Electrical stimulation of the pelvic floor versus vaginal cone therapy for the treatment of stress urinary incontinence

PURPOSE: to compare the effects of functional electrostimulation of the pelvic floor and therapy with cones in women with stress urinary incontinence (SUI). METHODS: randomized clinical study for which 45 patients with SUI were selected. The effects of functional electrostimulation of the pelvic floor were evaluated in the SUI treatment of 24 women, with the use of clinical data (micturition diary, pad test and a questionnaire about quality of life - I-QoL). The patients were submitted to two 20' weekly sessions for four consecutive months, under the supervision of a physiotherapist. The electrode used had 10 cm length and 3.5 cm width with a double metallic ring and a cylindrical shape, positioned in the medium third of the vagina. The electric parameters used were: intensity varying from 10 to 100 mA and 50 Hz of fixed frequency, with pulse duration of 1 ms. Also, we evaluated 21 patients who were submitted to vaginal cone treatment. The cone therapy was done with two 45 minute sessions per week. The cones' weight varied from 20 to 100 gr. RESULTS: there was no difference between the outcomes of electrostimulation of the pelvic floor and the vaginal cones for the treatment of SUI (p>0.05). After four months, there was a significant improvement in the I-QoL index of the patients treated both with electrostimulation (40.3 versus 82.9) or with the cones (47.7 versus 84.1). There was a significant decrease in pad weight in both groups, measured before and after the treatment (28.5 and 32 g versus 2.0 and 3.0 g for the electrostimulation and cone group, respectively). Finally, there was a significant decrease in the number of urinary leakage evaluated by the micturition diary in both groups (p0,05). Observamos, após quatro meses, melhora significativa dos índices de qualidade de vida das pacientes tratadas com eletroestimulação (40,3 versus 82,9) e com os cones (47,7 versus 84,1). Houve diminuição significante do peso do absorvente (pad test) nos dois grupos antes e depois do término dos tratamentos (28,5 e 32 g versus 2,0 e 3,0 g, para o grupo da eletroestimulação e cones, respectivamente). Finalmente, houve diminuição significativa no número de perdas urinárias avaliadas pelo diário miccional nos dois grupos (p<0,0001). CONCLUSÕES: a eletroestimulação e os cones vaginais foram efetivos no tratamento de mulheres com IUE.Universidade Federal de São Paulo (UNIFESP) Departamento de Ginecologia Setor de Uroginecologia e Cirurgia VaginalUniversidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUNIFESP, Depto. de Ginecologia Setor de Uroginecologia e Cirurgia VaginalUNIFESP, Depto. de GinecologiaSciEL

Tolerância da parturiente à extensibilidade perineal avaliada pelo EPI-NO: estudo observacional

Objective: To determine how parturient women tolerate the use of a perineal distensibility assessment technique using the EPI-NO device. Method: An observational study with a total of 227 full-term parturient women was performed. During the evaluation with EPI-NO, parturient patients were asked about their sensation of discomfort. The degree of discomfort was measured using the Visual Analogue Scale, with a score from zero to 10. The Mann-Whitney test was applied to assess perineal distensibility measured by EPI-NO and the degree of discomfort caused by the test according to parity. The relation between perineal distensibility and discomfort was analyzed by using the Spearman correlation test (r). Result: The test with EPI-NO caused only slight discomfort (mean Visual Analogue Scale of 3.8), and primiparous women reported significantly greater discomfort (mean Visual Analogue Scale of 4.5) than did multiparous (mean Visual Analogue Scale=3.1), with p<0.001 women. A negative correlation was observed, in other words, the greater the perineal distensibility on the EPI-NO, the lower the pain reported by the patients (r=-0.424; p<0.001). Conclusion: The assessment of perineal distensibility with EPI-NO was well tolerated by the parturient women.Objetivo: Determinar como a mulher parturiente tolera o uso de uma nova técnica de extensibilidade perineal, por meio do aparelho EPI-NO. Método: Estudo observacional com um total de 227 gestantes a termo. Durante a avaliação pelo EPI-NO, as parturientes foram perguntadas sobre a sensação de desconforto. O grau de desconforto foi medido usando a Escala Visual Analógica, com escore entre zero a 10. O teste de Mann-Whitney foi usado para avaliar a extensibilidade perineal avaliada pelo EPI-NO e o grau de desconforto causado pelo teste de acordo com a paridade. A relação entre extensibilidade perineal e desconforto foi avaliada pelo teste de correlação de Spearman (r). Resultado: O teste com EPI-NO causou apenas leve desconforto (média da Escala Visual Analógica de 3,8), sendo que as primíparas reportaram mais desconforto de modo significativo (média da Escala Visual Analógica de 4,5) que as multíparas (média da Escala Visual Analógica de 3,1), com p<0,001. Observou-se correlação negativa, ou seja, a maior extensibilidade no EPI-NO foi acompanhada de menor dor referida pelas pacientes (r=-0,424; p<0,001). Conclusão: A avaliação da extensibilidade perineal com EPI-NO foi bem tolerada pelas parturientes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

