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Comparative analysis of pelvic floor muscle training and Pilates in managing urinary incontinence among postmenopausal women: a randomized controlled trial
Abstract
This study is aimed at comparing the effectiveness of pelvic floor muscle training (PFMT) and Pilates on the improvement of urinary incontinence (UI), strength, and endurance of the pelvic floor muscles (PFMs), and the impact of UI on the quality of life in postmenopausal women.
Forty postmenopausal women were randomly divided in to two groups: PFMT (n = 20) and Pilates (n = 20). The participants were followed for 12 weeks, three times a week on nonconsecutive days. UI was assessed using the pad test and the voiding diary, PFM strength and resistance using bidigital assessment and manometry, and the impact of UI on quality of life using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), before and after the 3-month treatment.
There was a significant intra-group improvement in both groups for the pad test, mean daily urinary loss, and ICIQ-SF. The strength was significantly improved only in the PFMT group, and the endurance in both groups. Peak strength manometry was significantly improved only in the Pilates group, and the mean strength manometry in both groups. There was also an improvement in both groups for peak endurance manometry and mean endurance manometry. In the inter-group comparison, there was a significant improvement only in muscle strength, which was positive for group.
There was no difference between Pilates and PFMT for the management of women in post-menopause with stress urinary incontinence, provided that voluntary contraction of the PFMs is performed. However, further randomized clinical trials need to be carried out.
Background/Objectives: Urinary incontinence (UI) is particularly prevalent in women of all ages, but especially in older women, due to risk factors that contribute to pelvic floor muscle weakness. Urinary incontinence can have a significant psychosocial impact and compromise the quality of life of affected women. It is reported that physical activity seems to be inversely associated with UI. The aim is to summarize the impact of different modalities of physical exercises in management of older women with UI. Methods: Searches were performed in the databases PubMed, Web of Science, EMBASE and Scopus. The searches were performed on 10 December 2024. Only randomized clinical trials were included. Ninety-three papers were initially screened, and five full papers reached all the inclusion criteria describing the effects of exercise on urinary incontinence. The studies included a total of 352 elderly participants aged 60 years or older. Of these participants, 268 lived in nursing homes and 84 lived in a local community. The intervention period varied among the selected studies from 6 weeks to 12 months, and in general, the pelvic floor training was used. Results: Improvements in the quality of life and in the physical performance of the older women with UI were reported, although the risk of bias was classified as “some concerns”. Conclusions: Moreover, it is revealed that different types of exercises are used to “work” the pelvic floor muscle and contribute, in general, to reducing the symptoms, and improving the quality of life of older women with UI due to the positive impact of the exercises.
Descriptive, quasi experimental study with pre and post-test, which aimed to investigate the effects of Water Pilates (PA) on urinary incontinence, genital self-image and sexual function of elderly women. The sample consisted of seventeen elderly women aged 60 years or over, from a city in the interior of Rio Grande do Sul. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) was used as instruments to assess the impact of UI in quality of life and qualify urinary loss, the Female Sexual Function Index (FSFI) to assess sexual function and Female Genital Self-Image Scale (FGSIS) to assess women's perception of their own genitalia. The PA protocol was performed twice a week for 50 minutes performed for eight weeks, totaling 16 sessions. The protocol was divided into warm-up, strengthening exercises and stretching. It was observed that the sample was composed of young elderly women (69.5 ± 5.9 years), overweight and with low FSFI and FGSIS scores. There was no significant change in the mean values before and after the intervention of the ICIQ-SF, FGSIS and FSFI scores. It was concluded that the PA method had no effect on urinary loss, sexual function and genital self-image.
Background:
Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL.
Methods:
An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case-control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2.
Results:
Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = - 0.89; 95% CI - 1.3 to - 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high.
Conclusions:
UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.
Introdução: É a musculatura do assoalho pélvico (MAP) que sustenta a uretra e a bexiga, que se contrai durante o esforço de forma a prevenir a perda urinária. O enfraquecimento ou lesões nesta estrutura de suporte podem levar à sua disfuncionalidade. Segundo a Associação Internacional de Uroginecologia, a Incontinência Urinária (IU) é toda perda involuntária de urina. A IU pode ser classificada em 3 principais tipos: a Incontinência Urinária de Esforço (IUE) onde a perda involuntária de urina que ocorre durante a realização de como tossir, espirrar, levantar pesos, rir ou exercitar-se, Incontinência Urinária de Urgência (IUU), caracteriza-se por um desejo súbito e abrupto de urinar, difícil de ser inibido e a Incontinência Mista (IUM) que é a IUE somada à IUU. Embora a MAP não tenha sido enfatizada no trabalho original do Método Pilates (MP), algumas escolas têm integrado o foco na MAP em sua abordagem. O objetivo deste estudo foi revisar achados anteriores quanto aos efeitos do MP na funcionalidade do assoalho pélvico feminino e na IU. Método: Foram selecionados e analisados artigos de periódicos arbitrados e estudos presentes em bancos de dados acadêmicos. Resultados: dez estudos foram selecionados para análise dos resultados. Os estudos abordaram o efeito do MP na funcionalidade do assoalho pélvico feminino e na IU. Conclusão: Observou-se que o MP trouxe resultados positivos na maioria das variáveis analisadas em 9 dos 10 estudos selecionados, porém mais estudos são necessários.
Objectives
To estimate the prevalence of leisure-time physical activity (LTPA) or sports in the Brazilian population according to demographic and income variables.
