Navegando por Palavras-chave "Pelvic floor"

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    Assessing the Impact of Twin Pregnancies on the Pelvic Floor Using 3-Dimensional Sonography A Pilot Study
    (Amer Inst Ultrasound Medicine, 2014-07-01) Kubotani, Juliana Sayuri [UNIFESP]; Araujo Junior, Edward [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Passos, Jurandir Piassi [UNIFESP]; Jarmy Di Bella, Zsuzsanna Ilona Katalin de [UNIFESP]; Elito Junior, Julio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives-The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies.Methods-We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test.Results-For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. for the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. the differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). the mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm(2) at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm(2).Conclusions-Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.
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    Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2013-03-01) Araujo Júnior, Edward [UNIFESP]; Freitas, Rogério Caixeta Moraes De [UNIFESP]; Di Bella, Zsuzsanna Ilona Katalin De Jármy [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Nakamura, Mary Uchiyama [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.
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    Avaliação do impacto da correção cirúrgica de distopias genitais sobre a função sexual feminina
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-10-01) Prado, Daniela Siqueira [UNIFESP]; Arruda, Raquel Martins [UNIFESP]; Figueiredo, Raquel Cristina De Moraes; Lippi, Umberto Gazi; Girão, Manoel João Batista Castello [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São Paulo Francisco Morato de Oliveira Serviço de Ginecologia e Obstetrícia; Hospital do Servidor Público Estadual de São Paulo Francisco Morato de Oliveira; Hospital do Servidor Público Estadual de São Paulo Francisco Morato de Oliveira Setor de Uroginecologia e Cirurgia Vaginal
    PURPOSE: to identify the impact of pelvic reconstructive surgery on female sexual function, as well as the changes in vaginal anatomy, and to detect possible correlations between them. METHODS: a prospective, descriptive study, including 43 sexually active women with genital dystopy, undergoing surgery for pelvic organ prolapse, conducted between October 2004 and September 2006. The women completed the same multiple-choice questionnaire regarding sexual function, and analogic scales to quantify the degree of desire, arousal and satisfaction, and were clinically assessed using the pelvic organ prolapse quantification (POP-Q) staging system, before the surgery and three and six months after it. Statistical analysis was performed through the Bowker test for symmetry, Wilcoxon test, Student t test, chi2 and analysis of variance (ANOVA) as appropriate, with statistical significance set at 5% (p<0.05). RESULTS: all 43 women completed the follow-up at three and six months after the surgery, but two of them lost their partners after the surgery. Quality of sexual life improved significantly (p=0.03). Symptoms such as dyspareunia (25.6% before versus 17.1% after surgery), discomfort (27.9 versus 0%), embarrassment (20.9% versus 0%) and fear (2.3% versus 0%) significantly improved (p<0.001). Analogical scales scores regarding desire (5 versus 7, p=0.001), arousal (6 versus 8, p<0.001) and satisfaction with sexual life (5 versus 7, p<0.001) also improved. There was a statistically significant improvement (p<0.001) of the POP-Q stages after the surgery. However, there was no statistically significant correlation between changes in vaginal dimensions and changes in sexual function. CONCLUSIONS: after pelvic reconstructive surgery, there was a significant improvement in the quality of sexual life and of the POP-Q stages. However, there was no correlation between them.
