Dissertations / Theses: 'Pelvic floor muscles'

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Brown, Cindy Christine. "Reliability of electromyography detection systems for the pelvic floor muscles." Thesis, Kingston, Ont. : [s.n.], 2007. http://hdl.handle.net/1974/948.

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Pires, Telma Filipa Rodrigues Pereira. "Effects of pelvic floor muscles training on prevention and treatment of stress urinary incontinence in pregnant." Master's thesis, Universidade de Aveiro, 2015. http://hdl.handle.net/10773/16541.

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Mestrado em Fisioterapia
Introduction: Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life (QoL). Pelvic floor muscle training (PFMT) is considered the first-line treatment and prevention of SUI in pregnant women. Since there are few randomized controlled trial studies (RCT) in this population, it is important to check the effectiveness of another randomized protocol of the PFMT. Objectives: This study aimed to verify the effects of PFMT between the Intervention Group (IG) and the Control Group (CG) and exploring the effects with and without PFMT, in pregnant women. Methods: Participated in this RCT, pregnant women (aged 21-44 years), having been applied two questionnaires: King's Health Questionnaire (KHQ's) and Broome Pelvic Muscle self-efficacy Scale. The amount of urine was assessed using the modified pad test (20 minutes) and the muscular strength of the Pelvic Floor Muscles (PFM) was measured with Oxford Grading Scale. There were two moments of assessment, T1: 1st time of evaluation (pre- delivery) and T2: 2nd time of evaluation (6 weeks after delivery). The IG was added an exercise plan with duration of six weeks, applicable in Preparation for childbirth classes and at home exercise plan for 9 weeks. Results:The loss of urine, quantified by the Pad test significantly reduced, 0.86±0.83at T1 to 0.50±0.67at T2 in IG (p= 0.021). The degree of muscle contraction, measured by the Oxford Grading Scale, increased significantly in IG (p<0.001) from 3.59±0.85 to 4.82 ± 0:39 and did not change significantly in the CG (p=0.609). The total KHQ and severity of symptoms were observed significant improvements in both groups (p <0.05). As for the scale of Broome - Total scale women's IG improved significantly (p = 0.001 and p = 0.031, respectively) while in CG women no significant change (p> 0.05). Conclusion: PFMT can prevent and treat SUI, and recommend strength training of the PFM during pregnancy, two times per week for at least 6-9 weeks, making it extremely relevant for clinical practice.
Enquadramento: A Incontinência Urinária de Esforço (SUI) é o tipo mais comum em mulheres grávidas, tendo implicações prejudiciais para a qualidade de vida. O treino dos músculos do pavimento pélvico (PFMT) é considerado um tratamento de primeira linha para a SUI. Uma vez existirem poucos estudos randomizados controlados (RCT) nesta população, é importante verificar a eficácia de mais um protocolo randomizado de PFMT. Objetivos: Este estudo teve como objetivos verificar os efeitos do treino dos músculos do pavimento pélvico entre o grupo de intervenção (IG) e o grupo controle (CG) e explorar os efeitos com e sem treino dos músculos do pavimento pélvico, em mulheres grávidas. Métodos: Participaram neste RCT, mulheres grávidas (com idades compreendidas entre os 21-44 anos), tendo sido aplicados dois questionários: King´s Health Questionnaire (KHQ’s) e Broome Pelvic Muscle Self-Efficacy Scale. A quantidade de urina foi avaliada através do pad-test modificado (20minutos) e a força muscular dos músculos do pavimento pélvico (PFM) foi medida com o Oxford Grading Scale. Houve dois momentos de avaliação, a 1ª avaliação (T1), no período pré-parto e a 2ª avaliação (T2), 6 semanas após o parto. Ao IG foi acrescentado um plano de exercícios com duração de 6 semanas, aplicável nas aulas de preparação para o parto, com supervisão e um plano de exercícios ao domicílio, durante 9 semanas, sem supervisão. Resultados: A perda de urina, quantificada pelo pad test, reduziu significativamente, de 0.86±0,83 em T1 para 0.50±0.67 em T2 no IG (p = 0.021). O grau de contração muscular, avaliado pelo Oxford Grading Scale, aumentou significativamente no IG (p <0.001) de 3.59±0,85 para 4.82±0.39 e não sofreu alterações significativas no GC (p=0.609). No KHQ total e severidade dos sintomas observaram-se melhorias significativas em ambos os grupos (p <0,05). Quanto à escala de Broome – Total, as mulheres do IG melhoraram significativamente (p=0.001 e p=0.031, respetivamente) e nas mulheres do CG não se verificaram nenhumas alterações significativas (p> 0,05). Conclusão: O PFMT pode prevenir e tratar a SUI, e recomenda-se o treino da força do PFM durante a gravidez, 2 vezes por semana durante pelo menos 6-9 semanas, tornando-se de extrema relevância para a prática clínica.

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Van, der Walt Ina. "An investigation of pelvic floor muscle strength and vaginal resting pressure in nulliparous women of different race groups." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4196.

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Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The pelvic floor muscles (PFM) contribute to urinary continence and overactive PFM seem to be associated with pelvic pain syndrome (PPS). The literature indicates that ethnic differences regarding symptoms of urinary incontinence may exist. Research is needed to establish relationships between PFM function and symptoms reported by women of different ethnic groups. Objectives: To compare the PFM strength and endurance in black, white and coloured women. To investigate relationships between PFM strength, vaginal resting pressures, risk factors and symptoms associated with PFM dysfunction and PPS. Method: A cross-sectional study assessed the PFM strength and vaginal resting pressures of 122 nulliparous black (n=44), white (n=44) and coloured (n=34) university students. A self-developed questionnaire determined inclusion, demographic variables, factors affecting/factors associated with PFM strength and symptoms related to PPS. Maximum voluntary contraction pressure (cmH2O) and vaginal resting pressure (cmH2O) were measured with the Peritron TM 9300 (Cardio Design, Australia) used with the Camtech AS vaginal balloon sensor (Sandvika, Norway). Two sets of 3 maximum voluntary contractions of the PFM were recorded. Results: The mean age of the group was 22 ± 3.54 years and mean BMI of 23± 4.16 kg/m2. Black women (25 cmH2O ± 13.5) had significantly stronger PFM than white (p=0.02) or coloured (p<0.01) women, but no significant difference (p=0.78) in PFM strength existed between white (18.4 cmH2O ± 9.8) and coloured (15.6 cmH2O ± 8) women. In black women, PFM strength decreased significantly (p=0.02) between the sets, whereas no significant difference between sets was noted in the other ethnic groups. Increased PFM strength was associated with SUI (p=0.03) and amenorrhoea (p=0.01) and decreased PFM strength was associated with decreased frequency of bowel motion (p=0.01). In this sample, increased vaginal resting pressure was associated with menorrhagia (p=0.04). Conclusion: Black nulliparous women had stronger PFM than white and coloured women. There was no difference in PFM strength between white and coloured women. Endurance, as measured in this study, indicates that black women have decreased endurance of the PFM compared to white and coloured women. These findings inform the current research on ethnic differences in the prevalence of urinary incontinence. Preliminary data suggest that there was no relationship between vaginal resting pressures and symptoms of PPS and risk factors for PFM dysfunction, except for menorrhagia.
AFRIKAANSE OPSOMMING: Die bekkenvloer spiere (BVS) dra by tot urinêre kontinensie en ooraktiewe BVS kan moontlik geassosieer wees met pelviese pyn sindroom (PPS). Uit die literatuur blyk dit of daar etniese verskille bestaan in die simptome van urinere inkontinensie gerapporteer deur vroue. Navorsing is nodig om die verwantskap tussen BVS funksie en simptome wat deur pasiënte van verskillende etniese groepe gerapporteer word vas te stel. Doel: Om „n vergelyking te tref tussen BVS sterkte in swart, wit en kleurling vroue. Om vas te stel of daar assosiasies bestaan tussen BVS sterkte, rustende vaginale druklesings en risiko faktore en simptome geassosieer met bekkenvloer disfunksie en PPS. Metodologie: „n Dwarssnit studie het die BVS sterkte en rustende vaginale drukke van 122 nullipareuse swart (n=44), wit (n=44) en kleurling (n=34) universiteit studente geëvalueer. Insluiting, uitsluiting, demografiese veranderlikes, faktore wat kan affekteer/faktore geassosieer met BVS sterkte en simptome geassosier met PPS is deur „n self ontwikkelde vraelys geëvalueer. Maksimale willekeurige spiersametrekking drukke (cmH2O) en rustende vaginale drukke (cmH2O) was gemeet met „n Peritron™9300 perineometer (Cardio Design, Australië) wat saam „n vaginale ballon sensor (Camtech AS, Sandvika, Noorweë) gebruik is. Twee stelle van 3 maksimale willekeurige sametrekkings van die BVS was gemeet. Resultate: Die groep se gemiddelde ouderdom was 22±3.54 jaar en die gemiddelde liggaamsgewig indeks was 23±4.16kg/m2. Swart vroue (25 cmH2O ±13.5) het beduidend sterker BVS gehad as wit (p=0.02) en kleurling (p<0.01) vroue, maar daar was geen beduidende verskil (p=0.78) in BVS sterkte tussen wit (18.4 cmH2O ± 9.8) en kleurling (15.6 cmH2O ± 8) vroue nie. Die BVS sterkte in swart vroue het beduidend (p=0.02) verminder tussen die stelle, maar geen beduidende verskille was waargeneem in die ander etniese groepe tussen stelle. Verhoogde BVS sterkte was geassosieer met druklek (p=0.03), amenorrhoea (p=0.01) en verminderde BVS sterkte was geassosieer met verminderde frekwensie van opelyf (p=0.01). Verhoogde rustende vaginale drukke was geassosieer met menoragie in hierdie steekproef. Gevolgtrekking: Swart nullipareuse vroue het sterker BVS gehad as wit en kleurling vroue, Daar was geen verskil in BVS sterkte tussen wit en kleurling vroue nie. Uithouvermoë soos in hierdie studie getoets toon dat swart vroue verminderde uithouvermoë het i.v.m. wit en kleurling vroue. Hierdie bevindings dra by tot die huidige navorsing oor etniese verskille in die prevalensie van urinêre inkontinensie. Daar was geen verwantskap tussen vaginale rustende drukke en simptome van PPS en risiko faktore vir die ontwikkeling van bekkenvloer disfunksie, behalwe vir menoragie.

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Brooks, Kaylee. "Characteristics Predictive of Successful Pelvic Floor Muscle Training Outcomes Among Women with Stress Urinary Incontinence." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36667.

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Physiotherapist-supervised pelvic floor muscle (PFM) training is the recommended first-line treatment for women with stress urinary incontinence (SUI); however, only up to 50% of women are cured with this treatment. The primary objective of this study was to develop a predictive model of successful physiotherapy intervention outcomes among women with SUI using predictors that are accessible to clinicians. The secondary objective of this study was to run a preliminary investigation of morphologic differences between women with SUI who were cured with a physiotherapy intervention and those who were not cured, using a subset of ultrasound imaging data. Seventy-nine women with SUI were assessed at baseline on measures of demographic data (i.e. age, body mass index, etc.), 3-day bladder diary, 30-minute standardized pad test, clinical assessments of PFM strength and tone, and transperineal ultrasound assessments of PFM morphology. Women then attended a 12-week physiotherapy intervention and returned for a follow-up assessment. The multivariate logistic regression model was significant (p < .001) with two predictors: baseline ICIQ-FLUTS UI subscale (SUI severity; p = .01) and parity (p = .06). A significant ROC curve for the ICIQ-FLUTS UI subscale (p ˂ .01) predicts physiotherapy intervention outcomes with 55.6% sensitivity and 80.8% specificity at a cut-off score of 7.50. Women most likely to be cured with a physiotherapy intervention were those with lower scores on the ICIQ-FLUTS UI subscale and those who have given birth to fewer children. Significant differences were found in a subset of data between women with SUI who are cured with the physiotherapy intervention and women who are not cured on morphologic measures in standing of bladder neck height at peak cough (p = .03), descent of the bladder neck during maximal Valsalva maneuver (MVM; p = .04), levator hiatus circumference at rest (p = .03) and at maximal voluntary contraction in both standing and supine (MVC; p = .01; p = .03). Variables that were trending towards significance included bladder neck height in standing at rest, levator plate length (LPL) at maximal excursion during a cough and MVM in standing, and mid-urethral wall cross-sectional area. These significant differences indicate potential value in using ultrasound imaging outcomes as predictors of a cure with physiotherapy intervention in future models, and a combination of demographic, clinical, and morphologic variables may build a more robust predictive model.

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Semmen, Mahin. "Are Age-related Changes Evident in the Active and/or Passive Components of Pelvic Floor Muscle Force Outcomes in Nulliparous Women?" Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37717.

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Background: Age-related changes in pelvic floor muscle (PFM) biomechanics may contribute to urinary incontinence in older women; however, empirical evidence is scant. Purpose: This study aimed to understand the age-related changes in the biomechanical properties of the PFMs in women with no major risk factors for urinary incontinence. Methods: Thirty-three nulliparous women (20-64 years) were recruited to study active force, rate of force development, endurance, resistance to passive stretch and stiffness properties of the PFMs using an automated dynamometer. Separate regression analyses were performed to investigate the relationship between age and each outcome measure. Results: No significant relationships were observed between age and any of the outcome measures. Conclusion: The findings from this study do not support the presence of any age-related changes in PFM mechanics among women aged 20-64. Recruiting women over the age of 65 may be essential to detect age-related changes in PFM biomechanics in nulliparous women.

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Thubert, Thibault. "Impact d'un détournement d'attention sur les mécanismes neuromusculaires impliqués dans la contraction des muscles du plancher pelvien." Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066178/document.

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But: L’attention semble avoir un impact sur le fonctionnement des muscles périnéaux.Matériels : L’activité électromyographique (EMG) du sphincter anal externe (SAE) a été receuillie au cours d’effort de contractions périnéales volontaires et reflexe (provoquées par la toux) réalisées en réponse à un stimulus au marteau reflexe chez des femmes volontaires saines avec et sans épreuve de charge cognitive (ECC). Le temps de réaction (RT1) correspondant à la latence entre le stimulus et le début d’activité EMG du SAE lors d’une contraction périnéale volontaire, le RT3, correspondant au temps de latence entre le début d’activité EMG du SAE et le début d’activité EMG des muscles intercostaux externes (ICE) lors d’un effort de toux, ont été mesurés. Après randomisation (1/2) 13 femmes ont bénéficié d’une rééducation en double tache (cognitivo-musculaire) et 26 femmes constituaient le groupe témoin. Ces mêmes paramètres ont été enregistrés avant et apres rééducation dans les deux groupes.Resultats: Une ECC provoque un allongement du RT1 par un facteur 3,98 (p<0,001). Une ECC entrainne une diminution de 29% de la contraction périnéale réflexe: RT3 était respectivement de -80.00 ms sans ECC contre -56,7 ms en cas d’ECC (r=0,7, p=0,0045). Dans le groupe « rééducation » le RT1 en présence d’une ECC passait de 461,1 à 290,7 ms (r=0,6, p=0,006) contre 370 à 343 ms dans le groupe témoin (r=0,9, p=NS). Le RT3 dans le groupe « rééducation » en absence d’une ECC passait de -68,5 à -127,8 ms (r=1,9, p=0,03) et en présence d’une ECC de -42,6 ms à -59,3 ms (r=1,4, p=0,04). Conclusion: Une rééducation specifique corrige les effets provoqués par une ECC sur la contraction périnéale
Aims: Attention may be involved in pelvic floor muscles (PFM) Methods: The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded on healthy female volunteers, during voluntary and involuntary (induced by cough) PFM contraction, elicited by local stimulation, combined (or not) with a mental Distraction Task (DT). Reaction time (RT1), ie. the latency between stimulus and the onset of EAS EMG activity, RT3, ie. the latency between the onset of EAS EMG activity and the onset of External intercostal muscle (EIC) (cough) were measured. Following randomisation (2/1) 13 volunteers underwent dual task cognitive (an attentional test and PFM exercises) rehabilitation program and 26 were the control group (no specific instruction). RT1 and RT3 were recorded before and after the program in both group.Results: The mental distraction task led to a 3.98 times greater reaction time between stimulus and EAS EMG activation (RT1), (p<0.001). DT led to a 29% shorter anticipation of the involontary PFM contraction: RT3 were respectively -80.00 ms without a DT versus -56.67 ms with a DT (r=0.7, p=0.004). In the rehabilitation group RT1 in DT conditions decreased from 461.1 ms to 290.7 ms (r=0.6, p=0.006)vs 370 to 343 ms in the control group (r=0.9, p=NS). In the study group RT3 without a DT increased from −68.5 ms to −127.8 ms (r=1.89, p = 0.03) and from 42,6 ms to -59,3 ms with a DT (r= 1.4, p=0.04).Conclusions: A specific dual task rehabilitation can prevent the effect of DT on PFM contraction characteristics

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Pereira, Larissa Carvalho 1983. "Fatores que interferem na contratilidade dos músculos do assoalho pélvico e na sua coativação com os músculos transverso abdome/oblíquo interno durante o ciclo vital feminino = estudo eletromiográfico = Factors that interfere on the contractility of the pelvic floor muscle and in its coactivation with the transversus abdomen/internal oblique during the female life cycle : electromyographic study." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312549.

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Orientadores: Cássio Luís Zanettini Riccetto, Simone Botelho
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O assoalho pélvico (AP) feminino é uma estrutura complexa e vulnerável, suscetível a uma série de alterações funcionais ao longo da vida. Ampliar o conhecimento sobre esta estrutura poderia prevenir ou mesmo tratar tais disfunções. Objetivo: (1) Avaliar e comparar a contratilidade dos músculos do assoalho pélvico (MAP) em diferentes fases do ciclo vital feminino: nuligestas; primigestas; puérperas primíparas; climatéricas e pós-menopausadas. (2) Correlacionar a contratilidade dos MAP e sua coativação a partir da contração dos músculos transverso abdome/oblique interno (TrA/OI) com os fatores: idade; prática de atividade física; gestação; Índice de Massa Corpórea (IMC); paridade; presença e severidade dos sintomas urinários. Métodos: 331 mulheres participaram do estudo e foram avaliadas através dos questionários: International Consultation on Incontinence Questionnaire - Short Form (ICIQ UI-SF) e International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para estudo dos sintomas urinários e eletromiografia (EMG) dos MAP para avaliação da contratilidade. Destas mulheres 92 foram submetidas também à EMG dos músculos TrA/OI e analisadas de acordo com os fatores propostos para estudar a influenciar da contratilidade na coativação. Resultado: Entre os grupos estudados, as nuligestas apresentam maior contratilidade (46.59±16.83?V) dos MAP, seguido do grupo das primigestas (35.31±18.22?V), puérperas de parto cesariana (33.28±13.00?V), puérperas de parto vaginal (31.23±16.12?V), climatéricas (25.81±17.57?V) e pós menopausadas (21.23±15.11?V). Houve correlação negativa entre a contratilidade dos MAP e a idade (p<0.0001), paridade (p<0.0001), ICIQ-SF (p=0.0001) e ICIQ OAB (p=0.0006). Não foi verificada correlação entre MAP e IMC (p=0.1348) e as mulheres que praticam atividade físca apresentam maior contratilidade dos MAP (p=0.03). Sobre os fatores que podem interferir na coativação foram significativos: a gestação (p=0.01), prática de atividade física (p=0.03) e altos valores do escore do ICIQ IU SF (p<0.0001). Em análise multivariada a atividade física juntamente com ICIQ IU SF influenciaram a contratilidade dos MAP e TrA/OI (p<0.001). Conclusão: A contratilidade dos MAP durante o ciclo vital feminino apresenta-se na seguinte ordem decrescente: nuligestas, primigestas, primíparas pós parto cesariana, primíparas pós parto vaginal, climatéricas e pós menopausadas. Os MAP apresentam sua contratilidade correlacionada inversamente com a idade, paridade, e escores do ICIQ SF e ICIQ OAB. A coativação entre o TrA/OI e os MAP é influenciada diretamente pela atividade física, e inversamente pela gestação e ICIQ IU SF. Em análise multivariada, verificou-se que, conjuntamente, a coativação é influenciada diretamente pela prática de atividade física e inversamente pelo escore ICIQ IU SF
Abstract: The female pelvic floor (PF) is a complex and vulnerable structure, susceptible to a number of functional changes throughout life. Increasing the knowledge of this structure could prevent or even treat such disorders. Objective: (1) To evaluate and compare the contractility of the pelvic floor muscle (PFM) at different stages of the female life cycle: nulliparous; primigravidae; primiparous postpartum women; climacteric and menopause. (2) To correlate the contractility of the PFM and their coactivation from the contraction of the transversus abdomen muscles/ internal oblique (TrA/IO) with the following factors: age; physical activity; pregnancy; Body Mass Index (BMI); parity; presence and severity of urinary symptoms. Methods: 331 women were evaluated through questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF) and International Consultation on Incontinence Questionnaire Overactive Bladder (OAB-ICIQ) for study of urinary symptoms and PFM electromyography (EMG) for contractility assessment. Of these women 92 were also submitted to the TrA EMG / IO muscles and analyzed according to the proposed factors to study the influence of contractility in coactivation. Results: Among the groups, the nulliparous have greater contractility (46.59 ± 16.83_V) of PFM, followed by the group of first pregnancy (35.31 ± 18.22_V), cesarean birth mothers (33.28 ± 13.00_V), vaginal birth mothers (31.23 ± 16.12_V), weather (25.81 ± 17.57_V) and postmenopausal (± 15.11_V 21:23). There was a negative correlation between the contractility of PFM and age (p <0.0001), parity (p <0.0001), ICIQ-SF (p = 0.0001) and ICIQ OAB (p = 0.0006). There was no correlation between the contractility of PFM and BMI (p = 0.1348). Women who practice physical activity have greater contractility of PFM About the factors that can interfere with coactivation were significant: pregnancy (p = 0.01), physical activity (p = 0.03) and high values of the ICIQ UI SF score (p<0.0001). In multivariate analysis, physical activity along with ICIQ UI SF influence the contractility of PFM and TrA/IO (p<0.001). Conclusion: The contractility of PFM during the female life cycle is presented in the following descending order: nulliparous, primiparous, primiparous after cesarean delivery, primiparous after vaginal delivery, climateric and postmenopausal. The PFM present their contractility inversely correlated with age, parity, and scores of ICIQ SF and ICIQ OAB. The co-activation between the TrA /IO and PFM is directly influenced by physical activity, and inversely by pregnancy and ICIQ UI SF. In multivariate analysis, it was found that, together, the co-activation is directly influenced by physical activity and inversely by ICIQ UI SF score
Doutorado
Fisiopatologia Cirúrgica
Doutora em Ciências

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Souza, Samantha de Miranda Ferreira 1984. "Treinamento dos músculos do assoalho pélvico de mulheres em idade reprodutiva = avaliação funcional e sexual = Pelvic floor muscles training of women in reproductive age: functional and sexual evaluation." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311585.