Methods
Data from 60,202 Brazilian individuals (18 years and over) were analyzed, belonging to the National Health Survey 2013 sample. The prevalence of different modalities of LTPA and sports was estimated according to age, sex, skin color and income. The adjusted prevalence ratios were estimated by Poisson regression.
Results
Of every thousand Brazilians, 695 do not practice LTPA or sports. Walking is the most practiced LTPA (98/1000), followed by soccer (68/1000) and weight training (45/1000). For poor and black men, the most frequent LTPA was soccer, and, for women, gymnastics and walking. The prevalence of weight training and gymnastics was higher for white people compared with black people. All LTPA practices were more prevalent in individuals with higher income, except for soccer. Running on a treadmill and weight training had, respectively, 24.7 and 6.4 times higher prevalence in the richer quartile.
Conclusions
The study allowed identifying the type of LTPA and sport reported as the most frequent by the Brazilian population according to age, sex, skin color, and income, detecting strong social disparities in these practices.
The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks’ training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire—Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.
There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females’ sexual function and quality of life. Some evidences showed that pelvic floor muscle training can strength pelvic muscles and prevent sexual dysfunction. Therefore, current study aimed to review the effect of pelvic floor exercise on female sexual function and quality of life in the postpartum period.
PubMed, CINAHL, Medline, Scopus, Google scholar citations, Persian databases including SID and Iran Medex were searched using MeSH-based keywords to find published articles. Experimental and quasi-experimental studies in Persian and English were included. Data extracted was done in pre-defined checklist by two independent researchers. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-Analysis of the data was carried out by “Comprehensive Meta-analysis Version 2” (CAM).
The search resulted in 347 titles and abstracts, which were narrowed down to 12 potentially eligible articles. Pooled standardized differences in means (SMD) of sexual function in both pelvic floor exercise and control group were 0.462 [0.117 to 0.806], p = 0.009. The pooled SMD was 1.294 [0.926 to 1.663], p < 0001 for sexual quality of life. The pooled SMD was 0.232 [0.038–0.426], p = 0.019 for general quality of life.
Evidences showed that pelvic floor muscle training in primi or multi-parous women can boost sexual function and quality of life in postpartum. Although the majority of studies and the result of meta-analysis reported positive results, more high-quality RCTs are needed in this area. One limitation of our study is significant heterogeneity because of different intervention method.
Background: The Pilates Method is a program of physical and mental training that involves the whole body, aiming at the gain of muscular strength, mainly of the central region, formed by the abdominal muscles, the spine and the pelvic floor muscles (PFM). The PFM responds to sexual stimulation, with increased local blood circulation and involuntary contractions during orgasm. The training of this musculature assists in the female sexual function. Objective: To evaluate the influence of Pilates Mat associated with perineal contraction in the female sexual response. Method: Uncontrolled clinical trial in which participated twelve women between 20 and 50 years old, who performed Mat Pilates classes associated with perineal exercises, three times a week. The sexual response was evaluated through the Female Sexual Function Index (FSFI) and the contraction capacity of PFM through the Functional Evaluation of the Pelvic Floor (FEPF) before and after 21 sessions. Results: Given the proposed treatment, the FSFI responded positively (0.0099), with an improvement in the median and interquartile range that initially was 25.6 ± 5.4 and increased to 28.4 ± 1.2. The Functional Evaluation of the Pelvic Floor (FEPF) also achieved significant improvement (p= 0.0077), increased from the initial median and interquartile range of 2 ± 1.5 to 4 ± 1. Conclusion: Mat Pilates provides encouraging results, and its use is relevant to promote improved sexual response and strength gain of the pelvic floor muscle.
Background:
Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014.
Objectives:
To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations.
Search methods:
We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles.
Selection criteria:
Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm.
Data collection and analysis:
At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate.
Main results:
The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality.
Authors' conclusions:
Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
Background
The adverse effects of menopause on sexual function could be mitigated by pelvic floor muscle (PFM) training. This study aimed to investigate the effects of PFM exercises on sexual function in postmenopausal women. Methods: A randomised clinical trial was conducted among 97 Iranian postmenopausal women, aged 40 to 60 years. The participants’ baseline sexual functions were assessed using the Female Sexual Function Index (FSFI) questionnaire. They were then randomly designated to two groups: (1) the intervention group, which received specific instructions on PFM exercises and was followed up on a weekly basis; and (2) the control group, which received general information on menopause. After 12 weeks, the sexual functions of the participants were reassessed. Results: No significant difference was initially observed between the two groups in terms of demographic and socioeconomic characteristics and total scores of FSFI. After the intervention, however, the scores of arousal, orgasm and satisfaction were significantly higher in the intervention group (3.10, 4.36, and 4.84 vs 2.75, 3.89, and 4.36 respectively; P < 0.05). Conclusion: PFM exercises have the potential to improve the sexual function of postmenopausal women and are thus suggested to be included in healthcare packages designed for postmenopausal women.