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    Comparação entre as terminologias padronizadas por Baden e Walker e pela ICS para o prolapso pélvico feminino
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2004-07-01) Bezerra, Leonardo Robson Pinheiro Sobreira [UNIFESP]; Oliveira, Emerson de [UNIFESP]; Bortolini, Maria Augusta Tezelli [UNIFESP]; Hamerski, Maria Gorete [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: to compare Baden and Walker's (BW) classification system to the International Continence Society (ICS) standardization of terminology of female pelvic organ prolapse. METHODS: information about urogynecological investigation on 101 women, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, was retrospectively analyzed. Only patients who had undergone the standard ICS exam which quantifies the pelvic prolapse were selected. According to ICS, the prolapse is analyzed through a standard reference system relating the hymen to the anatomic position of six vaginal points: two in the anterior vaginal wall, two in the vaginal apex and other two in the posterior vaginal wall. The maximum amount of pelvic organ prolapse was viewed and recorded during a Valsalva's maneuver. The measurement of the most distal point of the prolapse was performed and it was compared to the BW classification system. The data were analyzed by kappa statistics, to assess the concordance between the two terminologies. RESULTS: There was total correspondence only for the posterior vaginal prolapse stage IV (one patient) and for the uterus prolapse stage 0 (29 patients) with severe rectocele and absence of prolapse, respectively, according to BW. In the three types of prolapses evaluated, the values of kappa statistics were below 0.4, indicating a weak concordance between the two terminologies. There is an extensive variation in the measurement of the most distal point of prolapse when the BW classification is perfomed. CONCLUSIONS: there is a weak concordance between the BW classification system and the ICS standardization of terminology of female pelvic organ prolapse.
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    Correlação entre a consciência de contração da musculatura do assoalho pélvico e equilíbrio em mulheres jovens
    (Universidade Federal de São Paulo, 2021-02-24) Oliveira, Thais Passos de [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/9708331128224695; http://lattes.cnpq.br/3573062822600051; Universidade Federal de São Paulo (UNIFESP)
    A musculatura do assoalho pélvico (MAP) é responsável por diversas funções como as continências urinária e fecal, sustentação dos órgãos pélvicos e facilitação da resposta sexual. Para desempenhar suas funções corretamente, essa musculatura precisa ser acionada de forma correta e com boa força. Existem ainda alguns fatores pouco estudados, como por exemplo, o equilíbrio, que pode ter relação com a função da MAP. Essa hipótese parte do princípio de que há evidências que apontam que a principal disfunção do assoalho pélvico, a incontinência urinária, tem correlação com a diminuição do equilíbrio. Objetivo: Investigar se existe correlação entre a consciência de contração da MAP e equilíbrio em mulheres jovens e quais fatores podem influenciar na qualidade da contração dessa musculatura. Métodos: Foram avaliadas 90 mulheres na faixa etária entre 19 e 30 anos, com vida sexual ativa, sem condições que pudessem prejudicar ou interferir na avaliação do assoalho pélvico ou do equilíbrio. A coleta foi realizada em um único dia através de três etapas: ficha de avaliação clínica e uroginecológica, avaliação do assoalho pélvico e testes de equilíbrio através da plataforma de força. Resultados: Foram analisadas 78 mulheres jovens (23,71±2,85 anos) normotróficas (IMC médio= 23,56±5,82 kg/m²), sendo a maioria nulíparas (94,9%), estudantes universitárias (78,2%) e fisicamente ativas (78,1%). A maioria tinha consciência da correta contração da MAP (60,25%) e quando usaram musculatura acessória, encontrou-se com maior frequência o bloqueio inspiratório (45,43%). Além disso, as mulheres que apresentaram consciência de contração correta da MAP atingiram um maior tempo de sustentação (4,55±3,03s) dessa musculatura. A consciência de contração da MAP não mostrou uma associação estatisticamente significante com nenhuma das variáveis do equilíbrio. Quando separadas as mulheres que apresentaram boa ou inadequada consciência de contração da MAP, não houve diferença estatisticamente significativa em relação às variáveis demográficas, cirúrgicas, ginecológicas, obstétricas e uroginecológicas. Conclusão: A consciência de contração da MAP não apresentou correlação com as variáveis do equilíbrio. A apneia foi a associação mais presente quando as mulheres não conseguiram contrair corretamente a MAP. As variáveis demográficas, cirúrgicas, ginecológicas, obstétricas e uroginecológicas não influenciaram na consciência de contração da MAP.