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Orientadores: Paulo César Giraldo, Rose Luce Gomes do Amaral
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) é uma técnica amplamente utilizada pela fisioterapia com o objetivo de aumentar a força muscular, aumentar o fluxo sanguíneo local e a mobilidade pélvica, além de informar a mulher sobre a sua anatomia e melhorar a conscientização corporal. O treinamento com esse foco poderia influenciar de maneira positiva a função dos músculos do assoalho pélvico (MAP) e a função sexual feminina. Objetivo: Avaliar as funções muscular e sexual feminina pré e pós TMAP de mulheres em idade reprodutiva sem disfunção uroginecológica e/ou sexual. Métodos: Ensaio clínico incluindo 68 mulheres nulíparas em idade reprodutiva sem disfunção uroginecológica e/ou sexual. A função dos MAP foi mensurada pré e pós TMAP pelas pressões intravaginais, potencial eletromiográfico de superfície (sEMG) e palpação bidigital. A função sexual foi avaliada pré e pós TMAP pelo questionário Female Sexual Function Index (FSFI) que enfatiza seis domínios (desejo, excitação, lubrificação, orgasmo, satisfação sexual e dor). O TMAP foi realizado em grupo, uma vez por semana durante 8 semanas, com 45 minutos de duração, usando 11 diferentes posições. Para cada posição foram solicitadas 5 contrações tônicas sustentadas por 6 segundos com igual tempo de relaxamento entre cada contração e 5 contrações fásicas, totalizando 110 contrações a cada sessão. As voluntárias foram orientadas a realizar em casa 30 contrações todos os dias da semana. Resultados: Foram observadas diferenças significativas ao compararmos os valores máximos das avaliações das pressões intravaginais pré e pós TMAP das contrações fásicas 41,7±13,7 vs. 47±14 (p=0,0023), tônicas de 10 segundos 42,7±13,8 vs. 47,7±15 (p=0,0085) e tônicas de 60 segundos 42,1±13 vs. 47,5±14,5 (p=0,0013) respectivamente. Também foram observadas diferenças significativas nos valores máximos do sEMG das avaliações pré e pós TMAP das contrações fásicas 27,7±11,2 vs. 31,3±12,6 (p=0,0009), tônicas de 10 segundos 27,7±10,9 vs. 31,5±13,6 (p=0,0017), tônicas de 60 segundos 28,6±11,8 vs. 31,1±13 (p=0,0232) e tempo de contração em segundos 41,7±22,1 vs. 49,3±27,7 (p=0,0252) respectivamente. Foram encontradas diferenças significativas pré e pós TMAP no escore total do FSFI 29,8±3,7 vs. 31,9±2,7 (p<0,0001) e nos domínios desejo 4,4±0,9 vs. 4,7±0,8 (p=0,0076), excitação 4,8±0,8 vs. 5,2±0,5 (p=0,0001), lubrificação 5,2±0,8 vs. 5,5±0,5 (p=0,0140) e orgasmo 4,5±1,4 vs. 5,3±0,9 (p<0,0001) respectivamente. Conclusão: O TMAP aumenta a função dos MAP e melhora a função sexual de mulheres em idade reprodutiva sem disfunção uroginecológica e/ou sexual
Abstract: Introduction: Pelvic floor muscles training (PFMT) is a technique widely used for physical therapy in order to increase muscle strength, increase local blood flow and pelvic mobility and inform women about their anatomy and improve awareness body. Training with this focus could positively influence the function of the pelvic floor muscles (PFM) and female sexual function. Objective: To evaluate the muscular function and female sexual function pre and post PFMT of women of reproductive age without urogynecologic and/or sexual dysfunction. Methods: A clinical trial including 68 nulliparous women of reproductive age without urogynecologic and/or sexual dysfunction. The function of the PFM was measured before and after the PFMT intravaginal pressures, potential surface electromyography (sEMG) and palpation bidigital. Sexual function was assessed before and after the PFMT the survey Female Sexual Function Index (FSFI) that emphasizes six domains (desire, arousal, lubrication, orgasm, sexual satisfaction, and pain). The PMAT group was performed once a week for 8 weeks, with 45 minutes using 11 different positions. For each position were requested 5 tonic contractions sustained for 6 seconds with equal relaxation time between contractions and 5 phasic contractions, totaling 110 contractions each session. The volunteers were instructed to perform 30 contractions at home every day of the week. Results: Significant differences were observed when comparing the maximum rating of intravaginal pressure pre and post PFMT of phasic contractions 41.7±13.7 vs. 47±14 (p=0.0023), tonic contractions of 10 seconds 42.7±13.8 vs. 47.7±15 (p=0.0085) and tonic of 60 seconds 42.1±13 vs. 47.5±14.5 (p=0.0013) respectively. There were also significant differences in the maximum values of sEMG pre and post PFMT of phasic contractions 27.7±11.2 vs. 31.3±12.6 (p=0.0009), tonic contractions of 10 seconds 27.7±10.9 vs. 31.5±13.6 (p=0.0017), tonics of 60 seconds 28.6±11.8 vs. 31.1±13 (p=0.0232) and contraction time in seconds 41.7±22.1 vs. 49.3±27.7 (p=0.0252), respectively. There were significant differences pre and post PFMT in total score FSFI of 29.8±3.7 vs. 31.9±2.7 (p<0.0001) and in those areas desire 4.4±0.9 vs. 4.7±0.8 (p=0.0076), arousal 4.8±0.8 vs. 5.2±0.5 (p=0.0001), lubrication 5.2±0.8 vs. 5.5±0.5 (p=0.0140) and orgasm 4.5±1.4 vs. 5.3±0.9 (p<0.0001) respectively. Conclusion: The PFMT increases the function of PFM and improves sexual function in women of reproductive age without urogynecologic and/or sexual dysfunction
Mestrado
Fisiopatologia Ginecológica
Mestra em Ciências da Saúde

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Czyrnyj, Catriona. "UROKIN: A Novel Software for Kinematic Analysis of Urogenital Motion Using Transperineal Ultrasound Imaging." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36147.

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Dynamic transperineal ultrasound (TPUS) video allows for kinematic analysis of urogenital morphology and mobility, however, measures are often limited to peak displacements of anatomical landmarks and are vulnerable to error incurred by probe rotation during imaging. This thesis aimed to (1) develop an algorithm to calculate kinematic curves of urogenital landmark motion from TPUS video and to (2) investigate the error incurred in these kinematic measures due to in-plane ultrasound probe rotation. UROKIN, a semi-automated software, was developed and, as a proof of concept, was used to identify differences in urogenital kinematics during pelvic floor muscle maximum voluntary contractions between women with and without stress urinary incontinence. A mathematical model revealed that the error incurred by TPUS probe rotation in the x- (anterior-posterior) and y- (cranial-caudal) directions, was a factor of: r, the radius of rotation; Ɵ, the in-plane angular probe rotation; and α, the angular deviation between the anatomical planes and the coordinate system in which error was calculated. As an absolute measure, the error incurred by in-plane probe rotation is reduced to a factor of only r and Ɵ. Moving forward, UROKIN must be adapted to include findings from (1), and must be tested for validity and reliability.

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Paulitsch, Alessandra Fayh. "O Magic Circle aumenta a atividade eletromiográfica abdominal e a pressão intravaginal no exercício The Hundred do Método Pilates?" reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/103910.

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O Método Pilates parte do princípio da centralização, no qual todo movimento começa e é sustentado no centro do corpo, chamado de centro de força, ou, ainda, de powerhouse. Com a finalidade de ajudar o praticante do método a localizar o powerhouse, aumentar o controle e o recrutamento dos músculos que o compõem, Joseph Pilates criou o acessório Magic Circle, o qual consiste num aro flexível com aproximadamente 40 cm de diâmetro, utilizado, entre outras finalidades, para aumentar a atividade dos músculos abdominais em alguns exercícios do Método Pilates. O objetivo deste trabalho foi comparar a atividade eletromiográfica abdominal, bem como analisar a pressão intravaginal, nos exercícios The Hundred e The Hundred modificado, executados com e sem o acessório Magic Circle. Foram analisados, simultaneamente, o sinal eletromiográfico de superfície dos músculos reto abdominal, oblíquo externo, oblíquo interno e adutor longo, e a pressão intravaginal durante a execução dos exercícios The Hundred e The Hundred modificado com e sem a utilização do Magic Circle. Verificou-se uma maior atividade nos músculos abdominais apenas quando o Magic Circle foi utilizado em situações de instabilidade, enquanto a pressão intravaginal não foi afetada pelo uso do acessório. O Magic Circle pode ser recomendado para uma maior ativação da musculatura abdominal nas situações de maior instabilidade mecânica e não é recomendado quando se busca uma maior pressão intravaginal.
The Pilates method is based on the centering principle, in which every movement starts and is supported by the center of the body, called strong core or powerhouse. In order to help the practitioner locate the powerhouse and increase the control and recruitment of its muscles, Joseph Pilates created the accessory Magic Circle, which consists of a flexible ring, approximately 40cm wide, used, among other purposes, to increase abdominal muscle activity in some exercises of the Pilates Method. The aim of this study was to compare the abdominal electromiographic activity, as well as to analyze intra-vaginal pressure in the exercises The Hundred and The Hundred modified, performed with and without the accessory Magic Circle. The study simultaneously analyzed the electomiographic signal on the surface of the rectus abdominis, external oblique, internal oblique, aductor longus, as well as intra-vaginal pressure during the performance of the exercises The Hundred and The Hundred modified with and without the use of the Magic Circle. There was higher activity on the abdominal muscles only when the Magic Circle was used in instability situations, while the intra-vaginal pressure was not affected by the use of the accessory. The Magic Circle can be recommended for higher activation of the abdominal muscles in mechanical instability situations and is not recommended when pursuing higher intravaginal pressure.

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Barbosa, Lia Janaina Ferla. "Função dos músculos do assoalho pélvico : comparação entre mulheres praticantes do método Pilates e sedentárias." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/108929.

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Pesquisas relacionadas os músculos do assoalho pélvico (MAP) tem ganhado espaço na última década principalmente quando se refere a alterações na sua função. A maioria das pesquisas encontradas na literatura diz respeito às disfunções dos MAP. É importante conhecer formas de condicionamento dessa musculatura que possa evitar a perda de função, seja por falta de exercícios os por alterações decorrentes do processo de envelhecimento. Sabe-se que em mulheres com disfunção o treinamento dos músculos do assoalho pélvico (TMAP) tem um efeito positivo na melhora da função desse grupo muscular o qual comumente é treinado isoladamente. Porém as formas de melhorar o condicionamento independente de um quadro de disfunção ainda são pouco investigadas, visto que mulheres não ingressam em um TMAP de forma preventiva. Já há registros de exercícios que podem gerar impacto negativo sobre a função dessa musculatura, como corrida e jump, mas não sobre exercícios que possam melhorar a função. A existência de um sinergismo entre os músculos profundos do tronco, em especial do transverso abdominal (TrA), e do assoalho pélvico (AP) é tema de estudos recentes e uma estratégia de prevenção seria a prática de exercício físico regular, que enfatize a coativação dos músculos abdominais e do AP. Assim, esta dissertação teve como foco de estudo identificar a presença ou não de sinergismo abdomino-pélvico em mulheres hígidas e também identificar se a função dos MAP de mulheres que praticam o Método Pilates diferem de sedentárias. O Método Pilates tem por objetivo melhorar o condicionamento de todos os grupos musculares que compõem o powerhouse, incluindo, portanto, TrA e os MAP. O primeiro estudo foi uma revisão sistemática das pesquisas que buscou identificar a presença de sinergismo em mulheres sem disfunções do assoalho pélvico. Tal revisão seguiu as recomendações propostas pela Colaboração Cochrane e a busca na literatura incluiu as bases MEDLINE, Cochrane CENTRAL e EMBASE, além de busca manual, do início das bases até agosto de 2013. Foram incluídos estudos observacionais transversais, com mulheres hígidas que foram avaliadas quanto à presença de sinergismo abdomino-pélvico. Foram incluídos 10 artigos e todos demonstraram a existência de sinergismo entre os músculos abdominais e músculos do assoalho pélvico (MAP) em mulheres hígidas nas posturas supina, sentada e em ortostase. O conhecimento desse sinergismo pode favorecer a proposição de estratégias de tratamento e prevenção das disfunções dos MAP feminino. O segundo estudo que compôs esta dissertação teve por objetivo verificar se existe diferença na função dos MAP entre mulheres praticantes do Método Pilates e sedentárias. O estudo foi observacional e transversal, com uma amostragem composta por mulheres praticantes do Método Pilates (GMP) e sedentárias (GS). O nível de significância e o poder estatístico foram fixados em 5% e 80%, respectivamente, e o tamanho da amostra foi de no mínimo 24 indivíduos para cada grupo - Grupo Método Pilates (GMP) e Grupo Sedentárias (GS). Para avaliação da função dos MAP utilizou-se a perineometria e a Escala PERFECT e uma Ficha de Anamnese. Foi utilizada estatística inferencial, sendo o nível de significância adotado menor ou igual a 0,05. Foram avaliadas um total de 60 mulheres, sendo 30 do GMP e 30 do GS. Este estudo demonstrou não haver diferença significativa entre o GMP e o GS em nenhuma das variáveis analisadas. Conclui-se que mulheres praticantes do Método Pilates não diferem de mulheres sedentárias em relação à função dos MAP.
Searches related muscles of the pelvic floor (MAP) has gained ground over the last decade particularly when it comes to changes in its function. Most studies found in the literature with regard to disorders of MAP. It is important to know ways of conditioning these muscles which can prevent loss of function, either by lack of exercise for the changes resulting from the aging process. It is known that the dysfunction in women with pelvic floor training (PFMT) muscles have a positive effect on the improvement of the function of this muscle group which is commonly trained alone. But the ways to improve the fitness of an independent frame of dysfunction are still poorly investigated, since women do not enter into a TMAP preventively. Already there are reports of exercises that can have a negative impact on the function of these muscles, such as running and jump, but not about exercises that can improve function. The existence of a synergism between the deep trunk muscles, particularly the transversus abdominis (TrA), and pelvic floor (AP) is the subject of recent studies and a prevention strategy would be the practice of regular exercise that emphasizes coactivation abdominal muscles and the AP. Thus, this dissertation focused study to identify the presence or absence of abdominal-pelvic synergism in healthy women and to identify the function of the MAP of women who practice Pilates differ from sedentary. The Pilates method aims to improve the conditioning of all muscle groups that make up the powerhouse, including therefore TrA and MAP. The first study was a systematic review of research aimed at identifying the presence of synergism in women without pelvic floor dysfunction. This review followed the recommendations proposed by the Cochrane Collaboration and the literature search included the MEDLINE, EMBASE and Cochrane CENTRAL databases, and manual search, the start of the bases until August 2013 transversal observational studies were included, with healthy women who were evaluated for the presence of abdominal-pelvic synergism. 10 articles were included and all demonstrated the existence of synergism between the abdominal muscles and pelvic floor muscles (PFMs) in healthy women in the supine, sitting postures and standing positions. Knowledge of this synergism may favor the proposition of strategies for treatment and prevention of disorders of the female MAP. The second study that composed this dissertation aimed to verify whether there are differences in the function of MAP between practitioners of Pilates and sedentary women. The study was observational and cross-sectional, with a sample composed by practitioners of Pilates (GMP) and sedentary (GS) women. The significance level and statistical power were set at 5% and 80%, respectively, and the sample size was at least 24 subjects for each group - Group Pilates Method (GMP) and Sedentary Group (GS). To evaluate the role of MAP was used perineometry and Scale PERFECT and a sheet of Anamnesis. Inferential statistics were used, and the significance level less than or equal to 0.05. A total of 60 women, 30 and 30 of the GMP GS were evaluated. This study showed no significant difference between the GMP and the GS in any of the variables analyzed. It is concluded that women who practice Pilates Method not differ from sedentary women in relation to the function of MAP.

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Darski, Caroline. "Associação entre a musculatura do assoalho pélvico e a função sexual de mulheres com diferentes tipos de incontinência urinária." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/151491.

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Introdução: Incontinência Urinária (IU) é comum na população feminina afetando um terço das mulheres adultas, podendo comprometer sua função sexual (FS). Ainda há controvérsia sobre o impacto da IU sobre a FS. A associação da FS e da funcionalidade da MAP é uma questão relevante que necessita aprofundamento. Objetivo: Comparar a FS de mulheres com Incontinência Urinária de Esforço (IUE) e Incontinência Urinária Mista (IUM), e correlacionar a funcionalidade da musculatura do assoalho pélvico (MAP) à FS destas mulheres. Método: Observacional e transversal, n=61 mulheres, de 30 a 70 anos que tiveram relação sexual nos últimos 12 meses. As participantes foram classificadas em dois grupos: IUE (n=22) E IUM (n=39). A avaliação foi constituída por ficha de anamnese, biofeedback pressórico, escala PERFECT, e questionário PISQ-12. A análise estatística foi realizada através do teste Shapiro-Wilk para verificar a normalidade dos dados. Para comparação dos dados foi utilizado o teste T de amostras independentes e o teste U de Mann-Whitney. Para correlação foi utilizado o teste de Correlação de Spearman. O nível de significância adotado foi de 5%. Resultados: Diferença significativa na paridade e duração da queixa entre os grupos; na comparação do escore total do PISQ-12 e no domínio físico; nos itens P e F da escala PERFECT. Não houve correlação significativa entre a CVM Média e o Escore Total PISQ-12. Conclusão: Não foi demonstrado correlação entre a função da MAP e a FS nos grupos. Porém, houve diferença significativa entre a FS nos grupos.
Introduction: Urinary Incontinence (UI) is common among the female population. It affects one third of adult women and can compromise their sexual function (SF). There are still controversy about the impacts of UI on the SF. The association of the SF and the functionality of the pelvic floor muscles (PMF) is a relevant issue that needs to be better comprehended. Goal: Comparing the SF of women with Stress Urinary Incontinence (SUI) and Mixed Urinary Incontinence (MUI), and correlating these women’s PMF functionality to their SF. Method: Observational and cross-sectional, n=61 women aged 30 to 70 yo, who had had sexual relations in the last 12 months. The participants were divided into two groups: SUI (n=22) and MUI (n=39). The assessment consisted of the anamnesis record, pressure biofeedback, PERFECT scale and the PISQ-12 questionnaire. Statistical analysis was carried out using the Shapiro-Wilk test to verify the normality of the data. The independent t-test and the Mann-Whitney U test were used for data comparison. Spearman’s rank correlation was used to correlate data. The adopted level of significance was 5%. Results: Significant difference between the groups regarding the parity and duration of complaints; the PISQ-12 total score and the physical domain; the items Power-Pressure and Fast of the PERFECT scale. There was no significant correlation between the Maximum Voluntary Contraction (MVC) and the PISQ-12 total score. Conclusion: The tests did not find a correlation between the PFM functions and the SF in the groups. However, there was a significant difference in the SF between groups.