A Incontinência Urinária é toda perda involuntária de urina, classificada em Incontinência Urinária de Esforço, de Urgência e Mista. A prevalência desta disfunção afeta negativamente a qualidade de vida das pessoas, sendo o tratamento fisioterapêutico recomendado como primeira opção. Dentre as técnicas fisioterapêuticas, encontram-se o biofeedback e o Método Pilates. O objetivo do estudo foi verificar a eficácia do tratamento fisioterapêutico para incontinência urinária com o método Pilates e o biofeedback manométrico em mulheres na menopausa. O estudo foi realizado na clínica da Universidade Estadual do Oeste do Paraná e a amostra foi constituída por 14 mulheres, divididas em dois grupos. O grupo 1 foi submetido ao tratamento com o biofeedback e o grupo 2 com o Método Pilates. Ambos realizaram trinta e duas sessões e foram avaliados antes e após os tratamentos considerados curto (após vinte e duas sessões), médio (após trinta e duas sessões) e longo prazo (após dois meses sem intervenções), por meio do Questionário de Incontinência Urinária ICIQ_SF e de uma Ficha de Coleta de Dados. Ambos os grupos apresentaram resultados estatisticamente significativos quando realizada a comparação intra-grupos em relação à frequência das perdas urinárias mensais, força das fibras rápidas do assoalho pélvico, gravidade da incontinência urinária e o impacto desta sobre a qualidade de vida das mulheres. Na duração das contrações mantidas, apenas o biofeedback apresentou diferenças estatisticamente significativas. Não houve diferença estatisticamente significativa entre os grupos. Ambas as técnicas propostas foram eficazes nas variáveis analisadas, exceto na duração das contrações mantidas.
Background:
Urinary incontinence (UI) is a distressing condition affecting at least 5 million women in England and Wales. Traditionally, physiotherapy for UI comprises pelvic floor muscle training, but although evidence suggests this can be effective it is also recognised that benefits are often compromised by patient motivation and commitment. In addition, there is increasing recognition that physical symptoms alone are poor indicators of the impact of incontinence on individuals' lives. Consequently, more holistic approaches to the treatment of UI, such as Modified Pilates (MP) have been recommended. This study aimed to provide preliminary findings about the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for UI, and to test the feasibility of a randomised controlled trial (RCT) design.
Methods:
The study design was a single centre pilot RCT, plus qualitative interviews. 73 women referred to Women's Health Physiotherapy Services for UI at Colchester Hospital University NHS Foundation Trust were randomly assigned to two groups: a 6-week course of MP classes in addition to standard physiotherapy care (intervention) or standard physiotherapy care only (control). Main outcome measures were self-reported UI, quality of life and self-esteem at baseline (T1), completion of treatment (T2), and 5 months after randomisation (T3). Qualitative interviews were conducted with a subgroup at T2 and T3. Due to the nature of the intervention blinding of participants, physiotherapists and researchers was not feasible.
Results:
Post-intervention data revealed a range of benefits for women who attended MP classes and who had lower symptom severity at baseline: improved self-esteem (p = 0.032), decreased social embarrassment (p = 0.026) and lower impact on normal daily activities (p = 0.025). In contrast, women with higher symptom severity showed improvement in their personal relationships (p = 0.017). Qualitative analysis supported these findings and also indicated that MP classes could positively influence attitudes to exercise, diet and wellbeing.
Conclusions:
A definitive RCT is feasible but will require a large sample size to inform clinical practice.
Trial registration:
ISRCTN74075972 Registered 12/12/12 (Retrospectively registered).
Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence.
Objective:
To investigate the influence of a protocol of Pilates exercises on the functionality and contractility of the pelvic floor muscles (PFM) of older women living in the city of Campo Grande, Mato Grosso, Brazil.
Method:
Ten women (median age of 63.4±4.5 years) with little or no pelvic floor dysfunction were subjected to 24 sessions of Pilates exercises lasting one hour each, for 12 weeks. The pressure of the pelvic floor muscles (PFM) was assessed using a perineometer (cmH20) and contractility was assessed with the PERFECT scheme. Data were described as median ± interquartile range and inferential analysis was performed using the Wilcoxon paired test, with a significance level of 5%.
Results:
In view of the proposed treatment, the degree of voluntary contraction of the PFM of the participants increased from 79.0±83.5 to 90.0±82.0 cmH20, with a statistically significant difference in paired comparison (p=0.012). According to the PERFECT scheme, there was an increase in contraction time (from 5.0±0.1 to 7.0±4.7 seconds) and in the number of fast repetitions (from 7.0±4.5 to 8.0±4.7), with a statistically significant difference for both variables (p=0.017 and p=0.008, respectively).
Conclusion:
The results indicate that the Pilates method increased the contractility and pressure of the PFM of elderly women with little or no PFM impairment. Further studies are required to determine whether the Pilates method is an effective method for the treatment of women with severe pelvic floor dysfunction.
Introduction and hypothesis:
Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI.
Methods:
Cochrane's recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group.
Results:
Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI.
Conclusion:
PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.
The Pilates method is a form of physical exercise that improves the control of the core muscles, improving the conditioning of all the muscle groups that comprise the core, including the pelvic floor muscles (PFM). Thus, this study had the goal of verifying the existence of differences in the functioning of the PFM in women who practice the Pilates method and sedentary women.
This was an observational, cross-sectional pilot study. A sample size calculation was performed using preliminary data and it determined that the sample should have at least 24 individuals in each group. The participants were 60 women aged 20 to 40 years; 30 women practiced the Pilates method (PMG) and 30 were sedentary (SG). An anamnesis file was used to collect personal data and assess the knowledge and perception of the PFM. The Perina® perineometer and vaginal palpation were used to determine the functionality of the PFM.
There was no significant difference between the PMG and the SG in any of the variables analyzed.
We concluded that the functionality of the PFM in younger women who practice the Pilates method is not different from that of sedentary women.
