156 research outputs found
Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?
Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration
Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study
Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment.
Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program.
Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged.
Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA
Application of a new method in the study of pelvic floor muscle passive properties in continent women
The aim of this study was to present a new methodology for evaluating the pelvic floor muscle (PFM) passive properties. The properties were assessed in 13 continent women using an intra-vaginal dynamometric speculum and EMG (to ensure the subjects were relaxed) in four different conditions: (1) forces recorded at minimal aperture (initial passive resistance); (2) passive resistance at maximal aperture; (3) forces and passive elastic stiffness (PES) evaluated during five lengthening and shortening cycles; and (4) percentage loss of resistance after 1 min of sustained stretch. The PFMs and surrounding tissues were stretched, at constant speed, by increasing the vaginal antero-posterior diameter; different apertures were considered. Hysteresis was also calculated. The procedure was deemed acceptable by all participants. The median passive forces recorded ranged from 0.54 N (interquartile range 1.52) for minimal aperture to 8.45 N (interquartile range 7.10) for maximal aperture while the corresponding median PES values were 0.17 N/mm (interquartile range 0.28) and 0.67 N/mm (interquartile range 0.60). Median hysteresis was 17.24 Nâmm (interquartile range 35.60) and the median percentage of force losses was 11.17% (interquartile range 13.33). This original approach to evaluating the PFM passive properties is very promising for providing better insight into the patho-physiology of stress urinary incontinence and pinpointing conservative treatment mechanisms
Test-retest reliability of clitoral blood flow measurements using color Doppler ultrasonography at rest and after a pelvic floor contraction task in healthy adult women
Aims: Test-retest reliability assessment of the dorsal clitoral artery's blood flow at rest and
after muscle activation has never been documented. If this outcome measure is to be used
in conditions impeding vascularity, it requires a psychometric evaluation. The aim of this
study was to assess the inter-session test-retest reliability of clitoral blood flow in healthy
women using color Doppler ultrasonography at rest and after a pelvic floor muscle (PFM)
contraction task.
Methods: Two assessment sessions were conducted using a clinical ultrasound system.
Clitoral blood flow measurements were repeated at rest and after a PFM contraction task.
Measurements of the peak systolic velocity (PSV), time-averaged maximum velocity
(TAMX), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI)
were taken. The test-retest reliability was assessed using paired t-test, intraclass correlation
coefficient (ICC), and Bland-Altman plots.
Results: For reliability at rest, ICC values were 0.95 for PSV, 0.87 for TAMX, and 0.67
for both PI and RI. The variability between measurements, as per Bland-Altman plots, was
small for PSV, TAMX, and RI and acceptable for PI. For reliability after the PFM
contractions task, ICC values were 0.85 for PSV, 0.77 for TAMX, 0.79 for PI, and 0.81 for
RI. The variability between measurements was small for PSV and RI and acceptable for
TAMX and PI. EDV parameter did not perform as well in both conditions.
Conclusions: Assessment of the clitoral blood flow with color Doppler ultrasound is
reliable at rest and after a PFM contraction task
Randomized controlled trial of physiotherapy for postpartum stress incontinence : 7-year follow-up
Objective
To estimate the long-term effect of intensive, 6-week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI).
Methods
The study was a single-blind randomized controlled trial. Fifty-seven postnatal women with clinically demonstrated persistent SUI 3 months after delivery participated in 8 weeks of either pelvic floor muscle training (PFMT) (28) or PFMT with deep abdominal muscle training (PFMT + TrA) (29). Seven years post-treatment, 35 (61.4%) participants agreed to the follow-up; they were asked to complete a 20-min pad test and three incontinence-specific questionnaires with an assessor blinded to each participant's group assignment.
