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Pelvic floor exercises with biofeedback for stress urinary incontinence
Capelini, Maria V.;Riccetto, Cassio L.;Dambros, Miriam;Tamanini, Jose T.;Herrmann, Viviane;Muller, Virginia;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000400015
Abstract: objective: prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence. materials and methods: fourteen patients diagnosed with stress urinary incontinence (sui) were selected for this study. all patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. the king's health questionnaire (khq) was applied before and after treatment to assess the impact in the quality of life. results: there was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). at urodynamics the authors observed a significant increase in valsalva leak-point pressure (from 103.93 cm h2o to 139.14 cm h2o), cistometric capacity (from 249.29 ml to 336.43 ml, p = 0.0015) and bladder volume at first desire to void (from 145 ml to 215.71 ml). those differences were kept during the first 3 months of follow up. the khq revealed significant differences except in the case of "general health perception", which covers health in general and not exclusively urinary incontinence. conclusion: treatment of sui with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.
Home exercises for pelvic floor in continent women one year after physical therapy treatment for urinary incontinence: an observational study
Krüger, Ana P.;Luz, Soraia C. T.;Virtuoso, Janeisa F.;
Brazilian Journal of Physical Therapy , 2011, DOI: 10.1590/S1413-35552011005000006
Abstract: objectives: to describe the results of home exercise targeting the pelvic floor in continent women one year after the end of a physical therapy treatment for the following outcomes: functional assessment of the pelvic floor and urinary incontinence. methods: this is an observational study that evaluated fifteen women one year after physical therapy treatment for stress urinary incontinence (sui). the outcomes for this study were: situations of urinary loss, use of daily protection, practice of home exercises for the pelvic floor, functional assessment of the pelvic floor (fapf) and patient satisfaction. we also investigated some confounding variables such as hormonal status, number of vaginal deliveries and previous history of episiotomy. results: one year after completion of physical therapy treatment, we observed that the fapf median remained stable over time (median=5, p=0.08). the presence of urinary incontinence was reported by 40% of women in the sample, however, was characterized as mild (i.e. not requiring the use of daily protection). there was also a significant association (p=0.001) between the completion of home exercises (twice or more per week) and the normal clinical status. confounding variables, which could compromise the clinical status, showed no significant association with the outcomes (p≥0.05). conclusion: home exercises contributed to the maintenance of continence following a physical therapy treatment.
High prevalence of urinary incontinence and poor knowledge of pelvic floor exercises among women in Ladysmith
JP Madombwe, S Knight
South African Journal of Obstetrics and Gynaecology , 2010,
Abstract: Introduction. The purpose of the study was to determine the prevalence of urinary incontinence in Ladysmith, KwaZulu-Natal, the health-seeking behaviour of affected women, and women’s knowledge of pelvic floor exercises. Methods. Between September 2005 and November 2005, a questionnaire was administered to 99 women aged 21 - 76 years. Results. We found that 35.4% (95% confidence interval (CI) 25.9 - 44.8%) of the sample had urinary incontinence. The most common type of incontinence was stress urinary incontinence, reported by 62.9% (95% CI 46.5 - 79.2%). Of the 99 women, 32.3% (95% CI 23.1 - 41.5%) had heard of pelvic floor muscle exercises and 18.2% (95% CI 10.6 - 25.8%) had actually done them. Of the 35 women with urinary incontinence 25.7% had sought professional help, most commonly because of a worsening in condition. Conclusion. Although the prevalence of urinary incontinence in Ladysmith is high, knowledge about the condition and its management among both women and health service providers is poor.