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    Efeito da adição do biofeedback ao treinamento dos músculos do assoalho pélvico para tratamento da incontinência urinária de esforço
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2012-11-01) Fitz, Fátima Faní [UNIFESP]; Resende, Ana Paula Magalhães [UNIFESP]; Stüpp, Liliana [UNIFESP]; Costa, Thaís Fonseca [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To investigate the effect of adding biofeedback (BF) to the training of pelvic floor muscles (PFMT) for the treatment of stress urinary incontinence (SUI). METHODS: A prospective pilot study, randomized and controlled with women with SUI without sphincter deficiency, detected by urodynamic study and who performed the correct PFM contraction. Women with neuromuscular disorders and grade III and IV genital prolapse were excluded. Forty women were randomized into a Control Group and BF Group. The PFMT protocol with BF equipment consisted of three sets of ten slow contractions (tonic), with a holding time of six to eight seconds at each contraction followed by a rest period of equal duration. After each sustained contraction, they performed three to four fast contractions (phasic) in the supine and standing position twice a week, for a total of 12 sessions. We evaluated the effect of adding BF to PFMT on quality of life using King's Health Questionnaire (KHQ) regarding urinary symptoms based on a voiding diary and regarding the function of pelvic floor muscles by digital palpation. The evaluation was performed initially and after 12 treatment sessions. Data are reported as mean and standard deviation. The Mann-Whitney test was used for the analysis of homogeneity and to determine differences between groups, and the Wilcoxon test was used to determine possible differences between the times of observation, with the level of significance set at 0.05. RESULTS: A significant decrease in the scores of the domains assessed by the KHQ was observed in the comparison between groups, except for the general health domain (BF Group: 32.8±26.9 versus Control Group: 48.4±29.5, p<0.13). Accordingly, there was improvement in PFM function after treatment in the BF Group, regarding power (4.3±0.8, p= 0.001), endurance (6.0±2.2, p<0.001) and fast (9.3±1.9, p=0.001). When comparing the groups, the BF Group showed a positive result regarding power (BF Group 4.3±0.8 versus Control Group 2.5±0.9, p<0.001), endurance (6.0±2.2 BF Group versus Control Group 2.7±1.9, p<0.001) and fast (BF Group 9.3±1.9 versus Control Group 4.6 ± 3.2, p<0.001). Reduction of nocturnal urinary frequency (1.2±1.2 versus 0.7±0.9, p=0.02) and of effort urine loss (1.5±1.4 versus 0.6±0.8, p=0.001) was observed in the BF Group. CONCLUSION: The addition of BF to the PFMT for the treatment of SUI, applied according to the protocol described, improved PFM function, reduced urinary symptoms, and improved of the quality of life.
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    Efeitos das isoflavonas sobre o assoalho pélvico e a vascularização peri-uretral de mulheres na pós-menopausa
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2006-09-01) Accorsi, Leni Aparecida Spagna [UNIFESP]; Haidar, Mauro Abi [UNIFESP]; Simões, Ricardo Santos [UNIFESP]; Accorsi Neto, Alfeu Cornélio; Mosquette, Rejane [UNIFESP]; Soares Júnior, José Maria [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de Catanduva Departamento de Ginecologia; Universidade de São Paulo (USP)
    PURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women.