Purpose:
To evaluate the effect of pelvic floor muscle training (PFMT) on female sexual dysfunctions.
Methods:
Twenty-six women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia) were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions) and at the end of the treatment (after ten sessions) by two-digit palpation (assessment of pelvic floor muscle, PFM, strength), intravaginal electromyography (EMG) (capture of PFM contraction amplitudes) and Female Sexual Function Index (FSFI, a questionnaire for the evaluation of sexual function). The women underwent PFMT in different positions for ten sessions (once or twice a week). For statistical analysis, absolute and relative frequencies were used for clinical characteristics and PFM strength. The Friedman test was used to compare the FSFI domain scores and EMG values, the Students t-test was used to determine the association between these values and the characteristics of the women, and the Wilcoxon test for percent modification of the EMG. The Mann-Whitney test permitted us to compare these values with clinical characteristics. The Spearman correlation test was used to correlate the EMG values with mean total score. Results were considered statistically significant if p<0.05.
Results:
A significant improvement (p<0.0001) of FSFI scores was observed at the end of treatment compared to the values observed before and in the middle of treatment. Regarding the EMG, the amplitudes of tonic and phasic contractions increased significantly during treatment (p<0.0001). Pelvic floor strength increased, which 69% of the women presenting grade 4 or 5 at the end of treatment, with a total improvement of sexual complaints.
Conclusions:
The PFMT improved muscle strength and electromyography contraction amplitudes, with improved sexual function, indicating that this physiotherapy approach may be successfully used for the treatment of female sexual dysfunctions.
The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength.
Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH(2)O). Two questionnaires--pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)--were also collected.
At baseline, the Pilates and PFMT groups measured 14.9 +/- 12.5 and 12.5 +/- 10.4 cmH(2)O, respectively (p = 0.41). Both the Pilates and PFMT groups got stronger (6.2 +/- 7.5 cmH(2)O, p = 0.0002 and 6.6 +/- 7.4 cmH(2)O, p = 0.0002, respectively), with no difference between groups p = 0.85. PFIQ and PFDI scores improved from baseline but not between groups.
Further study is required to determine if Pilates can actually treat pelvic floor dysfunction.
Evaluation of pelvic-floor muscle (PFM) function and strength is necessary (1) to be able to teach and give feedback regarding a woman's ability to contract the PFM and (2) to document changes in PFM function and strength throughout intervention. The aims of this article are to give an overview of methods to assess PFM function and strength and to discuss the responsiveness, reliability, and validity of data obtained with the methods available for clinical practice and research today. Palpation, visual observation, electromyography, ultrasound, and magnetic resonance imaging (MRI) measure different aspects of PFM function. Vaginal palpation is standard when assessing the ability to contract the PFM. However, ultrasound and MRI seem to be more objective measurements of the lifting aspect of the PFM. Dynamometers can measure force directly and may yield more valid measurements of PFM strength than pressure transducers. Further research is needed to establish reliability and validity scores for imaging techniques. Imaging techniques may become important clinical tools in future physical therapist practice and research to measure both pathophysiology and impairment of PFM dysfunction.
The aim of this study was to assess the effect of a program of supervised pelvic floor muscle training (PFMT) on sexual function, in a group of women with urodynamically diagnosed stress urinary incontinence (SUI), using a validated questionnaire. Incontinence episodes frequency and continence pads used per week were measured before and after treatment using a 7-day bladder diary. Improvements in sexual function were assessed using the Female Sexual Function Index (FSFI). Seventy women completed the 12-month program of supervised PFMT successfully. At the end of the study, incontinence episode frequency decreased by 38.1%, and patients required 39% less pads per week. All domains of the FSFI were also significantly improved with median total FSFI scores increasing from 20.3 to 26.8. This is one of the few studies to quantify, using a validated questionnaire, the improvement in sexual function of women with SUI, undergoing successfully a 12-month supervised PFMT program.
Objectives
Strong evidence indicates that pelvic floor muscle training (PFMT) increases pelvic floor muscles' strength (PFMS) and improves stress urinary incontinence and female sexual function.
The study aims to examine the association between pelvic floor muscle strength and female sexual function in healthy nulliparous women.
Methods
Forty-five sexually active women aged 22-35 years participated in the study. All women completed the FSFI questionnaire, validated in the Greek language. Two examiners evaluated pelvic floor muscle strength using both, the Modified Oxford Grading Scale and the Peritron manometer. Women formed two groups using the median values of Peritron manometer measurements of the total population. Group A included 21 females with weak pelvic floor contraction (≤ 41,1 cm H20), and Group B included 24 females with a strong pelvic floor (>41,2 cm H20). The results were analyzed with Mann-Whitney U tests for FSFI results and Spearman's correlation for the Modified Oxford Grading Scale and Peritron manometer values.
Results
There was no significant difference between the two groups concerning the participants’ demographic characteristics. Women with a strong pelvic floor (Group B) exhibited higher statistically significant results (p<0.001) in desire (Group A:3.11±0.14 vs Group B:3.91±0.21), arousal (4.08±0.53 vs 4.99±0.41), orgasm (4.22±0.36 vs 5.37±0.69), satisfaction (4.22±0.36 vs 5.37±0.69), lubrication (4.12±0.43 vs 5.01±0.49) and total FSFI score (27.12±1.09 vs 31.71±1.26). There was no statistically significant difference in the pain domain. There was also a strong correlation between PFMS evaluated with Modified Oxford Grading Scale and PFMS assessed Peritron manometer values (r=0.69).