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Cyr, Marie-Pierre. "Fonction des muscles du plancher pelvien chez les survivantes d’un cancer de l’endomètre atteintes de dyspareunie." Mémoire, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/11576.

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Contexte : Le cancer de l'endomètre est le plus fréquent des cancers gynécologiques. Il a été suggéré que les traitements oncologiques entraînent des dysfonctions des muscles du plancher pelvien. Ces dysfonctions pourraient contribuer au développement de conditions débilitantes comme la douleur lors des relations sexuelles (dyspareunie) qui atteint plus de la moitié des survivantes. Or, à l'heure actuelle, aucune étude n'a investigué la fonction des muscles du plancher pelvien en lien avec la dyspareunie chez des survivantes d'un cancer de l'endomètre. Objectifs : L'objectif principal vise à explorer les différences quant à la fonction des muscles du plancher pelvien entre des survivantes d'un cancer de l'endomètre atteintes de dyspareunie et des femmes sans douleur ayant subi l'hystérectomie totale pour des raisons bénignes. L'objectif secondaire est d'explorer les différences entre les deux groupes quant aux variables urogynécologiques, sexuelles, psychologiques et sociales. Méthodologie : Dans cette étude comparative exploratoire bicentrique, des survivantes d'un cancer de l'endomètre atteintes de dyspareunie (n=7) et des femmes asymptomatiques (n=7) ont assisté à une séance d'évaluation menée par une physiothérapeute. Les deux groupes ont été équilibrés selon l'âge, l'indice de masse corporelle et le nombre d'accouchements par voie vaginale. La fonction des muscles du plancher pelvien, y compris le tonus, la force maximale, la vitesse de contraction, la coordination et l'endurance, a été évaluée à l'aide du spéculum dynamométrique. Des questionnaires validés ont permis d'évaluer les variables secondaires. Des tests de Mann-Whitney ont été employés pour comparer les deux groupes quant à la fonction des muscles du plancher pelvien et les variables urogynécologiques, sexuelles, psychologiques et sociales (!=0,050). Résultats : Concernant la fonction des muscles du plancher pelvien, les survivantes atteintes de dyspareunie ont démontré un tonus à une ouverture vaginale minimale supérieur (p=0,018) et une endurance inférieure (p=0,048) aux femmes asymptomatiques. Les survivantes ont également présenté plus d'incontinence fécale (p=0,005) et une fonction sexuelle inférieure (p=0,004) comparativement aux femmes asymptomatiques. Aucune différence n'a été détectée pour les variables psychologiques et sociales. Conclusion : Les résultats de cette étude exploratoire suggèrent des dysfonctions des muscles du plancher pelvien, notamment un tonus supérieur et une endurance inférieure, chez les survivantes d'un cancer de l'endomètre atteintes de dyspareunie. D'autres études sont nécessaires afin de confirmer ces résultats. Ces constats préliminaires pourraient servir d'assises pour mieux comprendre les dysfonctions des muscles du plancher pelvien impliquées dans la dyspareunie chez cette population.
Abstract : Context: Endometrial cancer is the most common cancer in gynecological cancers. Oncological treatments are suggested to cause pelvic floor muscle dysfunction that could contribute to the development of debilitating conditions such as pain during sexual intercourse (dyspareunia), which affects more than half of survivors. However, to date, no study investigated pelvic floor muscle function in relation to dyspareunia in endometrial cancer survivors. Objectives: The main objective is to explore differences in pelvic floor muscle function between endometrial cancer survivors with dyspareunia and women without pain who underwent a total hysterectomy for benign conditions. The secondary objective is to explore differences between the two groups on urogynecological, sexual, psychological and social variables. Methodology: In this exploratory, bicentric comparative study, endometrial cancer survivors with dyspareunia (n=7) and asymptomatic women (n=7) attended one evaluation session conducted by a physiotherapist. The two groups were balanced in terms of age, body mass index and number of vaginal deliveries. The pelvic floor muscle function, including tone, maximal strength, contraction speed, coordination and endurance, was assessed with the dynamometric speculum. Validated questionnaires were used to evaluate secondary variables. Mann-Whitney tests were used to compare the two groups on muscular, urogynecological, sexual, psychological and social variables (!=0.050). Results: Concerning pelvic floor muscle function, survivors with dyspareunia demonstrated higher tone at a minimal vaginal aperture (p=0.018) and lower endurance (p=0.048) compared to asymptomatic women. Survivors also presented more fecal incontinence (p=0.005) and lower sexual function (p=0.004) compared to asymptomatic women. No differences were detected for psychological and social variables. Conclusion: The results of this exploratory study suggest impaired pelvic floor muscle function, notably higher tone and lower endurance, in endometrial cancer survivors with dyspareunia. Further studies are needed to confirm these findings. This preliminary evidence can be used as empirical data to better understand pelvic floor muscle impairments implicated in dyspareunia in this population.

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Syrkaševaitė, Eglė. "Dubens dugno raumenų treniravimo efektyvumas moterų šlapimo nelaikymo prevencijai." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2007. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2007~D_20070816_145220-81201.

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Tyrimo objektas. Moterų dubens dugno raumenų jėga ir jų treniravimo galimybės. Tyrimo problema. Dubens dugno raumenys vaidina svarbų vaidmenį šlapimo sulaikymui ir dubens organų palaikymui (Bo & Sherburn, 2005). Su amžiumi atrofuojasi (silpnėja ir nyksta) gleivinė, silpnėja dubens dugno raumenys, mažėja jungiamojo audinio, jis tampa ne toks elastingas, susilpnėja šlapimo pūslės sfinkteris (raumenų žiedas), pasikeičia šlapimo pūslės ir makšties anatomija (Thakar & Stanton, 2000). Kai sutrinka raumenų, laikančių uždarytą šlapimo pūslę, funkcija, gali atsirasti šlapimo nelaikymas. Ligoniai susiduria su daugybe socialinių ir psichologinių problemų, apribojamas žmogaus fizinis ir socialinis aktyvumas (Peeker et al., 2003). Tyrimo tikslas. Įvertinti dubens dugno raumenų treniravimo efektyvumą moterų šlapimo nelaikymo prevencijai. Tyrimo uždaviniai. 1. Įvertinti tiriamųjų dubens dugno raumenų jėgą prieš ir po kineziterapijos; 2. Įvertinti tiriamųjų dubens dugno raumenų pajėgumą amžiaus aspektu; 3. Nustatyti priklausomybę tarp dubens dugno raumenų pajėgumo, gimdymų skaičiaus ir gimdymo būdo; 4. Nustatyti ryšį tarp dubens dugno raumenų pajėgumo ir pilvo raumenų statinės ištvermės. Tyrimo metodika. Anketinės apklausos metu buvo išsiaiškintas tiriamųjų amžius, ūgis, svoris, gimdymų skaičius ir gimdymo būdas. Objektyvus dubens dugno raumenų jėgos testavimas buvo atliekamas penkiasdešimčiai moterų, naudojant dubens dugno raumenų treniruoklį bei dubens dugno raumenų funkcijos matavimo... [toliau žr. visą tekstą]
Object of research: Strength of women pelvic floor muscles and the possibilities of their training. Problem of research: Pelvic floor muscles play an important role in the urinary continence and support of pelvic organs (Bo & Sherburn, 2005). With age the mucous atrophies (weakens and wanes), the pelvic floor muscles weaken, connecting tissue diminishes, it becomes less elastic, sphincter (ring of muscles) of the bladder weakens, the anatomy of bladder and vagina changes (Thakar & Stanton, 2000). When the function of muscles that maintain the bladder closed disconcerts, the incontinence may manifest. Patients confront many social and psychological problems, physical and social activity of the person become limited (Peeker et al., 2003). Aim of research: Assess the effectiveness of pelvic floor muscle exercises to the prevention of incontinence of women. Goals of research: 1. Evaluate the strength of participants pelvic floor muscles before and after the physiotherapy; 2. Evaluate the strength of participants pelvic floor muscles with respect to the age; 3. Determine the relationship among the strength of pelvic floor muscles, number and ways of deliveries; 4. Determine the relationship between the strength of pelvic floor muscles and static endurance of abdominal muscles. Methods of research: With the help of questionnaire there were determined the age, height, weight, number of deliveries and ways of deliveries of participants. Pelvic floor muscle strength of fifty women was... [to full text]

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Duarte, Thaiana Bezerra. "Eficácia do treinamento dos músculos do assoalho pélvico associado à cirurgia para prolapsos de órgãos pélvicos (POP) em mulheres: ensaio clínico randomizado e controlado." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17152/tde-08062017-102357/.

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Os prolapsos dos órgãos pélvicos (POP) apresentam alta prevalência na população feminina, causando um grande impacto social e econômico negativo. Cerca de 11,1% das mulheres aos 80 anos têm indicação para a cirurgia de reparação de POP ou incontinência urinária. Há evidências de que o tratamento conservador, especificamente o treinamento dos músculos do assoalho pélvico (TMAP) é eficaz na redução dos sintomas do POP. No entanto, a literatura é escassa e controversa em relação à efetividade em associar-se o TMAP a procedimento cirúrgico quando há indicação cirúrgica. O objetivo primário deste estudo foi avaliar a eficácia em associar-se o TMAP a procedimento cirúrgico para correção de POP em relação aos seus sintomas. Os objetivos secundários foram verificar a capacidade de contração dos músculos do assoalho pélvico (MAP), a intensidade da contração voluntária máxima (CVM) dos MAP, percepção de melhora, a qualidade de vida, e função sexual. Foi conduzido um ensaio clínico randomizado e controlado com 96 mulheres com indicação médica para a cirurgia de reparação de POP em estágios II, III e IV alocadas em dois grupos: 48 no grupo submetido ao TMAP e 48 no grupo controle. O TMAP foi realizado em quatro sessões supervisionadas pré-cirúrgicas e sete sessões no pós-operatório. Todas as voluntárias foram avaliadas em três momentos: 15 dias antes da cirurgia e 40 e 90 dias após a cirurgia. O desfecho primário foi avaliado por meio do \"Questionário de desconforto no assoalho pélvico\" (PFDI-20) e os secundários por meio da Escala de Oxford Modificada, perineometria, \"Escala de impressão clínica global de melhora\" (PGI-I) \"Questionário de impacto no assoalho pélvico\" (PFIQ-7) e \"Questionário sexual para incontinência urinária e prolapso de órgãos pélvicos\" (PSIQ-12). Os dados foram analisados pela estatística descritiva por meio de frequências e porcentagens. Utilizou-se o teste t Student para verificar a diferença entre as médias dos dois grupos. Já o teste qui-quadrado para testar a diferença entre as proporções nas respostas dos dois grupos. Um modelo de regressão linear misto foi utilizado para verificar o efeito do tempo e dos grupos em relação aos desfechos. O nível de significância adotado foi p<=0,05. Ambos os grupos apresentaram melhora na sintomatologia após o seguimento. No entanto, não houve diferença significativa entre eles (4,3 IC 95%-14,4 a 23,2, p=0,65). Ambos os grupos apresentaram melhora na capacidade de contração dos MAP. Após 3 meses, a diferença entre os grupos em relação CVM foi -0,8 (IC 95% -8,1 a 6,4, p=0,81), em relação à percepção de melhora foi 0,4 (IC 95% -0,09 a 0,8, p=0,01), à qualidade de vida foi 2,7 (IC 95% -19,5 a 24,9, p=0,81) e em relação à função sexual -1,6 (IC 95% -7,6 a 4,4, p=0,59). Este estudo não demonstrou benefício adicional do TMAP em relação à sintomatologia de POP, capacidade de contração dos MAP, CVM dos MAP, qualidade de vida e função sexual. Entretanto, o grupo que recebeu o TMAP apresentou maior percepção de melhora
Pelvic organ prolapse (POP) has a high prevalence in the female population, causing a great negative social and economic impact. It is estimated that about 11.1% of women at age 80 are eligible for POP repair surgery or urinary incontinence. There is evidence that conservative treatment, specifically pelvic floor muscle training (PFMT), is effective in reducing POP symptoms. However, the literature is scarce and controversial regarding the effectiveness in associating PFMT with a surgical procedure when there is a surgical indication. The primary purpose of this study was to evaluate the efficacy in associating PFMT to a POP surgery in relation to its symptoms. The secondary purposes were to verify the capacity of pelvic floor muscles\' contraction (PFM), the maximum voluntary contraction (MVC) of the PFM, perception of improvement, quality of life and sexual function. A randomised controlled trial with 96 women with a medical indication for POP repair surgery in stage II, III and IV was conducted in two groups: 48 in the TMAP and 48 in control group. TMAP was performed in four supervised preoperative sessions and seven postoperative sessions. All volunteers were evaluated in three moments: 15 days before surgery and 40 and 90 days after surgery. The primary outcome was assessed using the \"Pelvic Floor Distress Inventory\" (PFDI-20) and the secondary endpoints using the \"Modified Oxford Scale\", perineometry, \"Patient Global Impression of Improvement\" (PGI-I), \"Pelvic Floor Impact Questionnaire\" (PFIQ-7) and \"Sexual Questionnaire for Urinary Incontinence /Pelvic Organ Prolapse\" (PSIQ- 12) and. Data were analyzed by descriptive statistics using frequencies and percentages. Student\'s test was used to verify the difference between the means in the groups. The chi-square test was performed to test the hypothesis whether there was a difference between the proportions of responses in both groups. A mixed linear regression model was used to verify the effect of time and groups on outcomes. The level of significance was set at p<=0.05. Both groups presented improvement in the symptomatology after the follow-up. However, there was no significant difference between them (4.3 95% CI -14.4 to 23.2, p=0.65). Both groups showed improvement in PFM contraction. After 3 months, the difference between groups in relation to MVC was -0.8 (95% CI -8.1 to 6.4, p=0.81), in relation to the perception of improvement was 0.4 (95% CI -0.09 to 0.8, p = 0.01), in relation to the quality of life was 2.7 (95%CI, p=0.81) and in relation to sexual function -1.6 (95% CI -7.6 to 4.4, p = 0.59) and This study did not demonstrated the additional benefit of PFMT on POP symptoms, PFM contraction, MVC, quality of life and sexual function. However, the group that received TMAP showed a greater perception of improvement

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Lapinskaitė, Loreta. "Diafragmos, skersinio pilvo ir dubens dugno raumenų funkciniai ryšiai ir jų kaita po gimdos šalinimo operacijos." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130613_144411-18873.

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Tyrimo tikslas: nustatyti diafragmos, skersinio pilvo ir dubens dugno raumenų funkcinius ryšius ir jų kaitą moterims po gimdos šalinimo operacijos. Tyrimo uždaviniai: 1. Įvertinti skersinio pilvo raumens aktyvumą ir ištvermę prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų. 2. Įvertinti diafragmos aktyvumą prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų; 3. Įvertinti dubens dugno raumenų jėgą ir ištvermę prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų. Tyrimo kontingentas ir metodai. Tyrime dalyvavo savanorės moterys, kurioms planuota gimdos šalinimo operacija. Jos atsitiktine tvarka buvo suskirstytos į dvi grupes: kontrolinę grupę (n=17), kurioje poveikis netaikytas, ir skersinio pilvo raumens lavinimo grupę (n=15), kurioje skirti skersinio pilvo raumens lavinimo pratimai. Diafragmos aktyvumas tirtas kvėpavimo slėgio matuokliu “MicroRPM“, dubens dugno raumenų jėga ir ištvermė – „Peritron 9300“ aparatu, o skersinio pilvo raumens aktyvumas ir ištvermė – Stabilizer“ prietaisu dieną prieš gimdos šalinimo operaciją ir praėjus šešioms savaitėms bei trims mėnesiams po jos. Išvados: 1. Po gimdos šalinimo operacijos, nelavinant skersinio pilvo raumens, jo aktyvumas ir ištvermė mažėja ir didžiausias mažėjimas stebimas šeštą savaitę po operacijos. Lavinant skersinį pilvo raumenį, jo jėga didėja tolygiai visu... [toliau žr. visą tekstą]
Research aim: To evaluate functional relations and their changes between diaphragm, transversus abdominis and pelvic floor muscles after hysterectomy. Objectives of study: 1.To evaluate an activity, endurance of transversus abdominis muscle in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. 2.To evaluate an activity of diaphragm muscle in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. 3.To evaluate strength and endurance of pelvic floor muscles in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. Contingent and methods of the study: All investigative women were divided randomly into two training groups: control (n=17), and transversus abdominis muscle (n=15). The strength of diaphragm was estimated with “MicroRPM“, pelvic floor muscles strength and endurance – „Peritron 9300“ device, and the activity and strength of transversus abdominis muscles was assessed with „Stabilizer“ one day before the operation of hysterectomy, six weeks and three months after it. Conclusions: 1.If there is no training of transversus abdominis muscle after uterus removal surgery, its activity and endurance decreases and the largest decrease is observed in the sixth week after surgery. While the transversus abdominis muscle is trained, its strength increases progressively all postoperative period and... [to full text]

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Silva, Valéria Regina 1983. "Comportamento dos músculos do assoalho pélvico e transverso do abdômen/oblíquo interno frente a dois programas de treinamento abdominopélvico em mulheres jovens nulíparas, continentes : estudo controlado, randomizado." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313089.