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    Efeitos do tratamento comportamental e do treinamento dos músculos do assoalho pélvico na síndrome da bexiga hiperativa: ensaio clínico randomizado controlado
    (Universidade Federal de São Paulo, 2013-11-07) Matias, Mayanni Magda Pereira [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Fitz, Fatima Fani [UNIFESP]; Bortoloni, Maria Augusta Tezelli [UNIFESP]; http://lattes.cnpq.br/0144526508674398; http://lattes.cnpq.br/1150368284144393; http://lattes.cnpq.br/6590913930590292; http://lattes.cnpq.br/0611209794570137
    Objetivo: O presente estudo tem como objetivo avaliar e comparar os efeitos do tratamento comportamental (TC) (que inclui as técnicas de mudanças no estilo de vida, programa educacional, treinamento vesical, supressão da urgência miccional e os exercícios dos músculos do assoalho pélvico associado ao treinamento dos músculos do assoalho pélvico (TMAP), do TC isolado e do TMAP isolado nas mulheres com síndrome da bexiga hiperativa (SBH) Métodos: Foi realizado um ensaio clínico randomizado e controlado em centro único com intervenção supervisionada. Cento e dez mulheres com SBH comprovada pelo diário miccional e pelo Overactive Bladder Questionnaire V8 (OAB-V8) foram randomizadas em três grupos: TC; TMAP; ou TC+TMAP. O objetivo primário foi avaliar a taxa de cura objetiva, considerando critério composto formado por: escore OAB-V8 <8 e ausência de episódios de incontinência urinária de urgência (IUU) no diário miccional. Os desfechos secundários foram avaliar os sintomas urinários (pelo diário miccional e OAB-V8), a função muscular (pela escala NEW PERFECT), a adesão ambulatorial e domiciliar aos exercícios, e a cura subjetiva (relato de satisfação e sem desejo de novo tratamento). Os testes não-paramétricos de Kruskal-Wallis, da Razão de verossimilhança, Qui-quadrado, e de Mann-Whitney foram usados para análise estatística com p valor < 0,05 como significante. Resultados: O percentual de cura objetiva foi significativamente maior no grupo TC + TMAP em comparação com o grupo TMAP e TC isolados nas análises per protocol (p=0,006) e intention-to-treat considerando as pacientes que perderam seguimento como curadas (p=0,004); e na comparação de intention-to-treat considerando as pacientes excluídas como não curadas, o grupo TC+TMAP foi superior em relação ao grupo TMAP (p=0,044). Observou-se similar redução dos sintomas urinários (frequência urinária, urgência miccional, IUU, noctúria e troca de protetor para perda de urina nos três grupos estudados após 12 semanas de tratamento comparado com os sintomas iniciais (p<0,05). O grupo TC+TMAP apresentou escore do OAB-V8 significativamente menor do que os grupos TMAP (p=0,040) e TC (p=0,027). Ainda, observa-se superioridade da performance muscular nos grupos TC+TMAP (p=0,001) e TMAP (p=0,002), bem como melhor endurance nos grupos TC+TMAP (0,004) e TMAP (p=0,0004), e ainda no número de contrações rápidas nos grupos TC+TMAP (p=0,004) e TMAP (p=0,005) quando comparados ao grupo TC. Não observamos diferença entre os grupos TC+TMAP e TMAP em relação ao número de séries de exercícios realizados semanalmente após o 1º, 2º e 3º meses de tratamento (p>0,05). A frequência nas sessões ambulatoriais foi semelhante entre os grupos, variando de 5 a 6 sessões em 12 semanas de tratamento. Os grupos do estudo foram semelhantes em relação à cura subjetiva. Conclusão: A combinação do tratamento comportamental com o treinamento dos músculos do assoalho pélvico mostrou-se mais efetivo do que as terapias isoladas no manejo das mulheres com SBH: maior taxa de cura objetiva e melhor qualidade de vida.
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    The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review
    (Pontifícia Universidade Católica do Paraná, 2014-12-01) Jácomo, Raquel Henriques; Fitz, Fátima Fani; Alves, Aline Teixeira; Fernandes, Isabella Silveira; Teixeira, Fellipe Amatuzzi; Sousa, João Batista De; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP); Faculdade de Ciências Médicas de Minas Gerais
    Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.
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    Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial
    (Associação Paulista de Medicina - APM, 2012-01-01) Bernardes, Bruno Teixeira [UNIFESP]; Resende, Ana Paula Magalhães [UNIFESP]; Stüpp, Liliana [UNIFESP]; Oliveira, Emerson [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Jármy Di Bella, Zsuzsanna Ilona Katalin [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Uberlândia Department of Gynecology and Obstetrics
    CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo (UNIFESP). METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.