Results:
Of the 35 (61.4%) who agreed to the follow-up: 26 (45.6%) took the 20-min pad test (12 PFMT and 14 PFMT + TrA) and 35 (61.4%) completed the questionnaires (18 PFMT and 17 PFMT + TrA). The baseline clinical characteristics of the follow-up and non-follow-up participants were not significantly different; nor did they differ between PFMT and PFMT + TrA participants enrolled in the follow-up study. At 7 years, the pad test scores for the PFMT group did not differ statistically from those of the PFMT + TrA group. When combining both treatment groups, a total of 14/26 (53%) follow-up participants were still continent according to the pad test.
Conclusion
The addition of deep abdominal training does not appear to further improve the outcome of PFM training in the long term. However, benefits of physiotherapy for postpartum SUI, although not as pronounced as immediately after the initial intervention, is still present 7 years post-treatment
Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods
Provoked vestibulodynia (PVD) is a highly prevalent and debilitating condition yet its management relies mainly
on non-empirically validated interventions. Among the many causes of PVD, there is growing evidence that pelvic
floor muscle (PFM) dysfunctions play an important role in its pathophysiology. Multimodal physiotherapy,
which addresses these dysfunctions, is judged by experts to be highly effective and is recommended as a firstline
treatment. However, the effectiveness of this promising intervention has been evaluated through only two
small uncontrolled trials. The proposed bi-center, single-blind, parallel group, randomized controlled trial
(RCT) aims to evaluate the efficacy of multimodal physiotherapy and compare it to a frequently used first-line
treatment, topical overnight application of lidocaine, in women with PVD. A total of 212 women diagnosed
with PVD according to a standardized protocol were eligible for the study and were randomly assigned to either
multimodal physiotherapy or lidocaine treatment for 10weeks. The primary outcome measure is pain during intercourse
(assessed with a numerical rating scale). Secondary measures include sexual function, pain quality,
psychological factors (including pain catastrophizing, anxiety, depression and fear of pain), PFM morphology
and function, and patients' global impression of change. Assessments are made at baseline, post-treatment and
at the 6-month follow-up. This manuscript presents and discusses the rationale, design and methodology of
the first RCT investigating physiotherapy in comparison to a commonly prescribed first-line treatment, overnight
topical lidocaine, for women with PVD
L' hypertension artérielle pulmonaire (étude rétrospective de la prise en charge de l' HTAP au sein du centre de compétence de Montpellier)
MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF
Le dĂ©veloppement du goĂ»t et des prĂ©fĂ©rences gustatives (du fĆtus Ă l'enfance)
Le goĂ»t est fonctionnel dĂšs le stade fĆtal et se dĂ©veloppe jusqu'au milieu de l'enfance avec la maturation des capacitĂ©s d'alimentation. Le nourrisson est capable de dĂ©tecter les diffĂ©rentes flaveurs transmises par la mĂšre lors de la grossesse puis lors de l'allaitement maternel. Les prĂ©fĂ©rences gustatives du nourrisson dĂ©pendent de la grossesse et de l'allaitement choisit par la mĂšre. Ces prĂ©fĂ©rences Ă©voluent dans le temps, elles sont influencĂ©es par plusieurs facteurs comme la composition de la salive, certains facteurs gĂ©nĂ©tiques, le choix d'allaitement et beaucoup d'autres facteurs intrinsĂšques. Arrive ensuite un Ăąge oĂč les enfants refusent de manger ou mĂȘme goĂ»ter certains aliments. Ce phĂ©nomĂšne, appelĂ© nĂ©ophobie, peut ĂȘtre attĂ©nuĂ© par des conseils officinaux. Le pharmacien peut ainsi conseiller les parents afin d'amĂ©liorer l'Ă©veil gustatif des enfants et, par consĂ©quent, participer Ă l'Ă©tablissement d'habitudes nutritionnelles, contribuant Ă la prĂ©vention de nombreuses pathologies liĂ©es Ă des dĂ©sĂ©quilibres alimentaires chez l'adulte.NANTES-BU MĂ©decine pharmacie (441092101) / SudocSudocFranceF
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