 12 weeks of treatment. RESULTS The pelvic floor muscle training group had significant improvement in their symptoms of urinary incontinence (P=0.001) and an increase in pelvic floor muscle strength (P=0.001, by the dependent t test) compared with the control group. All the symptoms of urinary incontinence were significantly decreased in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training (P<0.05). CONCLUSION The study demonstrated that pelvic floor muscle training is effective in reducing the symptoms of stress and mixed urinary incontinence and in increasing pelvic floor muscle strength.
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Affiliation(s)
- O Celiker Tosun
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - E Kaya Mutlu
- Istanbul University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Turkey
| | - A M Ergenoglu
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - A O Yeniel
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - G Tosun
- Tepecık Educaution and Research Hospital, Department of Obstetric and Gynecology, Turkey
| | - M Malkoc
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - N Askar
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - I M Itil
- Ege University, Department of Obstetric and Gynecology, Turkey
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Comparing Resisted Hip Rotation With Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence. ACTA ACUST UNITED AC 2014. [DOI: 10.1097/jwh.0000000000000008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:785263. [PMID: 24868546 PMCID: PMC4017841 DOI: 10.1155/2014/785263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
Abstract
The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results.
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Kim BI, Hwang-Bo G, Kim HR. Comparison of abdominal muscle thickness with vaginal pressure changes in healthy women. J Phys Ther Sci 2014; 26:427-30. [PMID: 24707099 PMCID: PMC3976018 DOI: 10.1589/jpts.26.427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/10/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to verify the efficacy of a pelvic floor muscle exercise program by comparing subjects' muscle thickness with changes in vaginal pressure. [Subjects] Two groups of female participants without a medical history of pelvic floor muscle dysfunction were evaluated. The mean age of Group I was 33.5 years and that of Group II was 49.69 years. [Methods] The participants were instructed to perform a pelvic floor muscle contraction. While measuring the vaginal pressure of the pelvic floor muscle, biofeedback was given on five levels, and the thicknesses of the transversus abdominis, external oblique, and internal oblique muscles were measured with ultrasound. [Results] The thickness of the transversus abdominis muscle was significantly increased at 30 cmH2O in Group I, and at 20 cmH2O in Group II. The thickness of the internal oblique abdominal muscle significantly increased at maximum contraction in Group II. [Conclusion] Different abdominal muscles contracted depending on vaginal pressure. The result may be used to create and implement an exercise program that effectively strengthens the pelvic floor muscles.
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Affiliation(s)
- Bo-In Kim
- Department of Physical Therapy, Graduate School, College of
Rehabilitation Science, Daegu University, Republic of Korea
| | - Gak Hwang-Bo
- Department of Physical Therapy, College of Rehabilitation
Science, Daegu University, Republic of
Korea
| | - Ha-Roo Kim
- Department of Physical Therapy, Graduate School, College of
Rehabilitation Science, Daegu University, Republic of Korea
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Volkmer C, Monticelli M, Reibnitz KS, Brüggemann OM, Sperandio FF. [Female urinary incontinence: a systematic review of qualitative studies]. CIENCIA & SAUDE COLETIVA 2013; 17:2703-15. [PMID: 23099757 DOI: 10.1590/s1413-81232012001000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/18/2011] [Indexed: 05/26/2023] Open
Abstract
Urinary incontinence has broad repercussions on female daily life. The objective of this study was to conduct a systematic review seeking to analyze results of qualitative research concerning female urinary incontinence published prior to 2009. After an electronic search, 53 research reports were identified with 30 fulfilling the exclusion and inclusion criteria. After classification according to the Critical Appraisal Skills Program, 13 constituted the analytical body for review. The data were synthesized according to the meta-ethnographical approach through reciprocal translation. Two categories emerged: life experiences among incontinent women; and proposals for care models for incontinent women. The restructuring of one's personal life metacategory points to individual adjustments necessary for dealing with the problem. In essence, the results reveal the option of the majority of women facing the loss of urine "silently" and point to the need for professionals to understand family perceptions in order to better comprehend the personal, family, and social implications involved in female urinary incontinence.