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Orientadores: Simone Botelho Pereira, Cássio Luís Zanettinni Riccett
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-27T01:20:14Z (GMT). No. of bitstreams: 1 Silva_ValeriaRegina_M.pdf: 1669073 bytes, checksum: 323991e89ad6dee82fb3e930b3074e31 (MD5) Previous issue date: 2015
Resumo: Introdução: A literatura recente tem investigado o efeito do treinamento abdominopélvico (TAP) como meio de prevenção e tratamento das disfunções do assoalho pélvico. Neste contexto, exercícios que promovam o treinamento muscular de forma global estão sendo explorados na pesquisa clinica. No presente estudo foram utilizados dois protocolos de TAP: um por meio de cinesioterapia e outro por meio de realidade virtual, a fim de investigar a interação dos músculos do compartimento abdominopélvico e, consequentemente, o comportamento dos músculos do assoalho pélvico (MAP) e Transverso do Abdômen (Tra) associado ao Obliquo Interno (OI), nas situações de contração voluntaria máxima (CVM), e de coativação. Objetivos: Investigar a atividade elétrica dos músculos do assoalho pélvico (MAP) e dos músculos abdominais (Tra/OI) frente a dois protocolos de treinamento: TAP Cinesioterapia (TAP CAP) e TAP Realidade Virtual (TAP RV); bem como identificar a presença de coativação entre os músculos. Pacientes e Métodos: Participaram desta pesquisa 47 mulheres jovens, nulíparas, continentes com idade média de 25,79 (±3,85) anos, divididas de forma randomizada em dois grupos: (G1) TAP_CAP (n=22) e (G2) TAP_RV (n=25). Os protocolos foram supervisionados por fisioterapeuta treinado, com duração de 30 minutos por sessão, três vezes por semana, totalizando 10 sessões. As mulheres foram avaliadas antes e após a realização dos protocolos, por meio de palpação digital (PD) dos MAP e eletromiografia (EMG) simultânea dos MAP e Tra/OI. Resultados: Os grupos apresentaram-se homogêneos quanto às condições sociodemográficas. Na avaliação por Palpação Digital observou-se aumento significativo na contratilidade dos MAP tanto no TAP_CAP (p=0,001) como no TAP_RV (p=0,0001), sem diferença entre os grupos (p=0,1). Em contrapartida, quando avaliado por EMG, não foi verificado diferença significativa na análise pré e pós- treinamento (p=0,05) em nenhum dos grupos. Ao solicitar a contração voluntária máxima do músculo Transverso do abdômen/ obliquo interno, para observação da coativação, observou-se resultado significativo (p=0,001) no grupo TAP RV após o treinamento. Entretanto, não foram encontrados resultados significativos no grupo TAP_CAP. Conclusão: O treinamento abdominopélvico por meio de realidade virtual proporcionou melhora da coativação dos músculos do assoalho pélvico em resposta à contração do Tra
Abstract: Introduction: Recent literature has investigated the abdominopelvic training effect (APT) effect as means of to prevent and treat pelvic floor dysfunction. In this context, globally muscle training exercises are being explored in clinical research. In the present study, two abdominopelvic protocols were used: by kinesiotherapy and by virtual reality, aiming to investigate the interaction of abdominopelvic enclosure muscles, and consequently, the behavior of the pelvic floor muscles (PFM) and transversus abdominis/internal obliquos (Tra/IO) muscle, in some peculiarly situations like maximum voluntary contraction (MVC) and coactivation. Aims: To investigate the pelvic floor and abdominal muscle¿s electrical activity using two training protocols: APT by kinesiotherapy (APT K) and APT by virtual reality (APT VR); as well as to indentify the presence of coactivation between these muscles. Patients and Methods: 47 young, nulliparous and continent women (mean age 25.79±3.85 years) participated in this study. They were randomly divided into two groups: (G1) APT_K (n=22) and (G2) APT_VR (n=25). The protocols were supervised by a physiotherapist, lasting 30 minutes per session, three times per week, during 10 sessions. The women were assessed before and after the completion of the protocols by digital palpation (DP) and electromyography (EMG) of simultaneous MAP and Tra/IO. Results: The groups were homogeneous in demographic conditions. There was a significant increase in PFM contractility in both APT_K (p = 0.001) and APT_VR (p=0.0001) groups when assessed by digital palpation, with no difference in the comparison between groups (p=0.1). In contrast, when measured by EMG, PFM electromyography activity did not showed a significant difference in pre and post training analysis (p=0.05). When requesting the Transverse / internal oblique maximum voluntary contraction, for observation of coactivation, a significant result (p=0.001) was observed in APT_VR group after training. However, no significant results were found in APT_K group. Conclusion: The abdominopelvic training by virtual reality showed an improvement in the coactivation of pelvic floor muscle contraction in response to Tra
Mestrado
Fisiopatologia Cirúrgica
Mestra em Ciências

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Schvartzman, Renata. "Avaliação do potencial de ativação mioelétrico do assoalho pélvico, qualidade de vida e função sexual de mulheres climatéricas com e sem dispareunia." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/56679.

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Introdução: As alterações do assoalho pélvico nas mulheres climatéricas, decorrentes das variações hormonais, de modificações físicas e do próprio envelhecimento dos tecidos, podem ser responsáveis por disfunções urinárias e sexuais. O papel da fisioterapia no tratamento da incontinência urinária tem sido documentado, porém há poucos estudos avaliando a disfunção sexual. Objetivos: Avaliar o potencial de ativação mioelétrica das musculaturas do assoalho pélvico, a função sexual através do Índice de Função Sexual Feminina (IFSF) e a qualidade de vida (Escala de Cervantes) de mulheres climatéricas com e sem dispareunia. Métodos: Estudo transversal realizado no ambulatório de Climatério do Serviço de Ginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com mulheres climatéricas entre 45 e 60 anos. As participantes eram submetidas a uma anamnese e dois questionários (de qualidade de vida - Escala de Cervantes e o Índice de Função Sexual Feminina - IFSF), além da avaliação da musculatura do assoalho pélvico por meio do biofeedback eletromiográfico. Resultados: A amostra foi composta por 51 mulheres com idade média de 52,1 anos (± 4,9). Não houve diferença estatisticamente significativa em relação ao tônus muscular de repouso entre mulheres com e sem dispareunia (p=0,152). Contudo, nas mulheres com dispareunia o IFSF apresentou um pior escore (p<0,001) assim como na escala de Cervantes (p=0,009) em comparação às mulheres sem dispareunia. Houve, também, uma associação inversa significativa entre o escore de dor do FSFI e a média do tônus de base (rs= -0,300; p= 0,033). Conclusão: O presente estudo demonstrou não haver diferença entre o tônus de repouso das musculaturas do assoalho pélvico de mulheres climatéricas com e sem dispareunia. Entretanto houve diferença entre os dois grupos quanto à qualidade de vida (Escala de Cervantes) e função sexual (IFSF). Outros estudos na área da fisioterapia e disfunção sexual são necessários para aprimorar a qualidade de investigação e intervenção de mulheres climatéricas com disfunção sexual.
Introduction. Alterations in the pelvic floor during menopausal years, which are the result of hormonal and physical changes and of tissue aging itself, can lead to urinary and sexual dysfunction. The role of physical therapy in the treatment of urinary incontinence is well documented, but few studies have assessed its role in sexual dysfunction. Aim. To assess the myoelectric action potential of pelvic floor muscles, sexual function (using the Female Sexual Function Index, FSFI) and quality of life (using the Cervantes Scale) in perimenopausal and menopausal women with and without dyspareunia. Methods. Cross-sectional study carried out at the outpatient Menopause clinic of the Department of Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in a sample of climacteric women aged 45 to 60 years. Participants were interviewed, completed two questionnaires (Cervantes Scale and FSFI), and underwent assessment of the pelvic floor muscles by the electromyographic biofeedback method. Results. The sample comprised 51 women with a mean age of 52.1±4.9 years. There were no statistically significant differences in resting muscle tone between women with and without dyspareunia (P = 0.152). However, women with dyspareunia scored worse on the FSFI (P < 0.001) and the Cervantes Scale (P = 0.009) as compared to women without dyspareunia. Furthermore, there was a significant inverse association between FSFI pain scores and mean resting tone (rs = -0.300; P = 0.033). Conclusions. Although myoelectric activation potentials were similar in women with and without dyspareunia, there were between-group differences in FSFI and Cervantes Scale scores. Further studies are required with the possibility of standardize assessment and physical therapy interventions in climacteric women with dyspareunia.

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Nyangoh, Timoh Krystel. "Musculature et innervation pelvi-périnéale en dissection anatomique assistée par ordinateur." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS128.

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Résumé : Introduction : Parmi les structures anatomiques impliqués dans la statique pelvienne, la continence urinaire et anale, le muscle élévateur de l’anus (MEA), le sphincter urétral (SU) et son innervation ont un rôle déterminant. Au cours de la grossesse, de l’accouchement par voie vaginale, de la chirurgie radicale pelvienne, des lésions des muscles du plancher pelvien ou de son innervation peuvent survenir. Ces lésions sont à l’origine de dysfonctions du plancher pelvien telle que le prolapsus uro-génital ou l’incontinence urinaire. Une meilleure connaissance de l’anatomie musculaire et nerveuse pelvi-périnéale est nécessaire pour diminuer la survenue et traiter ces troubles fonctionnels. Classiquement les muscles du plancher pelvien sont décrits comme entièrement striés sous contrôle somatique (nerf du MEA et/ou nerf pudendal (NP)). La dissection Anatomique Assisté par Ordinateur (DAAO) en utilisant des marqueurs nerveux et musculaires spécifiques peut aujourd’hui compléter les données établies par la dissection conventionnelle classique de sujets anatomiques.Objectif : L’objectif était de décrire l’innervation (origine, topographie, trajet, rapports, fonction) et la structure musculaire du MEA, de décrire l’innervation (origine, topographie, trajet, rapports, fonction) du sphincter urétral pour mettre en perspective les implications potentielles dans les dysfonctions du plancher pelvien.Méthodes : Nous avons étudié 9 fœtus humains (6 féminins et 3 masculins). Des coupes histologiques sériées de 5 µm d’épaisseur ont été effectuées dans les régions pelviennes de 7 fœtus âgés de 18 à 40 semaines de gestation. Pour chaque niveau de coupe, des lames ont été colorées puis traitées en immunohistochimie pour détecter : l’ensemble des fibres nerveuses (anticorps anti-protéine S100), les fibres autonomes cholinergiques (anti-VAChT), les fibres autonomes adrénergiques (anti-TH), les fibres autonomes nitrergiques (anti-nNOS), les fibres somatiques (anti-PMP 22), les fibres sensorielles (anti-CGRP), les fibres musculaires lisses (anti-SMA) et les fibres musculaires striées (anti-MYOG). Les coupes ont ensuite été numérisées par un scanner de haute résolution optique et les images ont été reconstruites en 3D avec le logiciel Winsurf®. Un fœtus additionnel a été entièrement destiné à réaliser de la microscopie électronique afin de confirmer nos résultats au niveau architectural musculaire.Résultats : Nous avons observé une innervation à la fois autonome (plexus hypogastrique inférieur (PHI)) et somatique (nerf du MEA et NP) du MEA. Nous avons individualisé des zones de cellules musculaires lisses au sein du plancher pelvien notamment de la partie médiane sous contrôle autonome (PHI) que nous nommons « compartiment médian musculaire lisse ».Nous avons systématisé le plancher pelvien musculaire en une zone médiale lisse sous contrôle nerveux autonome réalisant une interface entre les viscères pelviens, et une zone musculaire striée latérale sous contrôle nerveux somatique.Enfin, nous avons mis en évidence une double innervation à la fois somatique et autonome du sphincter urétral.Conclusion : La DAAO a permis de mettre en évidence une innervation pelvi-périnéale complexe avec l’intrication du système nerveux somatique et autonome. La fonction du contingent musculaire lisse pelvien reste à préciser
Abstract : Levator ani muscle (LAM), urethral sphincter (US), and their innervation play a major role in pelvic status, urinary continence and anal continence. During pregnancy, vaginal delivery, pelvic radical surgery, damage of pelvic floor muscles or of their innervation may occur. These lesions are responsible for pelvic floor dysfunction such as urogenital prolapse or urinary incontinence. Better knowledge of pelvi-perineal muscle and nerve anatomy is needed to reduce the occurrence and treat these pelvic floor dysfunctions. Classically pelvic floor muscles are described as entirely striated under somatic control (levator ani nerve (LAN) and /or pudendal nerve (PN)). Computer Assisted Anatomical Dissection (CAAD) using specific nerve and muscle markers can nowadays complete data established by conventional dissection of anatomical subjects.The objective was to describe the innervation and the muscular structure of the levator ani muscle, to describe nerve supply of the urethral sphincter in order to better understand pelvic floor dysfunction.Methods : We studied nine human fetuses (6 female and 3 male). Serial histological sections of 5 μm of thickness were performed in the lumbar and pelvic regions of seven human fetuses aged 18 to 40 weeks of gestation. For each level, slides were stained and then treated in immunohistochemistry to detect: general nerve fibers (anti-protein S100), autonomic cholinergic fibers (anti-VAChT), autonomic adrenergic fibers (anti-tyrosine hydroxylase), autonomic nitrergic fibers (anti-nNOS), somatic nerve fibers (anti-peripheral myelin protein 22), sensory fibers (anti-CGRP), smooth muscle fibers (anti-SMA) and striated muscle fibers (anti-MYOG). The slides were then digitized by a high-resolution optical scanner and the images were reconstructed in 3D using the Winsurf® software. One fetus was entirely reserved for electronic microscopy in order to confirm our results.Results: We observed that LAM innervation is supplied by both autonomic (inferior hypogastric plexus (IHP)) and somatic (LAN and PN). We have individualized areas of smooth muscle cells in the pelvic floor, particularly the median part controlled by the autonomic system that we named “smooth muscle medial compartment”.We systematized within the pelvic floor muscle a smooth medial part under an autonomic nervous control as interface between the pelvic viscera and a lateral striated muscle part under somatic nervous control.Finally, we have demonstrated a dual innervation both somatic and autonomic sphincter urethral.Conclusion : CAAD has demonstrated complex pelvic-perineal innervation with the interaction of the somatic and autonomic nervous system. The function of the pelvic smooth muscle contingent remains to be clarified

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Zachovajevienė, Brigita. "Dubens dugno, diafragmos ir liemens raumenų funkcinių ryšių ir jų kaitos įvertinimas vyrams po radikalios prostatektomijos." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130508_082155-84143.

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Dubens dugno raumenų aktyvinimas yra labai specifinis: dėl minėtų raumenų lokalizacijos pacientams yra sudėtinga įsivaizduoti, suprasti bei pajausti jų susitraukimą ir atliekamą funkciją. Kitas apsunkinantis veiksnys yra tas, kad daugumai pacientų dubens dugno raumenys asocijuojasi su intymumu ir lytiniu gyvenimu, ir jie vengia bei gėdisi spręsti šią problemą. Kita vertus, specialistams, dirbantiems su asmenimis, nelaikančiais šlapimo, sudėtinga įvertinti teisingą dubens dugno raumenų susitraukimą bei atliekamų pratimų efektyvumą. Šie apribojimai ir skatino ieškoti alternatyvių šlapimo nelaikymo bei dubens dugno raumenų disfunkcijų sprendimo būdų, įrodant egzistuojančius tiriamųjų raumenų funkcinius ryšius, jų poveikį funkciniams vyrų rodikliams po radikalios prostatektomijos. Šiame darbe taikant atskirų raumenų grupių aktyvinimą ir vertinant tiriamų raumenų fizinius rodiklius buvo ieškoma funkcinių sąsajų tarp dubens dugno, diafragmos ir liemens raumenų. Tikimasi, kad šio tyrimo rezultatai, išvados ir parengtos praktinės klinikinės rekomendacijos bus naudingos visiems reabilitacijos srities specialistams įvairiuose paciento gydymo etapuose, gydytojams urologams bei ginekologams, tiesiogiai susiduriančiais su asmenimis, turinčiais dubens dugno raumenų disfunkcijas. Sudarytos namų programos padės pacientams spręsti ne tik su šlapimo nelaikymu susijusias problemas, bet ir bus profilaktinė priemonė asmenims, esantiems padidintos rizikos grupėje.
Activation of pelvic floor muscles is extremely specific: due to the localization of the mentioned muscles, it is difficult for the patients to visualize, understand and feel the contraction and performed function. Another puzzling factor is the fact that many patients associate pelvic floor muscles with intimacy and sexual life and, therefore, try to avoid and are embarrassed to solve the problem. On the other hand, specialists working with patients with urinary incontinence find it difficult to evaluate a proper contraction of pelvic floor muscles and efficiency of performed exercises. These limitations have stimulated search for alternative solutions for urinary incontinence and pelvic floor muscles dysfunctions with the aim to prove existing functional relations between the studied muscles as well as their influence on the functional characteristics in men after radical prostatectomy. This particular thesis was aimed at finding functional associations between pelvic floor, diaphragm, and trunk muscles by applying activation of separate muscle groups and evaluating physical parameters of the studied muscles. It is expected that the results, conclusions, and prepared practical clinical recommendations of this research will be of use for all rehabilitation specialists in various stages of treatment, as well as for doctors urologists and gynaecologists, who deal directly with individuals possessing pelvic floor muscle dysfunctions.

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Gomes, Nádia Filipa Martins. "Efetividade da fisioterapia em mulheres com incontinência urinária no pós-parto - revisão bibliográfica." Bachelor's thesis, [s.n.], 2020. http://hdl.handle.net/10284/9576.

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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Objetivo: Verificar a efetividade da fisioterapia em mulheres com incontinência urinária no pós-parto. Metodologia: Foi realizada uma pesquisa computorizada de artigos clínicos randomizados controlados entre fevereiro e março de 2020 nas bases de dados Pubmed e Web of science, usando a estratégia de pesquisa de palavras chave. A qualidade metodológica foi avaliada através da Physiotherapy Evidence Database scoring scale (PEDro). Resultados: Foram encontrados 260 artigos sendo 30 selecionados e totalmente analisados. Dos seguintes estudos (n=30), 21 foram excluídos por não corresponderem aos critérios de inclusão e apenas 9 estudos foram classificados como de alta qualidade, marcando pontos no total de 7 segundo a escala de PEDro. Nos artigos verificamos que ao realizar exercícios dos músculos do pavimento pélvico foram obtidas melhorias significativas na IU. Conclusão: A fisioterapia demonstra-se efetivo no tratamento e prevenção da IU em mulheres pós-parto, nomeadamente exercícios supervisionados e constantemente avaliados por um fisioterapeuta.
Objective: To verify the effectiveness of physical therapy in women with postpartum urinary incontinence. Methodology: A computerized search of randomized controlled clinical articles was carried out between February and March 2020 in the Pubmed and Web of science databases, using the keyword search strategy. Methodological quality was assessed using the Physiotherapy Evidence Database scoring scale (PEDro). Results: 260 articles were found, 30 of which were selected and fully analyzed. Of the following studies (n = 30), 21 were excluded because they did not meet the inclusion criteria and only 9 studies were classified as high quality, scoring points in a total of 7 according to the PEDro scale. In the articles, we will check if significant improvements in UI were achieved when performing pelvic floor muscle exercises. Conclusion: Physiotherapy is shown to be effective in the treatment and prevention of urinary incontinence in postpartum women, including supervised exercises and constantly evaluated by a physiotherapist.
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Nunes, Erica Feio Carneiro. "Análise do tempo de resposta de contração dos músculos do assoalho pélvico provocado pela tosse entre mulheres continentes e com incontinência urinária de esforço." Universidade Nove de Julho, 2018. http://bibliotecatede.uninove.br/handle/tede/1891.

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Contextualization: Weakening of pelvic floor muscles (PMFs) has been considered a major cause of stress urinary incontinence (SUI). In this way, the physiotherapeutic treatment, classically, turned to the strengthening of these muscles. In this study it was hypothesized that, in addition to PMFs weakness, this dysfunction may also be related to a change in the pattern of reflex response of these muscles. Objective: The study objectives were to compare the contraction response time and strength of cough-induced PMFs among continents and SUI women, and to conduct a literature review on the use of biofeedback for pelvic floor muscle training in women with this dysfunction. Methods: Study II: A systematic review was conducted with a search of the databases Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS for randomized clinical trials that had biofeedback (BF) as a therapeutic tool for SUI. Study II: This was a cross-sectional study that evaluated the cough PMFs of 20 healthy women and 20 women with SUI. The clinical evaluation consisted of the application of questionnaires that assessed the severity of urinary incontinence and quality of life. Signal capture was performed with a 4-channel acquisition system (EMG System do Brasil Ltda®) to capture the signals obtained through vaginal dynamometry, electromyography (EMG) of the right external obliquus muscle and accelerometry. Statistical analysis was performed using the Shapiro-Wilk, independent t test or Mann-Whitney test according to the data distribution and the covariance analysis (ANCOVA) with post hoc Bonferrone test. The statistical significance considered for all tests was p <0.05. Results: Study I: the training of the PMFs with BF was not better than the control group (without training and orientation, vaginal electrical stimulation). However, these contradictory results and poor quality of the studies are probably not clinically significant. Study II: the contraction response of the PMFs was significantly different between the groups for the activation time of the PMFs (F = 19.51, P <0.0001, p2= 0.61), external oblique muscle activation time (F = 11.41, P <0.002, p2= 0.23) and time of the cough pulse (F = 4.21, P <0.04, p2= 0.10). Conclusion: The systematic review provides evidence that the training of BF-PMFs does not offer superior therapeutic benefits to other types of interventions in the treatment of female SUI. The cross-sectional study showed that women with SUI have delayed cough-induced contraction of PMFs.
Contextualização: O enfraquecimento dos músculos do assoalho pélvico (MAPs) tem sido considerada uma das principais causas da incontinência urinária por esforço (IUE). Dessa maneira, o tratamento fisioterapêutico, classicamente, se voltou para o fortalecimento desses músculos. Nesse estudo foi hipotetizado que, além da fraqueza dos MAP, essa disfunção também pode estar relacionada à uma alteração no padrão de resposta reflexa desses músculos. Objetivo: Os objetivos deste estudo foram comparar o tempo de resposta da contração e a força dos MAPs induzidos pela tosse entre mulheres continentes e com IUE e, realizar uma revisão de literatura sobre o uso do biofeedback para treinamento muscular do assoalho pélvico em mulheres com essa disfunção. Métodos: Estudo I: Foi realizada uma revisão sistemática com uma busca nas bases de dados Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL e LILACS por ensaios clinicos randomizados que tivessem o biofeedback (BF) como instrumento terapeutico para a IUE. Estudo II: Esse foi um estudo transversal que avaliou os MAPs durante a tosse de 20 mulheres saudáveis e 20 mulheres com IUE. A avaliação clínica consistiu na aplicação dos questionários que avaliaram a gravidade da incontinência urinária e a qualidade de vida. A captação dos sinais foi realizada com um sistema de aquisição com 4 canais (EMG System do Brasil Ltda®) para captar os sinais obtidos por meio da dinamometria vaginal, da eletromiografia (EMG) do músculo obliquo externo direito e da acelerometria. Para análise estatística foram utilizados os testes de Shapiro-Wilk, t independente ou Mann-Whitney test de acordo com a distribuição dos dados e a análise de covariância (ANCOVA) com test post hoc de Bonferrone. A significância estatística considerada para todos os testes foi de p<0,05. Resultados: Estudo I: o treinamento dos MAPs com BF não foi melhor do que o grupo controle (sem treinamento e orientação, estimulação elétrica vaginal). No entanto, estes resultados contraditórios e a má qualidade dos estudos provavelmente não são clinicamente significativos. Estudo II: A resposta de contração dos MAPs foi significativamente diferente entre os grupos para o tempo de ativação dos MAPs (F=19.51, P <0.0001,p2=0.61), Tempo de ativação do músculo obliquo externo (F=11.41, P < 0.002, p2=0.23) e tempo do pulso da tosse (F=4.21, P < 0.04, p2=0.10). Conclusão: A revisão sistemática fornece evidências de que a treinamento dos MAPs com BF não oferece benefícios terapêuticos superiores a outros tipos de intervenções no tratamento da IUE feminina. O estudo tranversal mostrou que mulheres com IUE apresentam atraso na resposta da contração dos MAPs induzidos pela tosse.