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    Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women
    (Springer, 2012-08-01) Resende, Ana Paula Magalhães [UNIFESP]; Petricelli, Carla Dellabarba [UNIFESP]; Bernardes, Bruno Teixeira [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Nakamura, Mary Uchiyama [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG).Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. the healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. the nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. the evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. in the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM.In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 mu v) than in the pregnant group (30 mu v), with p < 0.001. the same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005).In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.
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    Estudo randomizado controlado duplo-cego de avaliação do efeito da fotobiomodulação intravaginal em mulheres com transtorno da dor gênito-pélvica/penetração secundário a dor miofascial do assoalho pélvico
    (Universidade Federal de São Paulo, 2023-05-02) Chamma, Bruna Mello [UNIFESP]; Schor, Eduardo [UNIFESP]; Ploger, Christine [UNIFESP]; http://lattes.cnpq.br/4694996196890284; http://lattes.cnpq.br/8854353153245040; http://lattes.cnpq.br/2642338953044012
    A dor gênito-pélvica/penetração inclui os conceitos de dispareunia e vaginismo, onde há espasmo da musculatura de assoalho pélvico. A dor miofascial do assoalho pélvico (DMFAP) possui duração de pelo menos seis meses, e é frequentemente associada com pontos gatilho. O tratamento para a dor miofascial é clínico e pode ser realizado com recursos mais invasivos (como infiltração de anestésicos, acupuntura e agulhamento a seco) ou mais conservadores (como relaxantes musculares, modificações comportamentais, termoterapia, crioterapia, técnicas de terapia manual e a fotobiomodulação). A fotobiomodulação aumenta o aporte sanguíneo para as células no ponto gatilho que estão em hipoxemia, com a melhora da microcirculação local e favorece a remoção dos metabólitos celulares, quebrando o ciclo dor-espasmo-dor. Objetivo: Verificar o efeito da fotobiomodulação, em mulheres com queixa do transtorno da dor gênito-pélvica/penetração, secundária a dor miofascial. Método: Estudo randomizado controlado duplo cego com 25 pacientes com queixa de dor gênito pélvica/penetração divididas em 2 grupos: grupo de fotobiomodulação e o grupo placebo. As mulheres foram submetidas a 10 sessões de fotobiomodulação no assoalho pélvico e responderam a questionários específicos de pré e pós o protocolo de 10 sessões. Resultados: Com relação a intensidade da dor gênito pélvica/ penetração houve redução da queixa após a aplicação da fotobiomodulação (p= <0.001). No questionário FSFI observamos, diminuição significativa, após a aplicação da FBM no domínio dor(p=<0,001). Houve, também melhora significativa no desejo (p= 0,010), excitação (p= 0,033) e satisfação (P= 0,018). Com relação a lubrificação vaginal e orgasmo não houve diferença estatística. Conclusão: A fotobiomodulação se apresenta como potencial nova ferramenta para o tratamento, fisioterapêutico, de mulheres com dor gênito pélvica/penetração.
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    Acesso aberto (Open Access)
    Fisioterapia para consciência perineal: uma comparação entre as cinesioterapias com toque digital e com auxílio do biofeedback
    (Pontifícia Universidade Católica do Paraná, 2012-09-01) Pinheiro, Brenda de Figueiredo; Franco, Gisela Rosa; Feitosa, Suellen Maurin; Yuaso, Denise Rodrigues; Castro, Rodrigo de Aquino [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: A significant number of women (around 30 to 50%) are unable to contract correctly their pelvic floor muscles when given a command. OBJECTIVE: This study's objective was to compare pelvic floor muscle training with digital palpation to pelvic floor muscle training with biofeedback for perineal consciousness of women with stress urinary incontinence. METHOD: It was conducted a randomized clinical trial, comprising two groups, each of them formed by five interventional women with stress urinary incontinence and without perineal consciousness. RESULTS: Initially, the biofeedback group was formed by six women and the pelvic floor muscle training group was formed by five women, but one patient was excluded from the biofeedback group during the research. It was observed that there was a statistically significant improvement in both groups for the Power, Endurance, Fast and knowledge of the perineal region, but there was no significant difference between the two groups, i.e., both treatments are equally effective. CONCLUSION: Given the results, we conclude that both pelvic floor training with digital palpation and with biofeedback are excellent treatment options to gain perineal awareness.