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Affiliation(s)
- Cilene Volkmer
- Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil.
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Bø K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother 2013; 59:159-68. [PMID: 23896331 DOI: 10.1016/s1836-9553(13)70180-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
QUESTION What evidence is there for alternative exercises to specific pelvic floor muscle training for treatment of stress urinary incontinence in women? DESIGN A systematic review was conducted with searches of PubMed and PEDro to January 2013. The quality of randomised trials was evaluated using the PEDro scale. Each type of exercise was classified as being in a Development Phase, Testing Phase, or Refinement and Dissemination Phase. PARTICIPANTS Women with stress or mixed urinary incontinence with predominantly stress urinary incontinence. INTERVENTION Exercise regimens other than pelvic floor muscle training. OUTCOME MEASURES The primary outcome was urinary leakage. RESULTS Seven randomised controlled trials were found: three on abdominal training, two on the Paula method, and two on Pilates exercise. The methodological quality score ranged between 4 and 8 with a mean of 5.7. There was no convincing evidence for the effect of these exercise regimens so they remain in the Testing Phase. Because no randomised trials were found for posture correction, breathing exercise, yoga, Tai Chi, and general fitness training, these were classified as being in the Development Phase. CONCLUSION There is not yet strong evidence that alternative exercise regimens can reduce urinary leakage in women with stress urinary incontinence. Alternative exercise regimens should not yet be recommended for use in clinical practice for women with stress urinary incontinence.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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43
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Stuge B, Sætre K, Ingeborg Hoff B. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. ACTA ACUST UNITED AC 2013; 18:327-32. [DOI: 10.1016/j.math.2012.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 01/08/2023]
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Dumoulin C, Martin C, Elliott V, Bourbonnais D, Morin M, Lemieux MC, Gauthier R. Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7-year follow-up. Neurourol Urodyn 2013; 32:449-54. [DOI: 10.1002/nau.22330] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/12/2012] [Indexed: 11/11/2022]
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Pereira LC, Botelho S, Marques J, Amorim CF, Lanza AH, Palma P, Riccetto C. Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum? Neurourol Urodyn 2012; 32:416-9. [PMID: 23071085 DOI: 10.1002/nau.22315] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/22/2012] [Indexed: 11/11/2022]
Abstract
AIM The aim of this study was to simultaneously evaluate both transversus abdominis/internal oblique (Tra/IO) and pelvic floor muscles (PFM) during isometric exercises in nulliparous, pregnant, and postpartum women. METHODS The study included 81 women divided into four groups: (G1) nulliparous women without urinary symptoms (n = 20); (G2) primigravid pregnant women with gestational age ≥24 weeks (n = 25); (G3) primiparous postpartum women after vaginal delivery with right mediolateral episiotomy (n = 19); (G4) primiparous postpartum women after cesarean section delivery, with 40 to 60 days of postpartum (n = 17). The assessment consisted of simultaneous surface electromyography (EMGs) of the PFM and Tra/IO, during three isometric maximum voluntary contractions. RESULTS Only nulliparous women presented significant simultaneous Tra/IO and PFM co-activation when asked to contract PFM (P = 0.0007) or Tra/IO (P = 0.00001). CONCLUSIONS There is co-activation of the transversus abdominis/internal oblique and the pelvic floor muscles in young, asymptomatic nulliparous women. This pattern was modified in primigravid pregnant and primiparous postpartum women regardless of the delivery mode.