Conclusions
The strength of the pelvic floor muscles is an essential factor concerning better female sexual function
Conflicts of Interest
No Conflicts of Interest
Objective:
Female sexual dysfunction (FSD) is a significant public health issue, and it has a high global prevalence. Few effective treatment options are available for the treatment of FSD. We conducted a prospective clinical pilot study to investigate the beneficial effects of Pilates exercise on sexual function in women with FSD.
Methods:
Women aged between 20 and 50 years and who had regular menstrual cycles and sexual relationships and participating Pilates exercise program were asked to complete Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires before starting the Pilates exercise program. If the total FSFI score was less than 26.55, which is the cut-off for FSD, the subject was invited to participate in the study. Primary endpoints were changes in total and individual domain scores on the FSFI and BDI.
Results:
A total of 36 premenopausal women were included in the study. After a 12-week Pilates program, all domains of the FSFI were significantly improved, with mean±SD total FSFI scores increasing from 12.0±4.9 to 29.3±3.4 (P<0.0001). BDI scores were significantly decreased from 25.1±14.3 to 1.6±3.7 (P<0.0001) after the exercise program.
Conclusions:
This pilot study showed that Pilates exercise could improve sexual functions in women with FSD. Pilates may facilitate the treatment of sexual dysfunction in women.
Background
and purpose: There is limited evidence from randomised controlled trials (RCTs) regarding the use of yoga and Pilates for the management of urinary incontinence (UI) in women. This study aims to investigate the preliminary effects of using Pilates and yoga to manage UI.
Materials and methods
An assessor-blinded, prospective, three-arm parallel-group randomised controlled pilot trial was conducted in three elderly care centres in Hong Kong. Thirty women aged 60 years or above were included in the study. Study centres were randomly assigned to each of the three interventions (yoga, Pilates and pelvic floor muscle training [PFMT; standard care control]). Study interventions were provided once a week for four weeks, followed by unsupervised CD-guided home exercises for eight weeks. Outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), 1-h pad test, and feasibility measures such as adherence to the intervention programme, recruitment and retention rates and safety. Outcomes were assessed at baseline, 4 and 12 weeks. Statistical analysis was performed using two-way repeated measures analysis of covariance.
Results
All three interventions demonstrated a statistically significant effect on ICIQ-SF scores from baseline to weeks 4 and 12. Significant effects in UI were reported for yoga compared with Pilates (mean: −2.93, 95% CI −5.35, −0.51; p = 0.02).
Conclusion
Yoga poses intended to address the pelvic floor and core muscles were found to have superior benefits over Pilates exercises in terms of improved continence measured with the ICIQ-SF.
Background
The prevalence of sexual dysfunction is high in postmenopausal women and pelvic floor muscle training (PFMT) could improve sexual function during this period.
Aim
To assess the effect of a PFMT protocol on sexual function in postmenopausal women and to investigate the effect of this protocol on pelvic floor muscle function.
Methods
This is an assessor blinded randomized controlled trial including 77 postmenopausal women. The study was registered in ReBEC Trial: RBR-3s3ff7. The intervention group (n = 40) received an intensive supervised PFMT protocol during 12 weeks and the control group (n = 37) received no intervention.
Outcomes
The primary outcome of the study was assessed by the Female Sexual Function Index (FSFI) questionnaire and the secondary outcome was the evaluation of pelvic floor muscle function performed by digital palpation using the modified Oxford scale at baseline and after 12 weeks.
RESULTS
No difference between groups was found in the FSFI domains and total score at baseline and in the second evaluation after 12 weeks. However, after 12 weeks, a higher percentage of women without sexual dysfunction was found in the intervention group (95% CI = 27.97–72.03) when compared to the control group (95% CI = 7.13–92.87). No difference was found between groups in relation to the pelvic floor muscle function at the baseline (P = .2) and after 12 weeks (P = .06).
Clinical Implications
PFMT is a conservative intervention that can lead women to have less sexual dysfunction.
Strengths & Limitations
The protocol provided a reduced number of women with sexual dysfunction, the strength of this research is the study design and the limitation is to have used only one tool to assess sexual function although it is a validated questionnaire.
CONCLUSION
PFMT decreases sexual dysfunction in postmenopausal women.
Purpose:
Concerns exist around under-detection and under-treatment of urinary incontinence (UI) in specific patient groups, particularly older people. The aim of this study is to ascertain the prevalence of unreported UI in a large sample of older adults, to profile factors associated with under-reporting of UI and the association of unreported UI with quality of life (QOL).
Methods:
This study was embedded within the Irish Longitudinal Study on Ageing, involving a population-representative sample of almost 7,000 older adults (55% female, mean age 65 years). UI was defined as involuntary loss of urine from the bladder occurring on average at least twice per month. Unreported UI had not yet been reported to a healthcare professional. QOL was measured using the Control, Autonomy, Self-realisation and Pleasure-19 Scale (CASP-19).
Results:
Almost 40% (285/750) of participants with UI had not reported symptoms to a healthcare professional despite visiting their general practitioner (GP) on average over 4 times in the last year. Logistic regression modelling demonstrated that under-reporting of UI was associated with female sex, taking < 5 medications, less severe symptoms and lower number of GP visits. Linear regression models show that unreported UI was associated with significantly lower CASP-19 (β = - 1.20 (95% CI: - 2.19 to - 0.20)).