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    Acesso aberto (Open Access)
    Hiperatividade do detrusor: comparação entre oxibutinina, eletroestimulação funcional do assoalho pélvico e exercícios perineais. Estudo randomizado
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-09-01) Arruda, Raquel Martins [UNIFESP]; Sousa, Gabriela Olbrich de [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    PURPOSE: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. METHODS: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson chi2, analysis of variance (ANOVA) and the paired t-test were used. RESULTS: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p<0.05). There was reduction in the frequency of micturition in the Oxybutynin Group (p=0.014). Oxybutynin and ES Groups had reduction in nocturia episodes (p=0.003 and p=0.036, respectively). There were no significant differences in improvement between the three groups (p>0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who had accomplished oxybutynin, ES and PFT, respectively, were satisfied, without differences among the groups (p = 0.142). Urodynamic was normal in 8 (36.4%), 12 (57.1%) and 11 (52.4%) patients of the Oxybutynin, ES and PFT Groups, respectively. This urodynamic analysis revealed no differences between the three groups (p=0.358). The reduction of urge-incontinence correlated with patient satisfaction (p<0.05). CONCLUSIONS: treatments were equally effective; reduction of urge-incontinence was correlated with patient satisfaction.
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    Acesso aberto (Open Access)
    Identificação das estruturas músculo-ligamentares do assoalho pélvico feminino na ressonância magnética
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2001-12-01) Bezerra, Maria Rita Lima [UNIFESP]; Soares, Adriano Fleury F. [UNIFESP]; Faintuch, Salomão [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To determine the frequency and to assess the interobserver agreement of identification of muscular and ligamentous pelvic floor structures using magnetic resonance imaging. METHOD: Twenty asymptomatic female volunteers (aged 20--80 years old; mean: 50) were submitted to magnetic resonance imaging (1.5 T) examinations of the pelvis. Turbo spin-echo sequences were employed to obtain T1 and T2 weighted images on axial and sagittal planes. Two independent observers evaluated the scans in order to identify the levator ani (coccygeal, pubococcygeal, iliococcygeal and puborectalis muscles), obturatorius internus and urethral sphincter muscles, and the pubovesical and pubourethral ligaments. The frequency and the interobserver agreement of the identification of the anatomical structures were assessed (kappa statistic -- kappa). RESULTS: The frequency of identification of the structures ranged from 50 to 100%, and was slightly lower for identification of the ligaments. Interobserver agreement was as follows: levator ani and obturatorius internus muscle (kappa=1), pubococcygeal (kappa=0.62), iliococcygeal (kappa=0.86), puborectalis (kappa= 0.27), coccygeal (kappa=0) and urethral sphincter muscles (kappa=1), pubovesical (kappa=0.50) and pubourethral (kappa=0.58) ligaments. CONCLUSION: Magnetic resonance imaging of the pelvis allowed precise identification of the main muscular and ligamentous pelvic floor structures in most individuals, whereas interobserver agreement was considered good.
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    Acesso aberto (Open Access)
    Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence
    (Associação Paulista de Medicina - APM, 2007-09-01) Zanetti, Míriam Raquel Diniz [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Rotta, Adriana Lyvio [UNIFESP]; Santos, Patrícia Diniz dos [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo (UNIFESP). METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.