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Sousa, Maria Beatriz Melo e. "Efeitos de um protocolo de treino dos músculos do pavimento pélvico em atletas nulíparas com incontinência urinária: estudo comparativo entre um protocolo supervisionado e não supervisionado." Master's thesis, [s.n.], 2013. http://hdl.handle.net/10284/4780.

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Trabalho de Projeto apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Fisioterapia, ramo de Fisioterapia Materno-Infantil
Introdução: Estudos recentes evidenciam uma elevada prevalência de Incontinência Urinária (IU) em jovens atletas e nulíparas, especialmente na ginástica, atletismo e jogos de bola, condicionando o seu desempenho e interferindo com a qualidade de vida (QV). Assim, com a Fisioterapia pretende-se reabilitar estas atletas através do treino dos músculos do pavimento pélvico (TMPP) - tratamento classificado com o mais alto nível de evidência. Objetivo: Investigar a eficácia de um protocolo de TMPP no tratamento da IU em jovens atletas nulíparas. Metodologia: Estudo experimental, longitudinal com avaliações pré e pós-teste. Participaram nove jovens atletas nulíparas, divididas em dois grupos de intervenção que realizaram o protocolo de TMPP, um com supervisão da fisioterapeuta (n=4) e outro sem supervisão (n=5). Na primeira etapa do estudo as participantes responderam ao CONTILIFE, Escala de Auto-eficácia dos Exercícios de Broome (EAEB) e ao questionário sociodemográfico; na segunda etapa realizaram o International Physical Activity Questionnaire - Short Form (IPAQ-SF), o Pad-Test e os testes de Oxford e Perineometria; e na terceira foi aplicado o protocolo de TMPP. No tratamento de dados foi utilizado o Test-T e o Manny-Whitney test na análise indutiva e a Correlação de Spearman na análise correlacional, com o nível de significância p≤0,05. Resultados: Verificou-se uma prevalência de IU de 74%, assim como uma correlação negativa entre o CONTILIFE (score total) e a IU (p=0,018 e r=-0,336) e uma correlação positiva entre o CONTILIFE (score total) e o score total da EAEB (p=0,0132 e r=0,307). Encontraram-se diferenças estatisticamente significativas entre as atletas dos grupos de intervenção e o peso (p=0,029). A comparação entre o pré e pós-teste só foi significativa no parâmetro Pad-test (p=0,05). Todas atletas do grupo com supervisão registaram melhorias nos parâmetros analisados. Conclusão: O protocolo de TMPP parece ser eficaz no tratamento da IU em atletas nulíparas e foram encontradas diferenças entre o protocolo supervisionado e não supervisionado, nomeadamente no grupo com supervisão. Background: Recent studies show a high prevalence of Urinary Incontinence (UI) in young athletes and nulliparous, especially in gymnastics, athletics and ball games, interfering with their performance and consequently with quality of life (QoL). Thus, the Physiotherapy aim is to rehabilitate these athletes with the pelvic floor muscle training (PFMT) – classified with the higher level of evidence. Objective: Investigate the effectiveness of the PFMT protocol in the treatment of UI in young nulliparous athletes. Methods: Experimental and longitudinal study with pre and post-test evaluations. Participation of nine young nulliparous athletes, divided in two intervention groups, one with supervision of a physiotherapist (n=4) and another without (n=5) who did the PFMT protocol. In the first stage the participants answered to CONTILIFE, to Self-Efficacy Scale of Broome Exercises Broome and to a sociodemographic questionnaire; on second stage they did the International Physical Activity Questionnaire - Short Form (IPAQ-SF), Pad-Test and Oxford Test and perineometry; and in the third stage the PFMT protocol was applied. To data analysis it was used the T-test and Manny-Whitney test in inductive analysis and the Spearman’s Correlation in correlacional analysis and the level of significance was p≤0,05. Results: The prevalence of UI was 74%, this study shows a negative correlation between CONTILIFE (total score) and UI (p=0,018 e r=-0,336) and a positive correlation between CONTILIFE (total score) and Self-Efficacy Scale of Broome Exercises Broome (p=0,0132 e r=0,307). Statistical differences had benn found between athletes and weigth (p=0,029). The comparison between pre and posttest was significant in Pad-test (p=0,05). All athletes of intervention group with supervision had registered improvements. Conclusions: The PFMT protocol seems to be effective in the treatment of UI in young athletes and nulliparous and differences were found between the assisted and unassisted protocol, especially in the group with supervision.

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Dias, Leticia Alves Rios. "Influência do treinamento dos músculos do assoalho pélvico sobre os resultados do parto e perinatais em gestantes de baixo risco." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-24062010-134310/.

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A ausência de estudos nacionais e limitações metodológicas relacionadas às pesquisas que já avaliaram a repercussão do treinamento dos músculos do assoalho pélvico (TMAP) sobre o trabalho de parto, parto e resultados perinatais constituíram a fundamentação científica para o desenvolvimento desta pesquisa cujo objetivo foi verificar a influência de um programa de TMAP realizado durante a gravidez sobre variáveis inerentes ao parto e aos resultados perinatais. Trata-se de ensaio clínico prospectivo randomizado e controlado que incluiu 42 gestantes nulíparas de baixo risco. As voluntárias fizeram parte de um grupo controle (GC) que não treinou os músculos do assoalho pélvico (MAP) ou de um grupo de treinamento (GT) que realizou um treino intensivo e supervisionado dos MAP por 16 semanas. As voluntárias de ambos os grupos foram avaliadas com 20 e 36 semanas de idade gestacional (IG). Uma pesquisadora cega em relação à distribuição dos grupos fez a análise dos prontuários das participantes da pesquisa sendo coletadas as seguintes informações: IG na ocasião do parto; tipo de parto; duração do período expulsivo; tempo total de trabalho de parto; ocorrência de laceração e o seu grau; apresentação do recém-nascido; peso; tamanho; sexo e escores de Apgar dos recém-nascidos (RN). A análise estatística utilizou-se de procedimentos PROC FREQ e PROC MEANS do software SAS 9.0, modelos ANOVA, contrastes ortogonais baseados na distribuição t, modelos lineares de efeitos mistos, teste exato de Fisher, modelo de regressão quantílica e coeficiente de correlação de Pearson. No GC, 9,53% tiveram parto normal, 23,81% parto normal com episiotomia médio lateral (EML), 19,04% parto fórceps e 47,62% parto cesárea. No GT, 23,81% das mulheres tiveram parto normal, 38,1% parto normal com EML, 14,28% parto fórceps e 23,81% foram submetidas a cesárea. Não houve diferença estatística entre os grupos em relação a IG no momento do parto (p= 0,72); tipo de parto (p= 0,23); duração do período expulsivo (p= 0,28), tempo total de trabalho de parto (p= 0,91), ocorrência de laceração perineal (p= 0,66); peso (p= 0,43), tamanho (p= 0,61) e escores de Apgar dos RN (p= 1,00). Não houve relação entre o tipo de parto com uma melhor média de pico de perineometria na 36ª semana de IG entre os grupos (p= 0,15). Também não se observou diferença estatística entre as avaliações (20 e 36 semanas) em relação ao tipo de parto entre os grupos (p=0,61). Concluiu-se que não houve influência do programa de TMAP realizado durante a gravidez nas variáveis maternas e perinatais avaliadas neste estudo.
The lack of national studies and methodological limitations related to studies that have evaluated the impact of the pelvic floor muscles training (PFMT) on labor, delivery and perinatal outcomes were the scientific basis for the development of this research that aimed to verify the influence of a program of PFMT performed during pregnancy on variables inherent in the delivery and perinatal results. This is a prospective clinical randomized controlled trial that include 42 nulliparous women ate low risk. The volunteers were part of a control group (CG) that did not train their pelvic floor muscles (PFM) or a training group (TG) has done extensive training and supervision of PFM for 16 weeks. The volunteers of both groups were evaluated with 20 and 36 semanas de idade gestacional (IG). A blind researcher for distribution of the groups made the analysis of records of study participants. Were collected the following informations: GA at birth, type of delivery, duration of second stage, the total time of labor, incidence of laceration and the extent, presentation of the newborn, weight, size, gender, and Apgar score of newborns (NB). Statistical analysis was used procedures PROC FREQ and PROC MEANS of SAS 9.0, ANOVA models, orthogonal contrasts based on t-distribution models, linear mixed effects, Fisher\'s exact test, quantile regression and correlation coefficient of Pearson. In CG, 9.53% had vaginal delivery, 23.81% vaginal delivery with episiotomy, 19.04% forceps delivery and 47.62% cesarean section. In TG, 23.81% of women had vaginal delivery, 38.1% vaginal delivery with episiotomy, 14.28% forceps delivery and 23.81% underwent cesarean section. There was no statistical difference between the groups regarding GA at delivery (p = 0.72), type of delivery (p = 0.23), duration of second stage (p = 0.28), total work time delivery (p = 0.91), occurrence of perineal lacerations (p = 0.66), weight (p = 0.43), size (p = 0.61) and Apgar scores of NB (p = 1, 00). There was no relationship between the type of delivery with a best average in the peak of perineometer at 36 weeks of GA between the groups (p = 0.15). Also there was no statistical difference between the ratings (20 and 36 weeks) in relation to type of delivery between groups (p = 0.61). It was concluded that there was no influence of the PFMT program performed during pregnancy on maternal and perinatal variables evaluated in this study.

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Sartori, Dulcegleika Villas Boas [UNESP]. "Correlação entre a força muscular do assoalho pélvico e status hormonal da vagina em mulheres continentes." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/137964.

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Objetivos: Avaliar a correlação entre o status hormonal da vagina e hipermobilidade uretral com a força muscular do AP, nas diferentes faixas etárias em mulheres continentes. Métodos: Foram avaliadas prospectivamente 140 mulheres continentes, divididas em quatro grupos de acordo com a faixa etária, G1 (n = 34) de 30 a 40 anos, G2 (n = 38) de 41 a 50 anos, G3 (n =35) de 51 a 60 anos e G4 (n= 33) acima de 60 anos. Os seguintes parâmetros foram avaliados: dados demográficos utilizando questionário clinico; hipermobilidade do colo vesical usando o teste do cotonete; trofismo vaginal com exame ginecológico; status hormonal da vagina com a colpocitologia; força muscular do AP, utilizando a perineometria e eletroneuromiografia (EMG). Resultados: Não houve diferença estatisticamente significativa entre a força muscular do AP, características demográficas, trofismo vaginal e hipermobilidade do colo vesical nos diferentes grupos (p>0,05). Foi encontrado um maior número de mulheres atróficas acima de 60 anos. Houve uma excelente concordância no trofismo vaginal avaliado pelo exame ginecológico e colpocitologia (Kappa = 0,888). Porém observamos que as mulheres com hipermobilidade apresentavam menor força muscular em relação às mulheres sem hipermobilidade na EMG. Conclusão: Apesar da atrofia vaginal ser maior nas mulheres acima de 60 anos , não observamos diferença na força muscular do AP durante o processo de envelhecimento fisiológico. Sendo assim, não podemos dizer que o trofismo é o único fator relacionado à força muscular do AP, dificultando a indicação de mulheres para profilaxia. Palavras - chave: continência urinária; força muscular; músculo assoalho pélvico; status hormonal; prolapso; hipermoblidade do colo vesical
Objectives: To assess the correlation between hormonal status and PF muscle strength. Methods: 140 continent women were prospectively evaluated, and divided into four groups according to age: G1 (n = 34) 30-40 years, G2 (n = 38) 41-50 years, G3 (n = 35) 51-60, and G4 (n = 33) older than 60 years. The following parameters were evaluated: demographic data using clinical questionnaire; hypermobility of the bladder neck using the swab test; vaginal trophism by gynecological examination; hormonal status of the vagina by cytology; muscle strength of the PF using perineometer and electromyography (EMG). Results: There was no statistical difference between PF muscle strength, demographic characteristics, vaginal trophism, and hypermobility of the bladder neck in the different groups (p > 0.05). There was a larger number of atrophic women among those over 60 years of age. Vaginal trophism assessed by physical examination was highly consistent with the findings of colpocytology (Kappa = 0.888). We found, however, that women with hypermobility by EMG had less muscle strength as compared to those with no hypermobility. Conclusion: Although vaginal atrophy is more intense in women older than 60 years, no difference was found in muscle strength of the PF during the physiological aging process. As a consequence, it is not possible to state that trophism is the only factor related to PF muscular strength, thus precluding the selection of women who should be referred to prophylaxis. Key-notes: urinary continence; muscle strength; pelvic floor muscles; hormonal status; prolapse; bladder neck hypermobility

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Sartori, Dulcegleika Villas Boas. "Correlação entre a força muscular do assoalho pélvico e status hormonal da vagina em mulheres continentes." Botucatu, 2016. http://hdl.handle.net/11449/137964.

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Orientador: João Luiz Amaro
Resumo: Objetivos: Avaliar a correlação entre o status hormonal da vagina e hipermobilidade uretral com a força muscular do AP, nas diferentes faixas etárias em mulheres continentes. Métodos: Foram avaliadas prospectivamente 140 mulheres continentes, divididas em quatro grupos de acordo com a faixa etária, G1 (n = 34) de 30 a 40 anos, G2 (n = 38) de 41 a 50 anos, G3 (n =35) de 51 a 60 anos e G4 (n= 33) acima de 60 anos. Os seguintes parâmetros foram avaliados: dados demográficos utilizando questionário clinico; hipermobilidade do colo vesical usando o teste do cotonete; trofismo vaginal com exame ginecológico; status hormonal da vagina com a colpocitologia; força muscular do AP, utilizando a perineometria e eletroneuromiografia (EMG). Resultados: Não houve diferença estatisticamente significativa entre a força muscular do AP, características demográficas, trofismo vaginal e hipermobilidade do colo vesical nos diferentes grupos (p>0,05). Foi encontrado um maior número de mulheres atróficas acima de 60 anos. Houve uma excelente concordância no trofismo vaginal avaliado pelo exame ginecológico e colpocitologia (Kappa = 0,888). Porém observamos que as mulheres com hipermobilidade apresentavam menor força muscular em relação às mulheres sem hipermobilidade na EMG. Conclusão: Apesar da atrofia vaginal ser maior nas mulheres acima de 60 anos , não observamos diferença na força muscular do AP durante o processo de envelhecimento fisiológico. Sendo assim, não podemos dizer que o trofismo é ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Objectives: To assess the correlation between hormonal status and PF muscle strength. Methods: 140 continent women were prospectively evaluated, and divided into four groups according to age: G1 (n = 34) 30-40 years, G2 (n = 38) 41-50 years, G3 (n = 35) 51-60, and G4 (n = 33) older than 60 years. The following parameters were evaluated: demographic data using clinical questionnaire; hypermobility of the bladder neck using the swab test; vaginal trophism by gynecological examination; hormonal status of the vagina by cytology; muscle strength of the PF using perineometer and electromyography (EMG). Results: There was no statistical difference between PF muscle strength, demographic characteristics, vaginal trophism, and hypermobility of the bladder neck in the different groups (p > 0.05). There was a larger number of atrophic women among those over 60 years of age. Vaginal trophism assessed by physical examination was highly consistent with the findings of colpocytology (Kappa = 0.888). We found, however, that women with hypermobility by EMG had less muscle strength as compared to those with no hypermobility. Conclusion: Although vaginal atrophy is more intense in women older than 60 years, no difference was found in muscle strength of the PF during the physiological aging process. As a consequence, it is not possible to state that trophism is the only factor related to PF muscular strength, thus precluding the selection of women who should be referred to prophylaxis. Key-no... (Complete abstract click electronic access below)
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Freire, Nathalia de Souza Abreu. "Estabilização lombo-pélvica dinâmica para tratamento da incontinência urinária de esforço em mulheres: ensaio clínico controlado e randomizado." Universidade Federal de Juiz de Fora (UFJF), 2017. https://repositorio.ufjf.br/jspui/handle/ufjf/4815.