Conclusion:
Only 40% of older people with UI report symptoms to a healthcare professional despite frequent symptoms, and a significant association with poorer QOL. This highlights the need to educate older people around seeking help for UI, as well as opportunistically addressing UI as part of comprehensive age-attuned care.
Background
Although pelvic floor muscle training is widely recommendedin the literature as the gold standard for the treatment of pelvic floor dysfunctions, such as urinary incontinence, interest in other exercise regimens is increasing. However, it is unknown whether other exercise regimens increase pelvic floor muscle strength.
Methods
This was a systematic review of randomized clinical trials found in PEDro, tridatabase, Cochrane and PubMed on the efficacy of nonspecific exercises, such as Pilates, the Paula method, and hypopressive exercises, in strengthening pelvic floor muscles in adults without underlying neurological disorders and with or without pelvic floor dysfunction.
Results
Seven studies were analyzed, and the results demonstrated that Pilates, the Paula method, and hypopressive exercises are ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training. The protocol was registered in the PROSPERO database (www.crd.york.ac.uk/prospero/) under the number CRD42019123396.
Conclusion
Considering the available studies, we have concluded that Pilates, the Paula method and hypopressive exercises performed alone do not increase pelvic floor muscle strength. Pelvic floor muscle training continues to be the gold standard for increasing pelvic muscle strength.
Introduction
Many studies have been developed to investigate the relationship between urinary incontinence (UI) and female sexuality especially how it interferes on the sexual function of affected women, but many questions remain unclear.
Objectives
To summarize the relevant scientific literature published in the last 10 years that focused on the study of the impact of UI on the sexual function of incontinent women.
Methods
The PubMed and Bireme databases were searched using the keyword string “urinary incontinence” and “sexual function” or “sexual satisfaction” or “sexuality” for studies focusing the impact of UI on the sexual function of affected women older than 18 years, published in the last 10 years.
Main outcome measures
The main outcome measure was the review of published literature on the impact of UI on sexual function by reporting study design, group of population studied, type of UI, and findings.
Results
18 studies were selected for the study. UI has a negative impact on sexual function. The type of UI affected the quality of life and sexual function of the women in different ways. There is a shortage of articles that further study the underlying mechanisms of negative UI outcomes in sexual function.
Conclusion
UI has negative impact on sexual function. It is probable that this interference, directly or indirectly, contributes decisively to the avoidance of women in having sex. The way this influence occurs remains unclear, especially when we seek to understand the mechanisms involved in this outcome.
Pinheiro Sobreira Bezerra LR, Britto DF, Ribeiro Frota IP, et al. The Impact of Urinary Incontinence on Sexual Function: A Systematic Review. Sex Med 2020;XX:XXX–XXX.
Introdução: As disfunções sexuais são bastante prevalentes e apresentam impacto negativo sobre a vida das mulheres. O método Pilates pode ser um recurso para a melhora da função sexual feminina, por contribuir para o fortalecimento dos músculos do assoalho pélvico. No entanto, seus efeitos são pouco elucidados pela literatura. Objetivo: Avaliar os efeitos do método Pilates sobre a função sexual feminina. Métodos: Estudo quase experimental com corte transversal. Foram selecionadas 8 mulheres com vida sexual ativa. As mesmas realizaram 16 sessões de Pilates, duas vezes por semana com duração de 50 minutos. As pacientes foram instruídas a realizar a contração dos músculos do assoalho pélvico durante os movimentos. Para realização da pesquisa foram utilizados os seguintes instrumentos: Questionário de Avaliação e Female Sexual Function Index (FSFI). Resultados: Houve um aumento significativo do escore total do FSFI pós-intervenção (p = 0,002), bem como nos escores de desejo (p = 0,049), satisfação (p = 0,008), orgasmo (p = 0,002) e excitação (p = 0,008). Conclusão: Este estudo sugere que a prática de Pilates pode melhorar a função sexual feminina.Palavras-chave: Pilates, comportamento sexual, assoalho pélvico.
Background:
Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure.
Objectives:
To evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women.
Search methods:
The following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication.
Selection criteria:
Randomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included.
Data collection and analysis:
Two reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles.
Results:
4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32).
Conclusions:
No evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.
O Female Sexual Function Index (FSFI) é uma escala breve para avaliar a função sexual em mulheres. Ainda não foi traduzido e validado para uso em português. Objetivo: traduzir e validar o Female Sexual Function Index (FSFI) para utilização em português. Método: foi realizado estudo transversal. O “Female Sexual Function Index” foi traduzido e validado para língua portuguesa. A amostra de conveniência incluiu 215 mulheres que procuraram o Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clinicas de Porto Alegre e o Serviço de Orientação e Planejamento Familiar. Resultados: número de anos de estudo foi maior no grupo FA (8,34 ± 3,73 X 9,51 ± 4,23, p = 0,032); idade do parceiro (38,86 ± 8,76 X 34,25 ± 6,72 anos p < 0,001) e tempo de vida juntos (11,94 ± 7,26 X 8,11 ± 4,58 anos, p < 0,001) foram maiores no grupo LT. A maior correlação positiva em mulheres que desejavam esterilização cirúrgica foi entre orgasmo e satisfação (0,798), nas mulheres que desejavam engravidar a maior correlação foi entre desejo e excitação (0,627). Os escores dos domínios orgasmo e satisfação foram maiores para o grupo FA (P = 0,048 e P = 0,026, respectivamente). Conclusão: As mulheres de casais inférteis que desejam engravidar e mulheres férteis que desejam se submeter a esterilização cirúrgica apresentaram bons escores de satisfação sexual, sendo estes semelhantes entre os dois grupos.