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Affiliation(s)
- Larissa Carvalho Pereira
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
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Kim B, Shim J, Kim H. Comparison of Abdominal Muscle Activities with Vaginal Pressure Changes in Healthy Women. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Boin Kim
- Department of Physical Therapy ,HanmaEum Medical Center
| | - Jemyung Shim
- Department of Physical Therapy, Gimhae College University
| | - Haroo Kim
- Department of Physical Therapy, Bareunmom Orthopedics Clinic
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Resende APM, Stüpp L, Bernardes BT, Oliveira E, Castro RA, Girão MJBC, Sartori MGF. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourol Urodyn 2011; 31:121-5. [DOI: 10.1002/nau.21149] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/07/2011] [Indexed: 11/07/2022]
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Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol 2011; 30:437-43. [PMID: 21984473 DOI: 10.1007/s00345-011-0779-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 09/26/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The objectives of the present review was to present and discuss evidence for pelvic floor muscle (PFM) training on female stress urinary incontinence (SUI), pelvic organ prolapse (POP) and sexual dysfunction. METHODS This manuscript is based on conclusions and data presented in systematic reviews on PFM training for SUI, POP and sexual dysfunction. Cochrane reviews, the 4th International Consultation on Incontinence, the NICE guidelines and the Health Technology Assessment were used as data sources. In addition, a new search on Pubmed was done from 2008 to 2011. Only data from randomized controlled trials (RCTs) published in English language is presented and discussed. RESULTS There is Level 1, Grade A evidence that PFM training is effective in treatment of SUI. Short-term cure rates assessed as <2 g of leakage on pad testing vary between 35 and 80%. To date there are 5 RCTs showing significant effect of PFM training on either POP stage, symptoms or PFM morphology. Supervised and more intensive training is more effective than unsupervised training. There are no adverse effects. There is a lack of RCTs addressing the effect of PFM training on sexual dysfunction. CONCLUSIONS PFM training should be first line treatment for SUI and POP, but the training needs proper instruction and close follow-up to be effective. More high quality RCTs are warranted on PFM training to treat sexual dysfunction.
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Resende APM, Nakamura MU, Ferreira EAG, Petricelli CD, Alexandre SM, Zanetti MRD. Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000300016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A eletromiografia de superfície tem grande importância clínica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade elétrica promovida pelo recrutamento das unidades motoras, há boa correlação entre o número de unidades ativadas e a força muscular. É um dos métodos de maior especificidade na avaliação do assoalho pélvico, embora não haja consenso em relação à sua aplicação. Essa revisão de literatura foi desenvolvida com o objetivo de agrupar as informações sobre o uso da eletromiografia de superfície na avaliação do assoalho pélvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pélvico feminino por meio de eletromiografia de superfície. Apesar de sua metodologia ainda carecer de padronização, é um instrumento que deve ser considerado nas pesquisas científicas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfunções do assoalho pélvico possuem alterações no tempo de ativação dos músculos do assoalho pélvico (MAP) e músculos abdominais. Quanto à gestação e puerpério, ainda faltam evidências sobre possíveis alterações da ativação elétrica dos MAP nesses períodos.
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50
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Kim EY, Kim SY, Oh DW. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clin Rehabil 2011; 26:132-41. [DOI: 10.1177/0269215511411498] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes. Design: Randomized, single-blind controlled study. Setting: Outpatient rehabilitation hospital. Subjects: Eighteen subjects with postpartum urinary incontinence. Interventions: Subjects were randomized to either a supervised training group with verbal instruction from a physiotherapist, or an unsupervised training group after undergoing a supervised demonstration session. Main measures: Bristol Female Lower Urinary Tract Symptom questionnaire (urinary symptoms and quality of life) and vaginal function test (maximal vaginal squeeze pressure and holding time) using a perineometer. Results: The change values for urinary symptoms (−27.22 ± 6.20 versus −18.22 ± 5.49), quality of life (−5.33 ± 2.96 versus −1.78 ± 3.93), total score (−32.56 ± 8.17 versus −20.00 ± 6.67), maximal vaginal squeeze pressure (18.96 ± 9.08 versus 2.67 ± 3.64 mmHg), and holding time (11.32 ± 3.17 versus 5.72 ± 2.29 seconds) were more improved in the supervised group than in the unsupervised group ( P < 0.05). In the supervised group, significant differences were found for all variables between pre- and post-test values ( P < 0.01), whereas the unsupervised group showed significant differences for urinary symptom score, total score and holding time between the pre- and post-test results ( P < 0.05). Conclusions: These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence.
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Affiliation(s)
- Eun-Young Kim
- Department of Physical Therapy, The Graduate School, Daejeon University, Dong-gu, Daejeon, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Sport Science, Daejeon University, Dong-gu, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Sport Science, Daejeon University, Dong-gu, Daejeon, Republic of Korea
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