Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) 1.02 [95% confidence interval (CI) 1.90 to 0.14], P=0.02; I2 = not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2 = not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], Po0.0001; I 2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD

Prevalência e fator de risco para incontinência urinária e disfunção do assoalho pélvico dois anos após Diabete Melito gestacional

Submitted by Guilherme Lemeszenski ([email protected]) on 2013-08-22T18:50:32Z No. of bitstreams: 1 S0100-72032007000400010.pdf: 34885 bytes, checksum: 82deef45a5d6e4226ebf00cb00910cb9 (MD5)Made available in DSpace on 2013-08-22T18:50:32Z (GMT). No. of bitstreams: 1 S0100-72032007000400010.pdf: 34885 bytes, checksum: 82deef45a5d6e4226ebf00cb00910cb9 (MD5) Previous issue date: 2007-04-01Made available in DSpace on 2013-09-30T18:21:00Z (GMT). No. of bitstreams: 2 S0100-72032007000400010.pdf: 34885 bytes, checksum: 82deef45a5d6e4226ebf00cb00910cb9 (MD5) S0100-72032007000400010.pdf.txt: 4726 bytes, checksum: 760b9508afb7bc671305766a97f7718c (MD5) Previous issue date: 2007-04-01Submitted by Vitor Silverio Rodrigues ([email protected]) on 2014-05-20T13:35:49Z No. of bitstreams: 2 S0100-72032007000400010.pdf: 34885 bytes, checksum: 82deef45a5d6e4226ebf00cb00910cb9 (MD5) S0100-72032007000400010.pdf.txt: 4726 bytes, checksum: 760b9508afb7bc671305766a97f7718c (MD5)Made available in DSpace on 2014-05-20T13:35:49Z (GMT). No. of bitstreams: 2 S0100-72032007000400010.pdf: 34885 bytes, checksum: 82deef45a5d6e4226ebf00cb00910cb9 (MD5) S0100-72032007000400010.pdf.txt: 4726 bytes, checksum: 760b9508afb7bc671305766a97f7718c (MD5) Previous issue date: 2007-04-01UNESP Faculdade de Medicina de Botucatu Área de ObstetríciaUNESP Faculdade de Medicina de Botucatu Área de Obstetríci

Efeito da via de parto na força muscular do assoalho pélvico, em primíparas

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

Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus

OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies

Importância do modelo animal para testar hipóteses sobre a fisiopatologia do binômio diabetes e incontinência urinária feminina

Aims: To discuss the importance of studying animal models to test hypotheses about the mechanisms of urinary continence and pathophysiology of diabetes and urinary incontinence. Source of Data: A literature review was conducted in PubMed and SciELO. The key words used were diabetes, urinary incontinence, urethra, human and rats. Summary of Findings: There is a strong relation between the genesis of urinary incontinence and diabetes mellitus. Due to the similarity of normal distribution of skeletal muscle and urethra anatomy between humans and rats, these animal models have been used in current research about these disorders. Conclusions: The use of rats as an animal model is suitable for experimental studies that test hypotheses about the mechanisms of continence and pathophysiology of the binomial diabetes mellitus and urinary incontinence, thus enabling solutions of great value in clinical practice

Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study Prevalência de incontinência urinária e disfunção muscular do assoalho pélvico em primíparas dois anos após parto cesárea: estudo transversal

CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.<br> CONTEXTO E OBJETIVO &#201; ainda controversa na literatura a teoria de que eventos obst&#233;tricos e traumas no assoalho p&#233;lvico representariam menor risco para mulheres submetidas ao parto ces&#225;rea do que para aquelas submetidas a parto vaginal, no tocante a subsequente incontin&#234;ncia urin&#225;ria. O objetivo do estudo foi avaliar a preval&#234;ncia de incontin&#234;ncia urin&#225;ria e disfun&#231;&#227;o muscular do assoalho p&#233;lvico dois anos ap&#243;s o parto e os fatores respons&#225;veis por elas. TIPO DE ESTUDO E LOCAL Estudo transversal conduzido em universidade p&#250;blica. M&#201;TODOS Foram selecionadas 220 mulheres dois anos ap&#243;s parto ces&#225;reo eletivo ou parto vaginal. Foram avaliados sintomas de incontin&#234;ncia urin&#225;ria e disfun&#231;&#227;o muscular do assoalho p&#233;lvico por palpa&#231;&#227;o digital e perine&#244;metro. RESULTADOS A preval&#234;ncia de incontin&#234;ncia urin&#225;ria dois anos ap&#243;s parto vaginal e ces&#225;rea foi de 17% e 18,9% respectivamente. O &#250;nico fator de risco para disfun&#231;&#227;o muscular do assoalho p&#233;lvico foi o ganho de peso durante a gesta&#231;&#227;o. &#205;ndice de massa corporal inferior a 25 kg/m 2 e disfun&#231;&#227;o muscular do assoalho p&#233;lvico normal foram fatores de prote&#231;&#227;o contra incontin&#234;ncia urin&#225;ria. Incontin&#234;ncia urin&#225;ria na gesta&#231;&#227;o aumentou o risco de incontin&#234;ncia urin&#225;ria dois anos p&#243;s-parto. CONCLUS&#195;O Incontin&#234;ncia urin&#225;ria gestacional foi um precursor crucial de incontin&#234;ncia urin&#225;ria p&#243;s-parto. O ganho de peso durante a gesta&#231;&#227;o aumentou o risco posterior de disfun&#231;&#227;o muscular do assoalho p&#233;lvico e o parto ces&#225;rea eletivo n&#227;o foi uma a&#231;&#227;o de preven&#231;&#227;o para a incontin&#234;ncia urin&#225;ria