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    Acesso aberto (Open Access)
    Impacto dos exercícios hipopressivos na função muscular do assoalho pélvico e nos sintomas urinários de mulheres com incontinência urinária de esforço: ensaio clínico randomizado controlado
    (Universidade Federal de São Paulo (UNIFESP), 2018-11-28) Costa, Thais Fonseca [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Jármy Di Bella, Zsuzsanna Ilona Katalin de [UNIFESP]; http://lattes.cnpq.br/7368804318575164; http://lattes.cnpq.br/2545470341657690; http://lattes.cnpq.br/8795557222228448; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate and compare the activation of pelvic floor muscles (MAP) during the exercise of Gynastic Abdominal Hypopressive (GAH) and pelvic floor muscle training (TMAP) by means of surface electromyography (EMG) after three months of training. Methods: Twentysix women with stress urinary incontinence (SUI) were included. Patients were randomized to the GAH (n = 16) or TMAP (n = 15) groups. Primary outcome measures: Evaluate the surface EMG activity of the MAP (during the execution of the GAH and TMAP technique after three months of training). Secondary outcome measures: Objective cure of SUI at the threemonth followup (assessed by pad test <2g); mean of weekly episodes of urinary loss (by 7day voiding diary); function of the pelvic floor muscles (MAP) (by the Oxford and Perfect scale); evaluation of the Maximum Voluntary Contraction (CVM) (by surface EMG after three months); quality of life through the Incontinence Quality of Life Questionnaire (IQoL) ; Check the adherence to the home exercises in the three months of treatment. Evaluations were performed at baseline and after three months of treatment. Statistical analysis: ANOVA and Student's t test with 5% cut for significance. Results: The TMAP group presented significantly greater muscle activation, measured by the EMG, during the execution of the exercise when compared to the GAH group. Both groups presented the same objective cure and decrease of SUI severity (by pad test and sevenday voiding diary). Both groups presented similar improvement of the muscular function in the measures of Oxford, Endurance, Repetition and Fast; and when the groups were compared, the TMAP group presented better function in Oxford, Endurance and Repetition. In the CVM evaluation after three months of treatment, only the TMAP group presented better EMG activation of the MAPs. In relation to the improvement in the quality of life, evaluated by IQOL, when comparing the groups, there was no difference. In the evaluation of adherence to the home exercises, the TMAP group showed a better adherence only in the first month. Conclusions: Both GAH and TMAP had a positive impact on pelvic floor muscle function and urinary incontinence. GAH was not superior to TMAP, and it is possible that new studies with a larger sample size may find different results.
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    Acesso aberto (Open Access)
    Impacto dos exercícios hipopressivos na reabilitação do assoalho pélvico de mulheres com prolapso genital: estudo prospectivo, randomizado e controlado
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Resende, Ana Paula Magalhães [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Aim: To evaluate the effects of hypopressive exercises associated with pelvic floor muscles voluntary contraction in pereineal muscles of women with pelvic organ prolapse. Methods: In randomized controlled trial were compared two groups: intervention group (GI) and control group (GC). The groups were evaluated regarding to pelvic floor muscle function and pelvic organ prolapse stage. To evaluate the function, were used bidigital palpation, trough Oxford scale and the muscular endurance, time of contraction maintain in seconds. The surface electromyography was also used. It evaluates the pelvic floor muscle electrical activity. The pelvic organ prolapse stage was classified according to the Pelvic Organ Prolapse Quantification (POP-Q), by a gynecologist. The patients of GI Group underwent three individual sessions for learning the exercises, followed by three months of home exercises, with monthly appointments and fortnightly phone calls. The GC Group underwent to only one session, when received orientation to perform home exercises, without following a defined protocol. Both groups were revaluated after three months. Results: Were included 21 patients in GI group and 16 patients in GC group. The GI Group presented improvement of muscle function, measured by Oxford (p < 0,001), endurance (p < 0,001) and maximum voluntary contraction (MVC), evaluated trough surface electromyography (p=0,001). When compared both groups, GI group presented superior muscle function. With regard to pelvic organ prolapse, 70% of women in GI group decreased on stage of prolapse. This fact occurs in only 21% of women in GC group. Conclusion: hypopressive exercises associated with voluntary pelvic floor muscle contraction improved muscle function and decreased pelvic organ prolapse.