Surface electromyography has clinical and research importance for the physiotherapist. Although capturing electrical activity promoted by recruitment of motor units, there is a good correlation between the number of activated units and muscle strength. This is one of the methods of higher specificity in pelvic floor evaluation, although the lack of consensus regarding its application. The aim of this literature review was to cluster information regarding to the use of surface electromyography in the evaluation of pelvic floor. Papers were searched in Medline, Pubmed Lilacs, SciELO and Cochrane Library. Were selected papers which methods used surface electromyography to evaluate the pelvic floor. Although its methodology still lacks standardization, is an instrument that should be considered in scientific research in our country because it seems to have good reproducibility and reliability. Women with pelvic floor disorders have changes in the activation time of the pelvic floor muscles (PFM) and abdominal muscles. With respect to pregnancy and postpartum, there is a lack of evidence on possible changes in electrical activation of PFM in these periods.A eletromiografia de superfície tem grande importância clínica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade elétrica promovida pelo recrutamento das unidades motoras, há boa correlação entre o número de unidades ativadas e a força muscular. É um dos métodos de maior especificidade na avaliação do assoalho pélvico, embora não haja consenso em relação à sua aplicação. Essa revisão de literatura foi desenvolvida com o objetivo de agrupar as informações sobre o uso da eletromiografia de superfície na avaliação do assoalho pélvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pélvico feminino por meio de eletromiografia de superfície. Apesar de sua metodologia ainda carecer de padronização, é um instrumento que deve ser considerado nas pesquisas científicas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfunções do assoalho pélvico possuem alterações no tempo de ativação dos músculos do assoalho pélvico (MAP) e músculos abdominais. Quanto à gestação e puerpério, ainda faltam evidências sobre possíveis alterações da ativação elétrica dos MAP nesses períodos

Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence

CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo. METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises

Impacto da supervisão fisioterapêutica aos exercícios do assoalho pélvico para tratamento da incontinência urinária de esforço

CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo (UNIFESP). METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.CONTEXTO E OBJETIVO: A incontinência urinária é um problema de saúde pública, afetando mais de 200 milhões de pessoas em todo o mundo, sendo que sua forma mais comum é a de esforço. A cinesioterapia do assoalho pélvico vem sendo utilizada com grande sucesso em seu tratamento, embora não exista consenso de protocolo para sua aplicação. O objetivo foi comparar os resultados do tratamento em mulheres com incontinência urinária de esforço por meio de exercícios de fortalecimento do assoalho pélvico com acompanhamento fisioterapêutico, com os de um grupo sem acompanhamento. TIPO DE ESTUDO E LOCAL: Estudo randomizado, prospectivo e controlado, realizado no Setor de Uroginecologia e Cirurgia Vaginal da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Realizou-se estudo randomizado com 44 mulheres para tratamento da incontinência urinária de esforço com cinesioterapia perineal por três meses consecutivos, divididas em um grupo com acompanhamento fisioterapêutico e outro sem acompanhamento. Foram avaliadas, antes e depois do tratamento, pelo diário miccional, pad test, questionário de qualidade de vida (I-QoL), força muscular perineal, e também por avaliação subjetiva. A análise descritiva foi utilizada para caracterizar a casuística estudada. Para verificar a homogeneidade entre os grupos com relação às variáveis contínuas e categóricas, foram aplicados os testes de Kruskal-Wallis e o Qui-quadrado. Pelo teste pareado de sinais de Wilcoxon, avaliou-se o sucesso terapêutico. RESULTADOS: Ao término do tratamento, o grupo com acompanhamento teve melhores resultados segundo o pad test, o diário miccional e o questionário de qualidade de vida, quando comparado ao grupo controle. Quando avaliadas subjetivamente, apenas 23,8% das pacientes do grupo controle referiram satisfação com o tratamento. Já no grupo com acompanhamento fisioterapêutico, 66,8% referiram que não desejavam outro tratamento. CONCLUSÃO: O acompanhamento fisioterapêutico proporcionou melhores resultados subjetivos e objetivos no tratamento da incontinência urinária de esforço feminina pela cinesioterapia do assoalho pélvico