Pelvic floor muscle training decreases hip adductors isometric peak torque in incontinent women: an exploratory study

Effect of photobiomodulation associated with strengthening pelvic floor muscles in volunteers with urinary incontinence: a randomized, double-blinded, and placebo-controlled clinical trial

The dysfunctions of the female pelvic floor have a great influence on the quality of life of women, in all areas, social, psychological, and sexual. Stress urinary incontinence is the clinical condition in which the woman involuntarily loses urine to efforts, such as coughing and sneezing, causing great embarrassment and affecting her quality of life. The physiotherapeutic treatments include muscle strengthening; however, muscle fatigue is present when performing the exercises. Here we investigate the effects of photobiomodulation to prevent muscle fatigue in the pelvic floor in the treatment of stress urinary incontinence, associated with a muscle strengthening exercise protocol. We used an infrared laser (808 nm, 100 mW) and 3 J/point and fluence of 107.1 J/cm2. The application was performed at 3 points on the vaginal introits and at another 3 points inside the vaginal canal cavity for the treatment of stress urinary incontinence associated with strengthening exercises with vaginal cones. Twenty-two volunteers participated in the study, divided into two groups: group 1 (laser therapy + strengthening) and group 2 (placebo laser + strengthening). In the group 1 quality of life score, the assessment (11.63 ± 4.33) was the highest score at 17 and in the reevaluation (7.81 ± 5.14) the lowest was 0 (p < 0.05). The muscular strength increased considerably (p < 0.05) for group 1, where the vast majority of patients gained more than twice the strength in the pelvic apparatus (8.36 ± 6.65 before X 13.81 ± 8.92 after). The volunteers acquired an increase in the contraction of the muscles of the pelvic apparatus (p < 0.05) (3.45 ± 1.07); after laser application, this number increased considerably (4.27 ± 0.61). Endurance had an increase of almost 50% compared to placebo, demonstrating the resistance gain in the perineal muscles (3.90 ± 2.35 X 5 ± 1.90). We concluded that photobiomodulation treatment showed significant efficacy in relation to muscle fatigue in the pelvic apparatus right after a strengthening program in women with stress urinary incontinence.

Does imagining interrupting the flow of urine really elicit contractions of the pelvic floor muscles in stress-incontinent postpartum women?

Objectives:

This study evaluated if imagining interrupting the flow of urine really elicits contractions of the pelvic floor muscles (PFM) in stress-incontinent postpartum women.

Methods:

A total of 21 postpartum women with recent vaginal deliveries performed four trials of Kegel’s exercises, each prompted by a different contraction technique. PFM activities were measured with a surface electromyography via a vaginal electrode. Inferential statistics of repeated-measures one-way analysis of variance with Bonferroni post hoc analysis were performed to compare the effective recruitment of the PFMs across the four trials.

Results:

PFM activities significantly varied across the four trials ( p<0.001), with ‘imagination of interrupting urine flow’ eliciting the least muscular activity (25.40±10.98) and ‘abdominal bracing with hip adduction’ elicited the highest activity (49.67±11.33).

Conclusion:

Findings showed that utilizing many contraction techniques during Kegel’s education is more effective compared to educating patients with one contraction technique.

Level of Evidence:

Level 2.

Clinical functional evaluation of female's pelvic floor: integrative review

Abstract Introduction: The effectiveness of pelvic floor muscle training (PFMT) depends on the correct prescription of intensity, repetition and endurance of muscle contractions, which are provided by an adequate assessment of pelvic floor muscle. Objective: Verify the techniques, resources and strategies used for clinical functional evaluation of female pelvic floor (PF) described in literature. Methods: It’s an integrative review of published studies and books from 2010 until December 2015. Relevant articles with complete description of PF evaluation were found through the use of Scielo, LILACS, PubMed and Medline databases. Results: 34 articles that fulfilled all the criteria were selected. Conclusion: The most used techniques, resources and strategies were: anamnesis, physical examination, measurement of pelvic floor muscle activity using Modified Oxford Scale or perineometry, and use of questionnaires to analyze patient's perspective of their own symptoms. Thus, we could use the parameters obtained in the evaluation to plan an ideal PFMT for each patient, so the physiotherapist would have a good database to analyze the evolution and define the end of therapy.