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    Acesso aberto (Open Access)
    Pelvic floor muscle training decreases hip adductors isometric peak torque in incontinent women: an exploratory study
    (Pontifícia Universidade Católica do Paraná, 2013-03-01) Correia, Grasiéla Nascimento; Ferreira, Cristine Homsi Jorge; Aveiro, Mariana Chaves [UNIFESP]; Pereira, Vanessa Santos; Driusso, Patricia; University of São Paulo Faculty of Medicine of Ribeirão Preto Department of Biomechanics, Medicine and Rehabilitation of Locomotor System; Universidade Federal de São Paulo (UNIFESP); Federal University of São Carlos
    INTRODUCTION: The pelvic floor muscle (PFM) training is the most common treatment for urinary incontinence (UI), however many women performed the contraction of PFM with associated contraction of abdominal, gluteus and hip adductors muscles. OBJECTIVE: To assess the effects of pelvic floor muscle (PFM) training on isometric and isokinetic hip adductors peak torque (PT) among women suffering from urinary incontinence (UI). MATERIALS AND METHODS: It is a longitudinal and prospective exploratory study. This study included 15 physically active women aged 45 years old and over, who presented complaints of UI. The PFM function (digital evaluation and perineometry), isometric and isokinetic hip adductors PT and one hour pad test were performed before and after treatment. The PFM training was performed in group, one hour once a week for 12 sessions. RESULTS: Significant improvement of PFM function and pressure level (p = 0.003), and significant decrease of hip adductors isometric PT and one-hour pad test, were found post-treatment. Moderate negative correlations between PFM contraction pressure and hip adductors isokinetic PT for dominant side (DS) (r = -0.62; p = 0.03) and non-dominant side (NDS) (r = -0.64; p = 0.02); and between PFM fast fibers contraction and hip adductors isometric PT for DS (r = -0.60; p = 0.03) and NDS (r = -0.59; p = 0.04) were also found. CONCLUSIONS: The PFM training decreased hip adductors PT and improved PFM functions and UI.
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    Acesso aberto (Open Access)
    Percepção das mulheres sobre a utilização do EPI-NO como preparação para o parto
    (Universidade Federal de São Paulo, 2023-06-26) Oliveira, Sofia Vilanova de [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Amaral, Maria Teresa Pace do [UNIFESP]; http://lattes.cnpq.br/2305678329011722; http://lattes.cnpq.br/9708331128224695; http://lattes.cnpq.br/2702625550995849; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Women's perception should be better understood, especially with regard to what they consider essential to prepare for the moment of vaginal delivery. Among the strategies used for physical preparation, those referring to the pelvic region stand out. Some of these techniques do not have solid scientific evidence, such as the use of vaginal dilators (Epi No ®). Objective: to know and understand what women think about preparing for childbirth with the use of Epi No ®. Methods: this is a clinicalqualitative study with 18 women who used the Epi No ® device during pregnancy. The inclusion criteria were: women who had a pregnancy with a single fetus, aged over 19 years, who wanted to participate in the study, and with easy access to the computer and the internet. Those with cognitive impairment, with hearing or speech impairment that would affect the interview, and those who had pathologies during pregnancy were excluded. After virtually answering a questionnaire containing anamnesis and obstetric records, a meeting was scheduled through the Google Meet platform. At this meeting, a semi-structured interview was held, which was recorded after the thematic script was acculturated. For data analysis, the content analysis technique was used. Results: fourteen women were analyzed, most of whom were married, with an average age of 33 years and complete higher education. Most of them used the Epi No ® seven to 14 times before giving birth and considered the importance of the equipment as a preparation for the birth to be high. The importance of using Epi No ® as a preparation for vaginal delivery was highlighted as the main themes of the interviews: the psychological help it offers was mentioned mainly, providing greater proprioception and increasing women's safety. The barriers of Epi No ® stand out the difficulty of handling without a specialized professional and the pain they felt during its use. Conclusion: the women reported satisfaction with the experience of using Epi No ® as a preparation resource for vaginal delivery. They noticed that the equipment favors the body's proprioception and allows them to experience a simulation of the expulsive period