Introduction and hypothesis
The purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women.
Methods
Fifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique.
Results
The PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment.
Conclusions
Our findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.
Urinary incontinence (UI) is more common than any other chronic disease, such as hypertension, depression or diabetes, with the prevalence estimated between 9 and 74%. Among the various forms of urinary incontinence, stress incontinence (SUI) is the most prevalent (50%), with urgency incontinence (UUI) representing 11% and mixed type (MUI) 36% (3% not classified). Nowadays, the restoration of urinary continence is one of the greatest challenges for the well-being and quality of life of women. The introduction of minimally invasive surgical procedures changed the anti-incontinence surgery, leading to similar, or even better results as traditional, invasive techniques. The development of the mid-urethral slings offers a viable alternative to surgical correction of SUI. These further developments of mini-sling procedures are appropriate for local anesthesia, less traumatic, 'tension-free' (to ensure continence without obstruction), simple, rapid and repeatable. The latest minimally invasive approaches can be performed in day surgery, with clear advantages compared to traditional procedures. A novel approach through the use of vaginal laser techniques could represent an additional opportunity, as a non-invasive, outpatient method to treat SUI.
Introduction:
Women with urinary incontinence (UI) frequently present with complaints of sexual problems.
Aim:
To evaluate the predictors of sexual function improvement after participating in three physical therapy sessions and performing home-based pelvic floor muscle exercises (PFME) for the treatment of female UI.
Methods:
This is a secondary analysis of a randomized trial with a 3-month follow-up in which the sexual function of 54 women with UI was evaluated. These women joined three supervised physiotherapy sessions that included PFME and health education during 1 month, with a 15-day interval between each session, and kept practicing home-based PFME for a further 2 months.
Main outcome measure:
Sexual function was assessed using the Female Sexual Quotient, the pelvic floor muscle strength was measured using the modified Oxford scale, and UI was assessed using the International Consultation on Incontinence Questionnaire.
Results:
The mean of sexual quotient score improved after treatment (P = 0.001). With respect to specific domains of sexual function, improvement was observed only in the questions about sexual desire, arousal/excitement, and orgasm. Before treatment, 18 women (33.3%) were classified as having sexual dysfunction, and after treatment, eight remained with sexual dysfunction and two other joined this category (total of 18.5%). Those women who had sexual dysfunction at baseline experienced a higher level of improvement of the sexual quotient compared with those without sexual dysfunction (P = 0.001, 95% CI = 9.1-31.9). A multivariate linear regression with backward elimination revealed the following predictors of improvement of the sexual quotient: higher parity, higher adherence to PFME, improvement in the strength of PFM, and a decrease in the frequency of urine leakage (R(2) = 0.497).
Conclusion:
PFME was more beneficial with regard to sexual function in those women who presented with sexual dysfunction at baseline.
ABSTRACT Very few data are available on the impact of pelvic floor muscle training (PFMT) on sexual function in incontinent women. The aim of our study is to assess the impact of PFMT on female sexual function, using the Female Sexual Function Index (FSFI). We enrolled women with stress urinary incontinence (SUI), without overactive bladder symptoms, who completed a 3-month PFMT. All patients filled in the FSFI and the ICIQ-sf at baseline and at 3-month follow-up. Thirty-four patients completed all the questionnaires; 64.7% patients were referred with SUI without sexual disorders, while 35.3% complained of both SUI and sexual symptoms. The ICIQ-sf score significantly decreased after 3-mo of PFMT (p = 0.01). The FSFI score significantly improved after PFMT even in women with sexual disorders (12.5±9.5 vs 29.7±3.7; p <0.001). Our study showed that PFMT may improve female sexual function in women with pure SUI.
The Pilates Method, a body-mind exercise approach originally developed by Joseph Pilates, is becoming widely popular, although without a concomitant development of scientific research. The purpose of this paper is to describe Pilates clients' characteristics, their goals regarding the Method and the prevalence and intensity of musculoskeletal pain among them. Three hundred and twenty-seven subjects were assessed before participation in Pilates exercises started. Variables of interest were age, sex, main goals with the Method, participation in physical activities, assistance by health professionals, main areas of musculoskeletal pain and subjective pain intensity. The results reveal that the majority of Pilates clients are middle-aged women who did not participate regularly in other exercise activities and who had some complaint of musculoskeletal pain. Despite high pain prevalence, only about one quarter of our sample sought the Pilates Method specifically for rehabilitation. This reveals a large patient population in which Pilates-based rehabilitation may be applicable.
Introduction
Stress urinary incontinence is a frequent complaint in medical offices and studies have shown that women who practice high impact sports develop its symptoms.
Objective
To evaluate the prevalence of stress urinary incontinence in women who attend gyms and perform high impact exercises and correlate it with women who do not attend gyms.
Method
Prospective comparative study in which 488 nulliparous women of normal weight were divided into a Study Group, composed of women who attended gyms, and a Comparative Group, composed of women who did not attend gyms. Three questionnaires were used for the evaluation of stress urinary incontinence and the results of the ICIQ-SF questionnaire were used to compare the groups.
Results
There was a significant difference between groups on the ICIQ-SF. The average in the Study Group was 1.68 (+ 3.46) and in the Comparative Group the average was 1.02 (+ 2.69) (p = 0.006).