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INTRODUÇÃO. A incontinência urinária frequentemente causa prejuízo na qualidade de vida das mulheres. O tratamento fisioterapêutico para incontinência de esforço fundamentado no treinamento da musculatura do assoalho pélvico tende à redução da eficácia ao longo do tempo. A estabilização lombo-pélvica associada ou não ao treinamento do assoalho pélvico tem apresentado resultados favoráveis mesmo após a interrupção do tratamento. OBJETIVO. Comparar os resultados dos exercícios de estabilização lombo-pélvica dinâmica e exercícios para os músculos do assoalho pélvico em mulheres com incontinência urinária de esforço. PACIENTESEMÉTODO. Ensaio clínico controlado, randomizado, paralelo e cego com delineamento longitudinal envolvendo mulheres com queixa de perdas urinárias aos esforços. O desfecho primário foi a gravidade da incontinência. Qualidade de vida, bexiga hiperativa, força do assoalho pélvico e percepção de melhora, os desfechos secundários. Os grupos experimental (protocolo de exercícios de estabilização lombo-pélvica dinâmica e protocolo de exercícios para o assoalho pélvico) e controle (protocolo de exercícios para o assoalho pélvico) foram avaliados antes e após o tratamento e 90 dias após a intervenção. Para os dados descritivos, utilizaram-se medidas de tendência central, média ± desvio-padrão e mediana. Para testar diferenças entre os grupos utilizou-se o teste Qui-Quadrado para variáveis qualitativas e o t de Student para variáveis quantitativas. Os efeitos do protocolo experimental foram verificados por meio da ANOVA fatorial 2x3 (grupo vs. medida) de medidas repetidas. Os efeitos principais e/ou interações significativas foram analisados através de comparações múltiplas. O tamanho do efeito foi calculado pelo eta ao quadrado (η2) e pelo d de Cohen (d). Tabelas cruzadas em cada momento da avaliação analisaram a força dos músculos do assoalho pélvico. Para testar diferenças na percepção de melhora intragrupos utilizou-se o teste de Wilcoxon e o teste de Mann Whitney para diferenças intergrupos. Adotou-se significância de 5% (p ≤ 0,05). RESULTADOS. Para as variáveis sóciodemográficas e clínicas não foram observadas diferenças significativas entre os grupos (p>0,05), exceto para climatério, mais prevalente no grupo experimental (82% vs. 44%; p=0,02). Os grupos se comportaram de modo similar nos desfechos gravidade das perdas, frequência de perdas diurna e noturna, qualidade de vida, bexiga hiperativa, força dos músculos do assoalho pélvico e percepção de melhora, apresentando incremento no comparativo das avaliações inicial e final e manutenção dos resultados favoráveis 90 dias após o tratamento somente no grupo experimental. A diferença observada entre os grupos 90 dias após o tratamento foi de 9 moderada magnitude (d = 0,64) para a gravidade das perdas e elevada magnitude para frequência de perdas diurna (d = 2,67) e noturna (d = 2,50). CONCLUSÕES. Na avaliação pós tratamento os exercícios de estabilização lombopélvica associados aos exercícios para o assoalho pélvico tiveram efeito similar aos exercícios para o assoalho pélvico nos desfechos gravidade das perdas e qualidade de vida. Contudo, os exercícios de estabilização associados aos exercícios para o assoalho pélvico foram superiores nestes desfechos na avaliação de 90 dias.
INTRODUCTION: Urinary incontinence frequently triggers a decline in women’s quality of life. Physiotherapeutic treatment for stress incontinence based on pelvic floor muscles training tends to lose effectiveness over time. Lumbopelvic stabilization, whether associated or not with pelvic floor muscle training, has shown favorable results even after interruption of treatment. OBJECTIVE. To compare the results of dynamic lumbopelvic stabilization exercises with those for the pelvic floor muscle in women with stress urinary incontinence. PATIENTS AND METHOD. Randomized Controlled trial, parallel, and carried out blindly with longitudinal delineation involving women experiencing urinary stress loss. The primary outcome was incontinence severity. Quality of life, hyperactive bladder, strength of pelvic floor muscles and perception of improvement were secondary outcomes. The experimental (dynamic lumbopelvic stabilization exercise protocol) and control (pelvic floor muscle exercise protocol) groups were evaluated prior to treatment, immediately afterwards, and 90 days after intervention. For descriptive data, measurements of central tendency, average ± standard deviation, and median were used. To test differences between the groups, the Chi- Squared for qualitative variables and the Student’s t-test for quantitative variables were used. The experimental protocol’s effects were verified by means of the 2x3 ANOVA factorial of repeated measurements (group vs. measurement). The principal effects and/or significant interactions were analyzed using multiple comparisons. The effect’s size was calculated by eta squared (η2) and by Cohen’s d (d). Two-way tables at each point in the evaluation analyzed pelvic floor muscle strength. To test the differences in intergroup perception of improvement, the Wilcoxonn test was used and the Mann Whitney test for intergroup differences. A significance level of 5% (p ≤ 0.05) was adopted. RESULTS. For sociodemographic and clinical variables, significant differences between groups (p>0.05) were not observed, except for the climacterium, the most prevalent variable in the experimental group (82% vs. 44%; p=0.02). The groups behaved similarly in outcomes for severity of loss, frequency of day- and nighttime losses, quality of life, hyperactive bladder, pelvic floor muscle strength, and perception of improvement, showing an increase when comparing the initial and finally analyses, as well as in maintenance of favorable results 90 days after treatment only in the experimental group. The difference observed between the groups 90 days after treatment was of a moderate magnitude (d = 0.64) for severity of losses and elevated magnitude for the frequency of day and nighttime losses (d = 2.67 and d = 2.50, respectively). CONCLUSIONS. In post-treatment evaluation, lumbopelvic stabilization exercises have a similar effect to exercises for the pelvic floor muscles in outcomes for severity of loss and quality of life. Nevertheless, stabilization exercises associated with pelvic floor muscle exercises were superior in the outcomes of the post-90-day evaluation.

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Amorim, Karina Moyano. "Comparação de diferentes parâmetros de um dinamômetro de força transvaginal entre mulheres saudáveis e com incontinência urinária de esforço." Universidade Nove de Julho, 2017. http://bibliotecatede.uninove.br/handle/tede/1873.

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Changes in pelvic floor muscles (PMF) that occur in stress urinary incontinence (SUI) can be quantified using a transvaginal dynamometer. The objective of this study was to compare and test the accuracy of different parameters obtained by a transvaginal force dynamometer, from contraction of MAP, between healthy and SUI women. Seventeen healthy women (CG) and 17 women with stress urinary incontinence (GSUI) aged 20-60 years were included in this study. The MAP strength was evaluated by means of a transvaginal dynamometer, in a single test session. The data were collected with the patient in lithotomy, and the volunteers were instructed to perform a maximal contraction of the MAP and resist until exhaustion. The test was repeated three times with a 1 minute interval between tests. The dynamometric parameters used to evaluate the MAPs were: peak time (time at which the peak force occurred from the beginning of the MAP contraction), baseline (passive force), maximum force value of MAP contraction, contraction and mean contraction force of the MAP and endurance. The covariance analysis (ANCOVA) with Bonferrone's post hoc test showed that only the endurance variable was different between the groups (F=4.87, P=0.03; p2= 0.14). The accuracy of endurance to identify women with SUI was verified by the receiver operating characteristic curve (ROC). The area on the curve was 0.76 and the sensitivity and specificity were 76.60% for both conditions. In this study it was possible to verify that only the variable muscular resistance has moderate accuracy to identify women with stress urinary incontinence.
As alterações dos músculos do assoalho pélvico (MAP) que ocorrem na incontinência urinária por esforço (IUE) podem ser quantificadas por meio de dinamômetro transvaginal. O objetivo deste estudo foi comparar e testar a acurácia de diferentes parâmetros obtidos por um dinamômetro de força transvaginal, a partir da contração dos MAP, entre mulheres saudáveis e com IUE. Fizeram parte desse estudo, 17 mulheres saudáveis (GC) e 17 com incontinência urinária por esforço (GIUE) com faixa etária de 20 a 60 anos. A avaliação da força dos MAP foi realizada por meio de um dinamômetro transvaginal, em uma única sessão de teste. Os dados foram coletados com a paciente em litotomia, sendo as voluntárias instruídas a realizar uma contração máxima dos MAP e resistir até a exaustão. O teste foi repetido por três vezes com intervalo de 1 minuto entre as coletas. Os parâmetros dinamométricos utilizados para avaliar os MAP foram: tempo do pico (tempo em que ocorreu o pico de força a partir do início da contração dos MAP), linha base (força passiva), valor de força máxima da contração dos MAP, impulso de contração e força média da contração dos MAP e endurance. A análise de covariância (ANCOVA) com teste post hoc de Bonferrone, demonstrou que somente a variável endurance foi diferente entre os grupos (F=4.87, P=0.03; p2= 0.14). A acurácia do endurance para identificar mulheres com IUE foi verificada pela curva de característica de operação do receptor (ROC). A área sobre a curva foi de 0.76 sendo a sensibilidade e especificidade de 76.60% para ambas as condições. Nesse estudo foi possível verificar que somente a variável endurance possui acurácia moderada para identificar mulheres com incontinência urinária por esforço.

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Barros, Patrícia Zaidan de. "Eletroestimulação, exercícios dos músculos do assoalho pélvico e incontinência urinária." Universidade do Estado do Rio de Janeiro, 2015. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=9267.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
A incontinência urinária além de ser multifatorial com enorme complexidade terapêutica é um problema de ordem de saúde pública e que merece maior atenção, pois causa um imenso impacto negativo sobre a qualidade de vida das pessoas. São diversas as opções de tratamento da incontinência urinária, como os exercícios dos músculos do assoalho pélvico, tratamento com fármacos, injeção transuretral, e o esfíncter urinário artificial. A Sociedade Internacional de Continência recomenda como tratamento inicial os exercícios dos músculos do assoalho pélvico supervisionado, orientações de estilo de vida adequado, regimes urinários regulares, terapias comportamentais e medicação. A Revisão Sistemática desta Dissertação mostrou a necessidade de mais estudos com melhor qualidade metodológica para evidenciar o uso da eletroestimulação como intervenção eficaz no tratamento da incontinência urinária; O Estudo Transversal Retrospectivo, após a análise de 128 prontuários do Ambulatório de Fisioterapia Pélvica do Hospital Federal dos Servidores do Rio de Janeiro mostrou resultados significativos da Fisioterapia Pélvica para a redução da incontinência urinária e do impacto da incontinência urinária na vida diária destes pacientes. Por fim, o Experimento Controlado Randomizado, duplo cego, mostrou resultados significativos do uso da eletroestimulação associada aos exercícios dos músculos do assoalho pélvico como uma opção de tratamento conservador capaz de potencializar a continência urinária após a prostatectomia radical.
Urinary incontinence in addition to be multifactorial with great therapeutic complexity is a problem of public health order and it deserves more attention because it causes a huge negative impact on the quality of life. There are several treatment options for urinary incontinence, as the exercises of the pelvic floor muscles, drug treatment, transurethral injection, and the artificial urinary sphincter. The International Continence Society recommended as initial therapy exercises of the pelvic floor muscles supervised, appropriate lifestyle guidance, regular urinary regimes, behavioral therapies and medication. A Systematic Review of this dissertation showed the need for more studies with better methodological quality to highlight the use of electrical stimulation as an effective intervention in the treatment of urinary incontinence; The Cross Retrospective Study, after analysis of 128 medical records of Pelvic Physical Therapy Clinic of the Federal Hospital of Rio de Janeiro's servers showed significant results of pelvic physiotherapy to reduce urinary incontinence and the impact of urinary incontinence on daily life of these patients. Finally, the experiment Controlled randomized, double-blind, showed significant results of the use of electrical stimulation associated with the exercise of the pelvic floor muscles as a conservative treatment option capable of enhancing the urinary continence after radical prostatectomy.

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Silva, Marta. "Efeito do treino de força dos músculos do pavimento pélvico no tratamento da incontinência urinária de esforço em gestantes e puérperas, por meio da telerreabilitação." Bachelor's thesis, [s.n.], 2021. http://hdl.handle.net/10284/10628.

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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Objetivo: O efeito do treino dos músculos do pavimento pélvico na força, endurance e coordenação da contração em grávidas e puérperas, por meio de telerreabilitação. Metodologia: Pesquisa computadorizada nas bases de dados PubMed, Web of Science e PEDro. Para motor de busca foi utilizada a B-on. Inclui estudos experimentais randomizados controlados. A qualidade metodológica dos estudos foi avaliada através da Physiotherapy Evidence Database scoring (PEDro) Scale. Resultados: Com a aplicação dos critérios de inclusão e de exclusão, foram selecionados 5 artigos para esta revisão. Os estudos apresentam um score médio de 6 em 10. Conclusão: A fisioterapia por meio da telerreabilitação para o tratamento da incontinência urinária de esforço, segundo os autores, é vantajosa para as mulheres. No entanto, são necessários mais estudos nesta temática.
Objective: The effect of pelvic floor muscle training on strength, resistance and coordination of contraction in pregnant and postpartum women, through telerehabilitation. Methods: Computerized research on databases such as PubMed, Web of Science e PEDro. The search engine used was B-on. Includes randomized controlled trials (RCTs). The methodological quality of the studies was evaluated through the Physiotherapy Evidence Database (PEDro) Scale. Results: With the application of the inclusion and exclusion criteria, 5 articles were selected for this review. The studies show an average score of 6 out of 10. Conclusion: Physical therapy through telerehabilitation for the treatment of stress urinary incontinence, according to the authors, brings some advantages to women. However, further studies on this topic are needed.
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Waterfield, Ann Elisabeth. "A community study of pelvic floor muscle function in women." Thesis, Exeter and Plymouth Peninsula Medical School, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553764.

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Previous studies have indicated that pelvic floor muscle training supervised by a trained health care professional is beneficial, both as treatment and prevention of stress urinary incontinence. Currently there are few reports available in the literature that address pelvic floor muscle condition in the general population of women, and none which have investigated this group irrespective of continence status. However, it is known that verbal and written information are often insufficient for women to learn to contract their pelvic floor muscles correctly. The overall aims of this thesis were to ascertain by objective measurement what proportion of community dwelling women know how to and are able to voluntarily contract their pelvic floor muscles (PFM), and whether a nurse who had undertaken a short course training programme could effectively instruct women to increase strength, endurance and muscular co-ordination of the PFM. This might help to reduce one of the modifiable risk factors for incontinence and pelvic organ prolapse, namely pelvic floor muscle weakness. The first objective was to estimate the prevalence of pelvic floor muscle weakness in a community dwelling sample of women in both urban and rural areas of south west Devon and north east Cornwall, UK, who were attending their General Practice for routine health checks. The subjects were recruited from a general population and were not necessarily symptomatic of any incontinence or pelvic organ prolapse. The second objective was to investigate the relative importance of a number of specific factors (such as age, parity, body mass index etc.) that might be associated with pelvic floor muscle weakness in the sample of women. The key objective outcome measure was perineometry (vaginal squeeze pressure), focussing on pelvic floor muscle strength and endurance of contraction. In order to first assess a correct contraction, digital palpation (Modified Oxford Score) was used. Subjects with weak muscles, (scoring 2 or less) could be assigned to the second study. The final objective was to evaluate the effectiveness of an educational programme of PFMT delivered by Primary Care Nurses compared to a pelvic floor specialist nurse, or a control group with no training, over 3 months. The first study was a survey of pelvic floor muscle condition which investigated objectives 1 and 2. The second study, a randomised controlled trial of PFMT, addressed the final objective. In the survey, 762 women from a range of urban and rural General Practices, aged 19- 76 (mean age 46) were assessed. Forty four percent were found to have weak pelvic floor muscles (PFM). This declines further with age, increasing parity, body mass index, and obstetric factors such as having had a forceps delivery and/or episiotomy. The association of a weak pelvic floor with incontinence has also been confirmed. Although the majority of women knew of pelvic floor exercises (87%), few were practicing them at the time of the study .The greatest adverse effect on pelvic floor muscle strength was the transition from nulliparity to first childbirth. Generalized linear modelling was used to investigate the combined effects of multiple explanatory variables. Some women had strong muscles despite advancing age, obesity or grand multiparity. Those who were physically and sexually active had a significantly increased likelihood of strong PFM. Of the 337 women with weak PFM, 97 declined to take part in the second study. Two hundred and forty subjects were randomised to one of three groups (75 Control, 84 Practice nurse, 8\ Specialist nurse) for the RCT. Both treatment groups showed a significant increase in pelvic floor strength after 3 months' training, compared with Controls (p

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Pereira, Larissa Carvalho 1983. "Impacto da gestação e do parto na sinergia entre os musculos transverso do abdome/obliquo interno e o assoalho pelvico = avaliação eletromiografica." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312345.

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Orientadores: Cassio Luiz Zanettini Riccetto, Simone Botelho Pereira
Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
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Resumo: Introdução e objetivos: Os exercícios dos músculos do assoalho pélvico e do abdome devem ser minuciosamente avaliados e orientados para que, através da sinergia, haja aperfeiçoamento na qualidade dos exercícios e se conheça as reações desencadeadas durante a realização dos mesmos. É de grande importância entender a sinergia do recinto abdomino pélvico em diferentes fases da vida feminina, como na gestação e puerpério, pois, nestas fases surgem grandes alterações na musculatura abdominal e do assoalho pélvico, necessitando de maior atenção para que os exercícios sejam realmente eficazes. Sendo assim, este estudo observacional, teve como objetivo a avaliação eletromiográfica simultânea dos músculos transverso do abdome e do assoalho pélvico, durante exercícios comumente realizados por mulheres em fase gestacional e/ou puerperal. Métodos: Este estudo, clínico, prospectivo, observacional e controlado foi constituído de 81 mulheres, com idade média de 23,56 anos (DP=4,82), as quais foram divididas em quatro grupos: Grupo (A): 20 nulíparas; Grupo (B): 25 primigestas, com idade gestacional maior ou igual à 24 semanas; Grupo (C): 19 puérperas em fase remota (40 a 60 dias), pós parto vaginal; Grupo (D): 17 puérperas em fase remota (40 a 60 dias), pós parto cesariana. Inicialmente foi realizado a avaliação funcional do assoalho pélvico (AFA) e posteriormente o probe endovaginal foi posicionado. A atividade elétrica dos músculos abdominais e do assoalho pélvico foi registrada simultaneamente por eletromiografia de superfície. As contrações solicitadas do assoalho pélvico e do abdome foram máximas, voluntárias e repetidas três vezes, sendo as contrações do abdome do tipo isométrico e isotônico. Os resultados obtidos foram submetidos à análise de variância (ANOVA) com aplicação de Teste Contrastes Ortogonais através do programa estatístico "R", da R Development Core Team (2008). Os contrastes realizados foram: Contraste 1- Nulíparas versus demais grupos; Contraste 2- Gestantes versus Puérperas e Contraste 3- Puérperas pós parto vaginal versus Puérperas pós parto cesariana. O nível de significância adotado foi abaixo de 1%. Resultados: Durante os exercícios para o assoalho pélvico, foi mostrada significância da sinergia abdominal das mulheres nulíparas (p=0,0007) quando comparadas aos outros grupos. Os demais contrastes realizados para verificação da sinergia durante exercício do assoalho pélvico não apresentou significância (p=0,4509 e p=0,2786). Ao realizar o exercício abdominal do tipo isométrico, as nulíparas mostraram valores significativos ao serem comparadas aos demais grupos estudados (p=0,00001). Entretanto, quando os outros grupos foram comparados entre si, não houve significância (p=0,7949 e 0,9633). Quando solicitado o exercício abdominal isotônico, as nulíparas se mostraram sinérgicas quando comparadas às demais mulheres em fases específicas (p=0,00002) o que não ocorreu nas demais comparações (p=0,8355 e p=0,4662). Conclusão: Há sinergia entre os músculos transverso do abdome/oblíquo interno e o assoalho pélvico em mulheres, jovens, nulíparas e saudáveis. Mulheres em fase gestacional e puerperal remota não apresentam co-ativação dos músculos transverso do abdome/oblíquo interno e do assoalho pélvico, independente do tipo de parto e exercício solicitado
Abstract: Introduction and objectives: Pelvic floor and abdominal muscles exercises must be carefully evaluated and coached so that throughout synergy there can be improvement of the quality of the exercises as well as a greater knowledge of the reactions produced during their execution. It is of great importance to understand the synergy of the abdominal-pelvic area during the different stages of the women such as gestation and puerperium, since in those phases there are many and great alterations of the abdominal and pelvic floor muscles that require more attention during exercises executions resulting in real efficacy. This observational study had as objective to evaluate through simultaneous electromyography the transversus abdominis, obliquous internus and pelvic floor muscles during commonly used exercises performed by women in gestational and/or puerperal phases. Methods: This is a clinical, observational, prospective and controlled study which was composed of 81 women with a mean age of 23. 56 years old (SD=4,82) who were divided into 4 groups: Group (A): 20 nulliparous; Group (B): 25 primiparous with gestational age superior or equal to 24 weeks; Group(C): 19 in late puerperal phase (40-60 days) after vaginal delivery; Group (D): 17 in late puerperal phase (40- 60 days) after cesarean delivery. The Functional Pelvic Floor Evaluation (AFA) was made prior to the endovaginal probe positioning. The electric activity of the abdominal and pelvic floor muscles was simultaneously recorded through surface electromyography. The requested contractions of those muscles were maximum, voluntary and performed for three times, being both isometric and isotonic. The results were analyzed by ANOVA (analysis of variance) with Orthogonal Contrast Test using the statistic program "R" from R Development Core Team (2008). The used contrasts were: Contrast 1: Nulliparous versus other groups; Contrast 2-Pregnant versus Puerperals and 3-After Vaginal Delivery Puerperals versus After Cesarean Delivery Puerperals. The significance level was below 1%. Results: During exercises of the pelvic floor muscles, there was a synergic response of the abdominal muscles in the nulliparous group (p=0,0007) when compared to the other groups. There was no significance for the other contrasts regarding pelvic floor muscles exercises (p=0,4509 and p=0,2786). There were significant values for the nulliparous women during isometric abdominal exercise when compared to the other groups (p=0,00001). However when the other groups were compared among each other, there were no significant values (p=0,7949 and 0,9633). During isotonic abdominal exercise, the nulliparous women showed synergy when compared to the other women who were in specific stages (p=0,00002). It did no happen with other comparisons (p=0,8355 and p=0,4662). Conclusão: There is synergy among transversus abdominis, obliquous internus and pelvic floor muscles in young, nulliparous and healthy women. Pregnant and late puerperal women do not present co-activation of the transversus abdominis, obliquous internus and pelvic floor muscles, independently of the delivery mode
Mestrado
Pesquisa Experimental
Mestre em Cirurgia

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Stephen, Catriona. "Adherence to pelvic floor muscle exercises and the role of smart phone apps." Thesis, University of the Highlands and Islands, 2015. https://pure.uhi.ac.uk/portal/en/studentthesis/adherence-to-pelvic-floor-muscle-exercises-and-the-role-of-smart-phone-apps(4337fb88-fbed-4fe5-991a-3d8309eed192).html.

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Urinary incontinence (UI) is a condition commonly experienced by women worldwide. Many women suffer in silence as they refrain from or delay seeking help. Pelvic Floor Muscle Exercises (PFME) have proven to be effective and are recommended as the first line of treatment. Regular exercise of the pelvic floor muscles can prevent symptoms developing. However, there is evidence of lack of motivation and poor adherence to exercises. The use of mobile phone applications have been suggested as an effective resource for health behaviour interventions, especially for sensitive or embarrassing conditions. A mixed methodology was used to gather evidence about the experience of community dwelling women in the North of Scotland over a three month period. Of the twenty three participants who completed a three month explanatory randomised controlled trial, fifteen participants exercised at least daily on average by the end of the trial. Of the fifteen who exercised at least daily, five continued average exercise of at least daily at the twelve month follow-up. Taking part in the study helped women to focus on the exercises and this had a positive impact on their adherence. Eleven out of the fifteen participants with incontinence experienced an improvement in their symptoms after twelve weeks. This had a positive impact on their quality of life. Of those who experienced UI, the women who had the biggest increase in level of exercise also had the biggest improvement in symptoms. Participants in the intervention group of the trial were provided with apps for PFME. Six out of the ten of intervention group participants who completed the trial reported that the apps were not useful and of the four who found them useful, their level of use was varied. The data from this study suggests that simply being provided with apps or equipment to use the apps cannot be linked to improved levels of participation in the study. This suggests that the provision of technology is insufficient in itself to engage with individuals in health behaviour change and has important implications for future service provision in continence promotion and mHealth.

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Ng, Sau-loi, and 吳秀來. "A randomised controlled trial study of the efficacy of intensive pre-operative pelvic floor muscle training to decrease post-prostatectomy urinary incontinence." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198846.

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Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive. Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group. Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes. Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery. Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information. Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group.
published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing

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Alves, Fabiola Kenia 1987. "O efeito de um programa de treinamento dos músculos do assoalho pélvico realizado em grupo para mulheres na pós-menopausa = The effect of a pelvic floor muscle training performed in group to postmenopausal women." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313088.

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Orientadores: Simone Botelho Pereira, Cássio Luís Zanettini Riccetto
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O processo de envelhecimento é um dos principais fatores de disfunções uroginecológicas. O treinamento dos músculos do assoalho pélvico (TMAP) é o método de primeira escolha para o tratamento de incontinência urinária e também recomendado para a prevenção e tratamento de prolapsos dos órgãos pélvicos. O objetivo deste estudo foi avaliar o efeito de um programa de TMAP em grupo sobre a contratilidade muscular em mulheres na pós-menopausa, assim como sobre a presença de sintomas urinários e prolapsos de órgãos genitais. Métodos. Foi realizado um ensaio clínico, randomizado, controlado e cego com 30 mulheres na pós-menopausa (idade média de 65.93 ±8.76 anos), divididas em dois grupos: Resumo: Grupo Tratado (n=18) e Grupo Controle (n=12). A avaliação foi realizada antes e após o tratamento em ambos os grupos e consistiu de palpação vaginal (Escala Modificada de Oxford), eletromiografia de superfície dos músculos do assoalho pélvico, avaliação da presença de prolapsos dos órgãos pélvicos e avaliação de sintomas miccionais e vaginais por meio da aplicação dos questionários validados: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) e International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). O protocolo de tratamento consistiu de 12 sessões em grupo de 8-10 participantes, duas vezes na semana, por 30 minutos, totalizando seis semanas. Foram utilizados para análise estatística os Testes ANOVA, Teste de Comparação múltipla de Tukey, Teste de Wilcoxon e Teste Perfil de Contrastes. Resultados. A contratilidade dos músculos do assoalho pélvico aumentou significativamente depois do programa de treinamento tanto na eletromiografia (p=0.003) quanto na palpação digital (p=0.001). Houve decréscimo do escore do questionário ICIQ-OAB apenas no grupo tratado (p<0.001) com diferença significativa entre os grupos através do tempo (p=0.002). Houve decréscimo do escore do questionário ICIQ-UI SF com diferença significativa entre o grupo controle e o grupo tratado depois do tratamento (p=0.03). O grau do prolapso anterior também diminuiu apenas no grupo tratado (p=0.03). Não foram encontradas diferenças significativas no grau do prolapso posterior e no questionário ICIQ-VS. Conclusão. O programa de TMAP em grupo foi eficaz para o aumento da contratilidade muscular, diminuição da gravidade do prolapso de parede anterior e dos sintomas urinários em mulheres na pós-menopausa.
Abstract: Introduction. The aging process is one of the major reasons for urogynecological dysfunctions. Pelvic floor muscle training (PFMT) is the method chosen in the first place for the treatment of urinary incontinence, also indicated for the prevention and treatment of the pelvic organs' prolapses. The aim of this study was to evaluate the effects of a group pelvic floor muscle training program on post-menopausal women's pelvic floor muscle contractility , as well as on the presence of urinary symptoms and genital organ prolapses. Methods. A clinical, randomized, controlled and assessor-blinded study was conducted with 30 post-menopausal women (mean age 65.93 ±8.76 years), divided into two groups: Treatment Group (n=18) and Control Group (n=12). The evaluation was carried out using digital palpation (Modified Oxford Grading Scale), pelvic floor surface electromyography (sEMG), the Pop-Q System to evaluate the presence of pelvic organ prolapse using validated questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). The treatment protocol consisted of 12 group sessions, with 8-10 participants, carried out by a physiotherapist (main investigator), twice a week, with 30 minutes of duration each, totaling six weeks. The statistical analysis was performed using ANOVA, Tukey¿s Multiple Comparison Test, McNemar¿s Test and the Contrast Profile Test. Results. The pelvic floor muscle contractility increased after the training program, assessed by sEMG (p=0.003) and by vaginal palpation (p=0.001). There was a decrease in the ICIQ-OAB scores only in the treated group's final evaluation (p<0.001) with a significant difference between the groups along the time (p=0.002). There was a decrease in the ICIQ-UI SF scores (p=0.03) between the treated and control groups after the treatment. There was a significant decrease in the anterior pelvic organ prolapse (p=0.03) in the treated group. No significant differences were found in the posterior pelvic organ prolapse and the ICIQ-VS scores. Conclusion. Group pelvic floor muscle training program is an effective way to increase the pelvic floor muscle contractility and to decrease the anterior pelvic organ prolapse as well as urinary symptoms in post-menopausal women.
Mestrado
Fisiopatologia Cirúrgica
Mestra em Ciências

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Barbosa, Angélica Mércia Pascon. "Efeito da via de parto na força muscular do assoalho pélvico, em primíparas /." Botucatu : [s.n.], 2004. http://hdl.handle.net/11449/95375.

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Orientador: Marilza Vieira Cunha Rudge
Resumo: Objetivo - Determinar a influência da via de parto na força muscular do assoalho pélvico (AP) de primíparas, 4 a 6 meses pósparto. Sujeitos e Métodos - Estudo clínico, de corte transversal, para avaliar a função da musculatura do AP pelo teste da AFA e perineômetro pneumático e classificada em: zero - ausência de contração muscular, um - contração leve, dois - contração moderada não sustentada por 6 segundos e, três - contração normal sustentada por 6 segundos. As 94 mulheres, tinham entre 20 e 30 anos, foram divididas em 3 grupos de acordo com a via de parto: I com 32 primíparas pós-parto vaginal; II com 32 primíparas pós-parto cesárea e III com 30 nulíparas que serviram como grupo controle. A variável independente foi a via de parto e a dependente a força muscular do AP(1). Resultados e conclusões - A mediana e o 1º e 3º quartís da força muscular do AP foram menores (p=0.01) pós-parto vaginal (2.0;1-2) e intermediária pós-parto cesárea (2.0; 2-3) em relação as nulíparas (3.0;2-3) pelo AFA e perineômetro. Aumentou o risco relativo(RR) de exame alterado da força da musculatura do AP pós-parto vaginal (RR=2.579 IC 95%=1.32-5.04 p=0.002); (RR=2.31 IC 95%=1.24- 4.32 p=0.005) e pós-cesárea (RR=1.56 IC 95% = 0.94-2.57 p=0.12); (RR=1.38 IC 95%=0.85-2.23 p=0.29) pela AFA e perineômetro. O parto vaginal diminuiu a força muscular do AP de primíparas e comparando com a cesárea e as nulíparas.
Abstract: Objective - To evaluate the influence of the route of delivery on pelvic floor (PF) muscle strength, in primiparous patients at 4 to 6 months after delivery. Subjects and methods - A cross-sectional study was undertaken among primiparous women at 4 to 6 months postpartum to evaluate the PF muscle strength by AFA test and pneumatic perineometer, classified in: zero - lack of muscle contraction; one - weak contraction; two - moderate contraction not sustained for 6 seconds and three - normal contraction sustained for 6 seconds. 94 enrolled patients were divided in three groups based upon prior delivery route: I) 32 vaginal delivery with singleton cephalic presentation; II) 32 cesarean delivery; and III) 30 nuliparous patients served as a control group. The independent variable was the route of delivery and the dependent one was the muscle strength of the PF. Data were subjected to Student t test to estimate the relative risk and the Kappa test(1). Results and conclusions - The three subgroups were comparable with respect to maternal age, weight, gestational age and newborn weight. The 1st and the 3rd quartiles of the route of delivery on PF muscle strength were lower (p=0.01) for vaginal delivery (n=32) (2.0;1- 2) and intermediate for cesarean (n=32) (2.0; 2-3) comparing to the nuliparous (3.0; 2-3) by AFA test and pneumatic perineometer. The altered PF muscle strength in primiparous were significantly lower in the vaginal delivery group (RR=2.58, CI 95%=1.32-5.04, p=0.002); (RR=2.31, CI 95%=1.24-4.32, p=0.005); and postcesarean (RR=1.56, CI 95% = 0.94- 2.57, p= 0.12); (RR=1.38, CI 95%=0.85-2.23, p=0.29). Vaginal delivery decreases PF muscle strength when compared with caesarean delivery and control.
Mestre

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Dorey, Grace Francis. "Evaluation of pelvic floor muscle exercises and manometric biofeedback in the management of erectile dysfunction." Thesis, University of the West of England, Bristol, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271042.

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Hallam, S. M. "Enhancing self-efficacy and pelvic floor muscle exercise adherence through sEMG biofeedback : a randomised study." Thesis, University of Salford, 2012. http://usir.salford.ac.uk/33239/.

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Background Pelvic floor muscle exercises are a recommended first-line treatment for stress urinary incontinence (SUI) in women (NICE, 2006). Poor adherence to pelvic floor muscle exercises (PFME) is a recognised problem which has the potential to compromise successful treatment (Bø, 1995; Alewijnse et al., 2001). Biofeedback is thought to help motivate PFME practice but so far this has not been evaluated in a randomised study. Aim This study tests the hypothesis that use of clinic-based sEMG biofeedback improves women’s motivation to exercise (PFME adherence) by increasing pelvic floor muscle exercise self-efficacy, an important construct in pelvic floor muscle exercise adherence behaviour. Method After ensuring that they are able to make an informed decision to participate, a sample of sixty women referred for physiotherapy treatment of SUI between December 2008 and February 2010, gave consent to participate in the study. They were randomised into one of two groups. Thirty one women received clinic-based sEMG biofeedback in addition to the usual care, twenty nine received the usual care. Each participant attended clinic twice in a three month treatment period. Women were also asked to adhere to a daily home exercise programme (HEP). The primary outcome was pelvic floor muscle exercise self-efficacy. PFME self-efficacy and HEP adherence, were assessed by means of self-completed questionnaires. Results Ten women dropped out of the study before completion. Both groups improved on all outcomes, but no significant difference was found between the groups in terms of self-efficacy levels or exercise adherence rates. PFME recall was more accurate in the intervention group receiving clinic-based sEMG biofeedback. A positive and significant relationship was confirmed between PFME self-efficacy and PFME adherence. These findings are discussed in respect to the concept of self-efficacy and behavioural change. xi xii Conclusion In the short term, clinic-based sEMG biofeedback does not increase PFME self-efficacy or HEP practice beyond that achieved through instruction using vaginal palpation. These findings refute the belief that monitoring with sEMG biofeedback improves self-efficacy or women’s motivation to adhere to a HEP, but does suggest that biofeedback may be a useful adjunct to teaching PFME.

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Lovegrove, Jones Ruth Cerian. "Dynamic evaluation of female pelvic floor muscle function using 2D ultrasound and image processing methods." Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/157609/.

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The aim of this study was to define new quantitative parameters of dynamic Pelvic Floor Muscle (PFM) function using 2D transperineal (TP) ultrasound imaging combined with image processing methods (IPM). Ultrasound and digital vaginal data were obtained from a volunteer convenience sample of 23 continent and 9 Stress Urinary Incontinent (SUI) women recruited from the San Francisco Bay Area community, California, U.S.A. Two methods of IPM were used; speckle tracking for measuring displacement of the ano-rectal angle (ARA) and symphysis pubis (SP); and segmentation IPM for measuring displacement of the urethra. Good to excellent inter and intra observer reliability was established for processing the ultrasound images on stored audio-visual imaging files (AVI). Intraclass correlation coefficient (ICC) values: 0.61 to 0.99; 95% confidence intervals (CI) 0.08→0.84 to 0.97→0.99; standard error of measurement (SEM) 0.01to 0.25 cm. There was good agreement between measures on Bland and Altman analysis: mean difference 0.06 to -0.21 cm; 95% CI 0.02→0.45cm to -0.01→0.20cm. Validity of the IPM was confirmed with digital palpation, and furthermore indicated good sensitivity and specificity. Technical and methodological limitations of the IPM, and suggestions for future studies were discussed. Several research questions were addressed using TP ultrasound combined with IPM that enabled the dynamic evaluation of pelvic floor (PF) displacement throughout an entire manoeuvre, rather than limiting the quantification from static images at rest to the end of the manoeuvre. In this way, IPM determined unique quantitative data regarding the automatic displacement, velocity and acceleration of the ARA and urethra during a cough, Valsalva, voluntary PFM contraction, The Knack and a Transversus Abdominis contraction. During automatic events that raised intra-abdominal pressure (IAP), normal PFM function produced timely compression of the PF and additional external support to the urethra, reducing the displacement, velocity, and acceleration. In women with SUI, who have weaker urethral attachments, this shortening contraction did not occur; consequently, the urethra of women with SUI moved further and faster for a longer duration. Caution regarding the generalisability of this study is warranted due to the small number of women in the SUI group and the significant difference in parity between groups. However this non-invasive physiological measurement tool demonstrated a new way of assessing the PFM. It is envisaged that this study will provide the foundation for future studies with larger parity matched populations and eventually improve the rehabilitation of women with SUI and other PF disorders.

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Sousa, Vanessa de Oliveira [UNESP]. "Avaliação comparativa da força muscular do assoalho pélvico em mulheres nulíparas e primigestas." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/88903.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
O objetivo desse estudo foi avaliar a força dos músculos do assoalho pélvico (AP) em nulíparas e primigestas utilizando a avaliação subjetiva e objetiva. 100 mulheres com idade entre 20 e 30 anos foram estudadas prospectivamente. As participantes foram distribuídas em dois grupos: Grupo G1 (n=50) composto por mulheres nulíparas voluntárias saudáveis sem disfunções urinárias, Grupo G2 (n=50) por primigestas. Dados demográficos, como atividade física, foram obtidos utilizando questionário clinico. Avaliação subjetiva dos músculos do AP foi feita por palpação digital vaginal em duas porções (anterior e posterior). A avaliação objetiva da força dos músculos do AP foi realizada utilizando um perineômetro portátil (Dynamed DM-01) em três diferentes posições: em decúbito dorsal com membros inferiores estendidos (P1), decúbito dorsal com membros inferiores fletidos (P2) e sentada (P3). Esses parâmetros foram avaliados em um só momento no grupo G1 e na 20ª, 36ª semana de gestação e após 45 dias do parto em G2. Em G2, 14 mulheres foram excluídas por perda de seguimento. A média de idade foi de 23 anos em G1 e 22 em G2 (p>0,05). 84% das mulheres em G1 e 80% em G2, relataram orgasmo (p>0,05). Em G1, 54% apresentaram constipação intestinal e 50% em G2 (p>0,05). A atividade sexual foi significativamente maior em G2 (97%) quando comparado a G1 (84%). Na porção anterior, a avaliação feita por palpação digital vaginal da contração dos músculos do AP foi considerada normal em 52% das nulíparas (G1), em 39%, 22% e 25% na 20ª, 36ª semana de gestação e 45 dias após o parto, respectivamente em G2. Na porção posterior, a palpação digital vaginal foi normal em 76% de G1, em 67%, 36% e 44%, na 20ª, 36ª semana de gestação e 45 dias após o parto, respectivamente, em G2. Houve diferença...
The aim of this study was to assess pelvic floor muscle (PFM) strength in nulliparous and primiparous using subjective and objective evaluation. 100 women with age between 20 and 30 years were prospectively studied . Participants were distributed into 2 groups: Group G1 (n = 50) composed by voluntary healthy nulliparous women without urinary complaints; Group G2 (n = 50) by primiparous females. Demographic data, such as physical activity, was obtained using clinical questionnaire. Subjective evaluation of pelvic floor muscle (PFM) was performed using transvaginal digital palpation (TDP) into 2 positions (anterior and posterior). Objective evaluation of PFM strength was assessed using a portable perineometer (DM 01 Dynamed) in three different positions: in lying position with straight limbs (P1), with bent limbs (P2) and sitting (P3). These parameters were recorded at one moment in group G1 and in 20th and 36th weeks during pregnancy and after 45 days of the delivery in G2.Results: In G2, 14 women were excluded due to the lost follow-up. The median of age was 23 years in G1 and 22, in G2 (p> 0.05). 84% of women in G1 and 80% in G2, reported orgasm (p> 0.05). In G1, 54% presented intestinal constipation and 50% in G2 (p>0.05). The sexual activity was significantly higher in G2 (97%) as compared to G1 (84%). In anterior position, the TDP evaluation of PFM contraction was considered normal in 52% of nuliparous (G1),and in 39%, 22% and 25%, at 20th and 36th week of pregnancy and 45 days afer delivery, respectively in G2. In posterior position, the TDP was normal in 76% of G1, and in 67%, 36% and 44%, at 20th and 36th week of pregnancy and 45 days afer delivery, respectively, in G2. There was a significant statical difference between all periods of evaluation as anterior as posterior position in G2 as compared to G1, except when ...(Complete abstract click electronic access below)

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Piassarolli, Virginia Pianessole 1983. "Treinamento muscular do assoalho pelvico nas disfuncões sexuais femininas." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312361.