Conclusion
Women who attend gym and perform high impact exercises have a higher prevalence of urinary incontinence symptoms, independent of the exercise modality, than women who do not perform any high impact exercise.
Aims of study1.To develop a digital technique to assess pelvic floor muscles (PFM).2.To validate the technique and test for validity and reliability.3.To translate the assessment into an exercise-based regimen.Method and ResultsPERFECT is an acronym with P representing power (or pressure, a measure of strength using a manometric perineometer), E = endurance, R = repetitions, F = fast contractions, and finally ECT = every contraction timed. The scheme was developed to simplify and clarify PFM assessment. The pressure (referred to hereafter as power, although actually a surrogate measure of muscular strength) of a contraction was validated by examining perineal lift and perineometric pressure during a maximum voluntary contraction (MVC). Data analysis demonstrated significant positive correlations between power and both lift (r = 0.864; p = 0.031) and perineometric pressure (r = 0.786; p = 0.001); digitally assessed endurance correlated with the area under the pressure curve of a sophisticated perineometer (r = 0.549; p = 0.001). A study of inter-examiner reliability demonstrated highly significant positive correlations between two examiners for power (r = 0.947; p < 0.001), endurance (r = 0.946; p < 0.001), repetitions (r = 0.730; p < 0.005) and number of fast contractions (r = 0.909; p < 0.001). Scatter diagrams confirmed a lack of systematic bias between examiners.Test-retest reliability produced highly significant correlations (p < 0.001) between power (r = 0.929) and endurance values (r = 0.988) recorded on two different occasions, with no convincing evidence of significant discrepancies between the pair of assessments.ConclusionsThe PERFECT scheme has demonstrated reliability and validity as an assessment tool. Furthermore, it is proposed that this scheme provides guidelines for the planning of patient-specific exercise programmes which satisfy the principles of muscle training.
Our purpose was to determine the objective and subjective efficacy of transvaginal electrical stimulation for treatment of common forms of urinary incontinence in women.
A prospective, double-blind, randomized clinical trial included 121 women with either urinary incontinence caused by detrusor instability or genuine stress incontinence, or both (mixed incontinence). Participants used the assigned device for 8 weeks. Identical preintervention and postintervention assessment included multichannel urodynamic testing, quality-of-life scale, and urinary diaries.
A total of 121 women completed this study at four North American urogynecology centers. Detrusor instability was cured (stable on provocative cystometry) in 49% of women with detrusor instability who used an active electrical device (p = 0.0004, McNemar's test), whereas there was no statistically significant change in the percentage with detrusor instability in the sham device group. There was no statistically significant difference between the preintervention and postintervention rates of genuine stress incontinence for either the active device group or the sham device group.
This form of transvaginal electrical stimulation may be effective for treatment of detrusor overactivity, with or without genuine stress incontinence.
To determine whether voluntary abdominal muscle contraction is associated with pelvic floor muscle activity.
Pelvic floor muscle activity was recorded during contractions of the abdominal muscles at 3 different intensities in supine and standing positions.
Research laboratory.
Six women and 1 man with no histories of lower back pain.
Not applicable.
Electromyographic activity of the pelvic floor muscles was recorded with surface electrodes inserted into the anus and vagina. These recordings were corroborated by measurements of anal and vaginal pressures. Gastric pressure was recorded in 2 subjects.
Pelvic floor muscle electromyography increased with contraction of the abdominal muscles. With strong abdominal contraction, pelvic floor muscle activity did not differ from that recorded during a maximal pelvic floor muscle effort. The pressure recordings confirmed these data. The increase in pressure recorded in the anus and vagina preceded the pressure in the abdomen.
In healthy subjects, voluntary activity in the abdominal muscles results in increased pelvic floor muscle activity. The increase in pelvic floor pressure before the increase in the abdomen pressure indicates that this response is preprogrammed. Dysfunction of the pelvic floor muscles can result in urinary and fecal incontinence. Abdominal muscle training to rehabilitate those muscles may be useful in treating these conditions.
After a comprehensive review of terminology of lower urinary tract function/dysfunction, the International Continence Society (ICS) has recommended the use of the terms overactive bladder syndrome (OAB) and detrusor overactivity. Detrusor overactivity is defined as a urodynamic observation characterized by involuntary detrusor contractions during the filling phase that may be spontaneous or provoked. Detrusor overactivity is subdivided into idiopathic detrusor overactivity and neurogenic detrusor overactivity. Because detrusor overactivity is a urodynamic diagnosis, it is essential to record symptoms and signs during urodynamic studies to correlate them with any involuntary contractions. The ICS 2002 report describes 2 types of detrusor overactivity: (1) phasic, which may or may not lead to urinary incontinence; and (2) terminal, which is a single involuntary detrusor contraction that often results in complete bladder emptying. OAB, as defined by ICS 2002, is a new term and is a symptomatic diagnosis. OAB is defined as urgency, with or without urge incontinence, and usually with frequency and nocturia. The ICS endorsement of the term OAB recognizes that patients with this symptom syndrome are almost always treated by nonsurgical means on an empirical basis, ie, without a urodynamic confirmation of the presumed diagnosis, detrusor overactivity. The ICS believes that these terms are more intuitive and will make it easier for patients and physicians alike to understand. It is hoped that general use of the new ICS definitions will facilitate effective communications between patients and their physicians concerning their urologic dysfunctions.
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