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Orientadores: Ellen Hardy, Maria Jose Duarte Osis
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Objetivo: avaliar o efeito do treinamento dos músculos do assoalho pélvico (MAP) nas disfunções sexuais femininas. Sujeitos e Métodos: realizou-se um ensaio clínico com 26 mulheres que apresentavam diagnóstico de disfunção sexual (transtorno de desejo sexual, transtorno de excitação, transtorno orgástico e dispareunia) no período de fevereiro de 2008 a maio de 2009. Foi administrado um questionário denominado FSFI (Female Sexual Function Índex) para verificar a função sexual. A contração dos músculos do assoalho pélvico foi avaliada por meio da palpação vaginal (bi-digital) e, em seguida, realizou-se uma eletromiografia de superfície para avaliar amplitudes de contração. Tais procedimentos ocorreram previamente, na metade e após o tratamento. As mulheres realizaram exercícios para os músculos do assoalho pélvico em diferentes posições, uma ou duas vezes por semana, totalizando 10 sessões de tratamento. Na análise das variáveis ao longo do tempo, utilizou-se o teste não-paramétrico e o Anova de Friedman, o teste de Bonferroni e o teste de correlação de Spearman. Adotou-se um nível de significância de p<0,05 para análise dos dados. Resultados: Observou-se uma melhora significativa (p<0,0001) dos escores de todos os domínios e do escore total do FSFI ao final do tratamento quando comparadas a avaliação inicial e intermediária. Em relação a eletromiografia de superfície, as amplitudes das contrações fásicas e tônicas aumentaram significativamente (p<0,0001) ao longo do tratamento. Houve também um aumento na força do assoalho pélvico, com 69% das mulheres apresentando grau 4 ou 5 na avaliação final. Ao final do tratamento, a maioria das participantes (18) recebeu alta por não mais apresentar queixas relativas à função sexual. Conclusão: O treinamento dos MAP resultou em melhora na força e nas amplitudes da eletromiografia, acompanhadas de aumento significativo nos escores de função sexual, o que indica que essa abordagem terapêutica pode ser utilizada com sucesso no tratamento das disfunções sexuais femininas
Abstract:Objective: To evaluate the effect of pelvic floor muscle training in female sexual dysfunctions. Subjects and Methods: 26 women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and dyspareunia) were enrolled in a clinical trial, between February 2008 and May 2009. To evaluate the sexual function we used Female Sexual Function Index (FSFI) questionnaire. Bi-digital palpation was applied to assess muscle strength and surface electromyography to contraction amplitudes. The assessment was carried out before, during (after five sessions) and at the end of the treatment (after 10 sessions). The women underwent pelvic floor muscle training, once or twice a week, for 10 sessions in different positions. To analysis during the follow-up period, non parametric's and ANOVA's Friedman test, Bonferroni test and Spearman Correlation test were applied. Results were considered statistically significant if p<0.05. Results: All FSFI scores were higher (p<0.0001) at the end of the treatment in comparison with the values observed before and in the middle of the treatment. Regarding surface electromyography, tonic and phasic contractions amplitudes significantly increased over time (p<0.0001). Pelvic floor strength also increased in 69% of the women who had 4 or 5 grade in final evaluation. Eighteen participants had a total improvement of sexual complaints at the end of the treatment. Conclusions: The pelvic floor muscle training improved strength and surface electromyography amplitudes while the sexual function scores increased. This indicates that physiotherapy approach may be successfully used in the female sexual dysfunctions treatment
Mestrado
Tocoginecologia
Mestre em Tocoginecologia

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42

Chen, Shu-Yueh. "A causal model : factors influencing pelvic muscle exercise adherence among Taiwanese women with urinary incontinence /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7355.

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Alewijnse, Dianne. "Urinary incontinence in women long-term adherence to and outcome of pelvic floor muscle exercise therapy /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2002. http://arno.unimaas.nl/show.cgi?fid=7013.

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44

Crafoord, Kristina. "Genital prolapse surgery : A study of methods, clinical outcome and impact of pelvic floor muscle function." Doctoral thesis, Linköpings universitet, Obstetrik och gynekologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17417.

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Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse. Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery. A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively. Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values. Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.

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Crotty, Kay. "Investigation of optimal cue to instruction for pelvic floor muscle contraction in women using ultrasound imaging." Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/15431.

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Background: Pelvic floor muscle (PFM) training is recommended as first line conservative management for stress urinary incontinence (SUI). The fundamental issue of how to optimally contract the PFM has not previously been investigated. An effective voluntary PFM contraction is known to positively influence the bladder neck and urethra which are urethrovesical (UV) structures associated with continence. The PFM may be globally or selectively contracted according to cue to instruction. The main research question was to investigate which cue to instruction for a PFM contraction has the potential to optimise position of UVSs following a brief period of practice in continent nulliparous pre-menopausal women (aiming to provide normative data) and parous menopausal women with previously unreported SUI. Hypotheses: Posterior or combined cues for instruction of PFM contraction are more influential in optimising UV position (UVP) during PFMC following brief practice than an anterior cue. Posterior or combined cues are equally influential in altering UVP. Aims: Preliminary aim was to investigate the reliability and suitability of 2-DRTUS and angle of urethral inclination (AUI) for imaging of selective contraction of the PFM and ease of reading images by a non diagnostic imaging researcher. Principal aim was to investigate if there is an optimal cue to instruction for a PFM contraction in two groups of women. Study 1: pre menopausal nulliparous continent women (to provide normative data) and Study 2: post menopausal parous stress incontinent women. Secondary aims were investigation of posture; ability to selectively contract the PFM contraction; and cue preference. Method: Study 1: Twenty women who were able to effectively and selectively contract were taught the following cues: anterior; posterior; anterior and posterior combined. Following 4 weeks of practice, perineal 2-D RTUS images of three PFMC for each cue were captured in supine and standing twice (for repeatability analysis) five minutes apart. Two raters measured AUI. Data analysis was undertaken using a Customized General Linear Model (GLM) ANOVA with Bonferroni correction for interactions between all variables; subject, cue, posture and test. Seventeen data sets were available for analysis. Study 2: Methodology was based on Study 1. Twenty-one women were taught the study cues, followed the practice protocol and underwent data collection in the supine position. Twenty-one sets of data were available for analysis. Results: Reliability: ICC [1,3] for intra rater reliability was 0.957 [CI 95%: 0.946 to 0.967 p=0.000], inter rater reliability [2,1] 0.820 [CI 95%: 0.768 to 0.861] and for repeatability [1,3] 0.781 [CI 95%: 0.690 to 0.849 p=0.000] (continent) and 0.954 [CI 95%:0.931 to 0.971 p=0.000] (incontinent). Principal results Study 1: anterior vs posterior cues (difference) 3.979˚ (CI 95%: [0.503 to 7.455 p=0.021]); anterior vs combined 3.777˚ (CI 95%: [-0.099 to 6.853 p= 0.059]) posterior vs combined cues -0.602˚ (CI 95%: [-2.874- 4.078 p=1.00]). Aggregated data from tests 1 and 2: anterior vs posterior 4.240° (CI 95%: [1.213 to 7.267 p=0.003]); anterior vs posterior 3.756° (95%CI: [0.729 to 6.783 p=0.009]); posterior vs combined-6.48° (95% CI: [-3.511 to 2.542 p=1.000]). Principal results Study 2: anterior vs posterior 3.936˚ (95%CI: [0.863 to 7.008p=0.008]; 4.946˚ anterior vs combined (95%CI: [1.873 to 8.018 p=0.001]); posterior vs combined 1.010° (95%CI: -[2.062 to 4.082 p=1.000]). Aggregated analysis was anterior vs posterior 3.703˚ (95%CI: [1.639 to 5.761 p=0.000]); anterior vs combined 5.089˚ (95%CI: [3.0287 to 7.1503 p=0.000]) and posterior and combined 1.389° (95%CI: [-0.672 to 3.450 p=0.309]). Secondary results: 2-D RTUS and the AUI were found to be suitable for investigating selective PFM contraction. Posture: supine vs standing (difference) 9.496˚ (p=0.000); (posture did not affect absolute AUI). Three continent (13%) and 2 incontinent (7%) subjects were unable to selectively contract the PFM. Cue preference in both studies was posterior or combined. Conclusions: AUI was significantly narrower/optimal when instruction for PFM contraction included a posterior cue, in both continent and stress incontinent women. This is proposed to be due to optimal recruitment of puborectalis. Puborectalis may be more important in urinary continence than widely recognized. This study has provided seminal information with respect to optimal cue to contraction for a PFM contraction and will change practice. Investigation of the potential impact of these findings clinically is required. It is proposed that further understanding will lead to standardisation of PFM instruction, ease of comparability between PFM research studies, and will clarify PFM instructions for the media and lay public.

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46

Chan, Fun-yee, and 陳芬怡. "An evidence-based pelvic floor muscle training program to prevent urinary incontinence for patients following radical prostatectomy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581376.

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Sousa, Vanessa de Oliveira. "Avaliação comparativa da força muscular do assoalho pélvico em mulheres nulíparas e primigestas /." Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/88903.

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Resumo: O objetivo desse estudo foi avaliar a força dos músculos do assoalho pélvico (AP) em nulíparas e primigestas utilizando a avaliação subjetiva e objetiva. 100 mulheres com idade entre 20 e 30 anos foram estudadas prospectivamente. As participantes foram distribuídas em dois grupos: Grupo G1 (n=50) composto por mulheres nulíparas voluntárias saudáveis sem disfunções urinárias, Grupo G2 (n=50) por primigestas. Dados demográficos, como atividade física, foram obtidos utilizando questionário clinico. Avaliação subjetiva dos músculos do AP foi feita por palpação digital vaginal em duas porções (anterior e posterior). A avaliação objetiva da força dos músculos do AP foi realizada utilizando um perineômetro portátil (Dynamed DM-01) em três diferentes posições: em decúbito dorsal com membros inferiores estendidos (P1), decúbito dorsal com membros inferiores fletidos (P2) e sentada (P3). Esses parâmetros foram avaliados em um só momento no grupo G1 e na 20ª, 36ª semana de gestação e após 45 dias do parto em G2. Em G2, 14 mulheres foram excluídas por perda de seguimento. A média de idade foi de 23 anos em G1 e 22 em G2 (p>0,05). 84% das mulheres em G1 e 80% em G2, relataram orgasmo (p>0,05). Em G1, 54% apresentaram constipação intestinal e 50% em G2 (p>0,05). A atividade sexual foi significativamente maior em G2 (97%) quando comparado a G1 (84%). Na porção anterior, a avaliação feita por palpação digital vaginal da contração dos músculos do AP foi considerada normal em 52% das nulíparas (G1), em 39%, 22% e 25% na 20ª, 36ª semana de gestação e 45 dias após o parto, respectivamente em G2. Na porção posterior, a palpação digital vaginal foi normal em 76% de G1, em 67%, 36% e 44%, na 20ª, 36ª semana de gestação e 45 dias após o parto, respectivamente, em G2. Houve diferença... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The aim of this study was to assess pelvic floor muscle (PFM) strength in nulliparous and primiparous using subjective and objective evaluation. 100 women with age between 20 and 30 years were prospectively studied . Participants were distributed into 2 groups: Group G1 (n = 50) composed by voluntary healthy nulliparous women without urinary complaints; Group G2 (n = 50) by primiparous females. Demographic data, such as physical activity, was obtained using clinical questionnaire. Subjective evaluation of pelvic floor muscle (PFM) was performed using transvaginal digital palpation (TDP) into 2 positions (anterior and posterior). Objective evaluation of PFM strength was assessed using a portable perineometer (DM 01 Dynamed) in three different positions: in lying position with straight limbs (P1), with bent limbs (P2) and sitting (P3). These parameters were recorded at one moment in group G1 and in 20th and 36th weeks during pregnancy and after 45 days of the delivery in G2.Results: In G2, 14 women were excluded due to the lost follow-up. The median of age was 23 years in G1 and 22, in G2 (p> 0.05). 84% of women in G1 and 80% in G2, reported orgasm (p> 0.05). In G1, 54% presented intestinal constipation and 50% in G2 (p>0.05). The sexual activity was significantly higher in G2 (97%) as compared to G1 (84%). In anterior position, the TDP evaluation of PFM contraction was considered normal in 52% of nuliparous (G1),and in 39%, 22% and 25%, at 20th and 36th week of pregnancy and 45 days afer delivery, respectively in G2. In posterior position, the TDP was normal in 76% of G1, and in 67%, 36% and 44%, at 20th and 36th week of pregnancy and 45 days afer delivery, respectively, in G2. There was a significant statical difference between all periods of evaluation as anterior as posterior position in G2 as compared to G1, except when ...(Complete abstract click electronic access below)
Orientador: João Luiz Amaro
Coorientador: Mônica de Oliveira Orsi Gameiro
Banca: Carlos Trindade Filho
Banca: Carla Adelino Suaid
Mestre

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48

McClurg, Doreen Elizabeth. "Urinary dysfunction in multiple sclerosis : effect of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation." Thesis, University of Ulster, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433932.

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49

Aiello, Nathália Andreatti 1984. "Contração muscular do assoalho pélvico e incontinência urinária em primíparas após o parto vaginal espontâneo e fórcipe = Pelvic floor muscle contraction and urinary incontinence in primiparas with spontaneous and forceps delivery." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312596.

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Orientador: Eliana Martorano Amaral
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: Avaliar a influência do parto vaginal espontâneo ou instrumental por fórcipe na contração muscular do assoalho pélvico de primíparas e na incontinência urinária (IU). Métodos: Estudo de coorte prospectivo, realizado no Hospital Universitário da Faculdade de Medicina de Jundiaí (HU-FMJ). Foram selecionadas 133 primíparas, no puerpério imediato, com idade entre 18-35 anos, que tiveram parto vaginal com episiotomia espontâneo ou instrumental por fórcipe. A contração dos músculos do assoalho pélvico (MAP) foi avaliada 40-55 dias após o parto, por meio de eletromiografia de superfície - EMGs (avaliando-se tônus de base ¿ TB, contração voluntária máxima - CVM e contração sustentada média - CSM) e por graduação de força segundo Escala de Oxford Modificada (graus 0-5). Avaliou-se a presença de IU durante a gestação e puerpério, utilizando o Internacional Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Os métodos estatísticos utilizados foram teste de Qui-Quadrado (X2) ou exato de Fisher para comparar proporções e teste Mann Whitney para comparar médias. Resultados: A média de idade foi de 22,3 anos (±4,2), o IMC gestacional foi de 27,6 Kg/m2 (±5,1). Apenas 44 mulheres realizaram avaliação puerperal, sendo uma descontinuada, 72,1% submetidas ao parto vaginal (PV) e 27,9% ao parto fórcipe (PF). A ocorrência de laceração perineal foi mais frequente no grupo PF (33,3%) do que no grupo PV (3,2%), mas as complicações devidas à episiotomia foram relatadas em apenas 7,0% dos casos, todos no grupo PV. A prevalência de IU foi de 37,6% durante a gestação e 39,5% no puerpério, sendo 32,3% do grupo PV e 58,3% do grupo PF. Houve mais IU desencadeada no puerpério no grupo PF [RR=3,10 (IC=95% 1,16-8,28); p=0,0468]. O sintoma urinário predominantemente referido no puerpério em ambos os grupos foi a urgeincontinência (29,5%), e a média do escore ICIQ foi 2,3 (±3,8) para o grupo PV e 4,2 (±3,9) para o grupo PF, não havendo diferença significativa entre os grupos. Apresentaram grau reduzido de força muscular 66,7% das puérperas do grupo PF e 27,6% do grupo PV. Os valores médios encontrados para TB, CVM e CSM do grupo PV foram 4,6?V, 23,2?V e 16,8?V e do grupo PF 3,4?V, 14,2?V e 10,7?V, respectivamente, havendo diferença significativa para TB e CVM. Conclusão: Entre as mulheres do estudo em questão observou-se associação do parto fórcipe com a diminuição da função dos MAP 40-55 dias após o parto na graduação de força por palpação e parâmetros eletromiográficos de TB e CVM, sem associação com IU
Abstract: Objective: To evaluate the influence of the spontaneous or instrumental vaginal delivery by forceps in the muscular contraction of the pelvic floor of primiparas and urinary incontinence (UI). Methods: Prospective cohort study, carried out in the University Hospital of the Faculty of Medicine of Jundiaí (HU-FMJ). 133 primiparas in the immediate puerperium, aged between 18-35, that have had vaginal delivery with spontaneous or instrumental episiotomy by forceps were selected. The contraction of the pelvic floor muscles (PFM) was evaluated 40-55 days after delivery, by means of surface electromyography - EMGs (evaluating tonus of basis - TB, maximum voluntary contraction - MVC and average of sustained contraction - ASC) and by muscle strenght graduation according to the Modified Scale of Oxford (degrees 0-5). The presence of UI during pregnancy and puerperium was evaluated according to the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The statistical methods used were the Qui-Square test (X2) or the accurate Fisher indicator to compare ratio and the Mann Whitney test to compare averages. Results: The average age was 22,3 years old (±4,2), gestacional BMI was 27,6 Kg/m2 (±5,1). Only 44 women returned for the puerperal evaluation and one volunteer was discontinued, 72.1% gave birth via spontaneous vaginal delivery (VD) and 27.9% via instrumental vaginal delivery (FD). The occurrence of perineal laceration was more frequent in the FD group (33.3%) than in the VD group (3.2%), but complications due to episiotomy were reported in only 7.0% of the cases, all in the VD group. There were more UI triggered puerperium in the group PF [RR=3,10 (CI=95% 1,16-8,28); p=0,0468]. The prevalence of UI was of 37,6% during pregnancy and 39.5% in the puerperium, where 32,3% of the VD group and 58,3% in the FD group. The urinary symptom predominantly related in the puerperium in both groups was the urge incontinence (29.5%), and the average of the ICIQ score was 2,3 (±3,8) for the VD group and 4,2 (±3,9) for the FD group, without significant differences between the groups. Showed reduced degree of muscular strength 66,7% of the puerperal in the FD group and 27.6% of the VD group. The found average values for TB, MVC and SVC in the VD group was 4,6 ?V, 23,2?V and 16,8?V and in the FD group was 3,4 ?V, 14,2?V and 10,7?V, respectively, with significant difference for TB and MVC. Conclusion: Among the women of the study concerned noted an association of forceps delivery and the reduction of the function of MAP was observed 40-55 days after delivery in the graduation of muscle strenght for palpation and electromyographic parameters of TB and MVC, not associated with UI
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde

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50

Barbosa, Angélica Mércia Pascon [UNESP]. "Efeito da via de parto na força muscular do assoalho pélvico, em primíparas." Universidade Estadual Paulista (UNESP), 2004. http://hdl.handle.net/11449/95375.

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Universidade Estadual Paulista (UNESP)
Objetivo – Determinar a influência da via de parto na força muscular do assoalho pélvico (AP) de primíparas, 4 a 6 meses pósparto. Sujeitos e Métodos – Estudo clínico, de corte transversal, para avaliar a função da musculatura do AP pelo teste da AFA e perineômetro pneumático e classificada em: zero - ausência de contração muscular, um - contração leve, dois - contração moderada não sustentada por 6 segundos e, três - contração normal sustentada por 6 segundos. As 94 mulheres, tinham entre 20 e 30 anos, foram divididas em 3 grupos de acordo com a via de parto: I com 32 primíparas pós-parto vaginal; II com 32 primíparas pós-parto cesárea e III com 30 nulíparas que serviram como grupo controle. A variável independente foi a via de parto e a dependente a força muscular do AP(1). Resultados e conclusões – A mediana e o 1º e 3º quartís da força muscular do AP foram menores (p=0.01) pós-parto vaginal (2.0;1-2) e intermediária pós-parto cesárea (2.0; 2-3) em relação as nulíparas (3.0;2-3) pelo AFA e perineômetro. Aumentou o risco relativo(RR) de exame alterado da força da musculatura do AP pós-parto vaginal (RR=2.579 IC 95%=1.32-5.04 p=0.002); (RR=2.31 IC 95%=1.24- 4.32 p=0.005) e pós-cesárea (RR=1.56 IC 95% = 0.94-2.57 p=0.12); (RR=1.38 IC 95%=0.85-2.23 p=0.29) pela AFA e perineômetro. O parto vaginal diminuiu a força muscular do AP de primíparas e comparando com a cesárea e as nulíparas.
Objective – To evaluate the influence of the route of delivery on pelvic floor (PF) muscle strength, in primiparous patients at 4 to 6 months after delivery. Subjects and methods – A cross-sectional study was undertaken among primiparous women at 4 to 6 months postpartum to evaluate the PF muscle strength by AFA test and pneumatic perineometer, classified in: zero – lack of muscle contraction; one – weak contraction; two – moderate contraction not sustained for 6 seconds and three – normal contraction sustained for 6 seconds. 94 enrolled patients were divided in three groups based upon prior delivery route: I) 32 vaginal delivery with singleton cephalic presentation; II) 32 cesarean delivery; and III) 30 nuliparous patients served as a control group. The independent variable was the route of delivery and the dependent one was the muscle strength of the PF. Data were subjected to Student t test to estimate the relative risk and the Kappa test(1). Results and conclusions – The three subgroups were comparable with respect to maternal age, weight, gestational age and newborn weight. The 1st and the 3rd quartiles of the route of delivery on PF muscle strength were lower (p=0.01) for vaginal delivery (n=32) (2.0;1- 2) and intermediate for cesarean (n=32) (2.0; 2-3) comparing to the nuliparous (3.0; 2-3) by AFA test and pneumatic perineometer. The altered PF muscle strength in primiparous were significantly lower in the vaginal delivery group (RR=2.58, CI 95%=1.32-5.04, p=0.002); (RR=2.31, CI 95%=1.24-4.32, p=0.005); and postcesarean (RR=1.56, CI 95% = 0.94- 2.57, p= 0.12); (RR=1.38, CI 95%=0.85-2.23, p=0.29). Vaginal delivery decreases PF muscle strength when compared with caesarean delivery and control.

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