Home exercises for pelvic floor in continent women one year after physical therapy treatment for urinary incontinence: an observational study Exercício domicilar para o assoalho pélvico em mulheres continentes após tratamento fisioterapêutico para incontinência urinária: um estudo observacional  [cached]
Ana P. Krüger,Soraia C. T. Luz,Janeisa F. Virtuoso
Brazilian Journal of Physical Therapy , 2011,
Abstract: OBJECTIVES: To describe the results of home exercise targeting the pelvic floor in continent women one year after the end of a physical therapy treatment for the following outcomes: functional assessment of the pelvic floor and urinary incontinence. METHODS: This is an observational study that evaluated fifteen women one year after physical therapy treatment for Stress Urinary Incontinence (SUI). The outcomes for this study were: situations of urinary loss, use of daily protection, practice of home exercises for the pelvic floor, functional assessment of the pelvic floor (FAPF) and patient satisfaction. We also investigated some confounding variables such as hormonal status, number of vaginal deliveries and previous history of episiotomy. RESULTS: One year after completion of physical therapy treatment, we observed that the FAPF median remained stable over time (Median=5, p=0.08). The presence of urinary incontinence was reported by 40% of women in the sample, however, was characterized as mild (i.e. not requiring the use of daily protection). There was also a significant association (p=0.001) between the completion of home exercises (twice or more per week) and the normal clinical status. Confounding variables, which could compromise the clinical status, showed no significant association with the outcomes (p≥0.05). CONCLUSION: Home exercises contributed to the maintenance of continence following a physical therapy treatment. OBJETIVOS: Descrever os resultados da prática de exercícios domicilares para o assoalho pélvico em mulheres continentes nos quesitos avalia o funcional do assoalho pélvico (AFA) e presen a de incontinência urinária após um ano de tratamento fisioterapêutico. MéTODOS: Estudo observacional com 15 mulheres um ano após o tratamento fisioterapêutico para incontinência urinária de esfor o (IUE). As variáveis analisadas neste estudo foram: situa es de perda urinária, utiliza o de prote o diária, manuten o dos exercícios domiciliares para o assoalho pélvico, AFA e satisfa o da paciente em rela o ao tratamento. Também foram investigadas algumas variáveis de confus o, como: estado hormonal, número de partos vaginais e realiza o de episiotomia. RESULTADOS: Após um ano do término do tratamento fisioterapêutico, observou-se que a AFA manteve-se (Md=5; p=0,08). Quanto à presen a de perda urinária, 40% da amostra relatou ser leve, n o sendo necessária a utiliza o de protetores diários. Observou-se também associa o significante (p=0,001) entre a prática de exercícios domiciliares e o quadro clínico normal. As variáveis de confus o, que p
In Vivo Hip Joint Loading during Post-Operative Physiotherapeutic Exercises  [PDF]
Verena Schwachmeyer, Philipp Damm, Alwina Bender, J?rn Dymke, Friedmar Graichen, Georg Bergmann
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077807
Abstract: Introduction After hip surgery, it is the orthopedist’s decision to allow full weight bearing to prevent complications or to prescribe partial weight bearing for bone ingrowth or fracture consolidation. While most loading conditions in the hip joint during activities of daily living are known, it remains unclear how demanding physiotherapeutic exercises are. Recommendations for clinical rehabilitation have been established, but these guidelines vary and have not been scientifically confirmed. The aim of this study was to provide a basis for practical recommendations by determining the hip joint contact forces and moments that act during physiotherapeutic activities. Methods Joint contact loads were telemetrically measured in 6 patients using instrumented hip endoprostheses. The resultant hip contact force, the torque around the implant stem, and the bending moment in the neck were determined for 13 common physiotherapeutic exercises, classified as weight bearing, isometric, long lever arm, or dynamic exercises, and compared to the loads during walking. Results With peak values up to 441%BW, weight bearing exercises caused the highest forces among all exercises; in some patients they exceeded those during walking. During voluntary isometric contractions, the peak loads ranged widely and potentially reached high levels, depending on the intensity of the contraction. Long lever arms and dynamic exercises caused loads that were distributed around 50% of those during walking. Conclusion Weight bearing exercises should be avoided or handled cautiously within the early post-operative period. The hip joint loads during isometric exercises depend strongly on the contraction intensity. Nonetheless, most physiotherapeutic exercises seem to be non-hazardous when considering the load magnitudes, even though the loads were much higher than expected. When deciding between partial and full weight bearing, physicians should consider the loads relative to those caused by activities of daily living.
Spinal Loads during Post-Operative Physiotherapeutic Exercises  [PDF]
Antonius Rohlmann, Verena Schwachmeyer, Friedmar Graichen, Georg Bergmann
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0102005
Abstract: After spinal surgery, physiotherapeutic exercises are performed to achieve a rapid return to normal life. One important aim of treatment is to regain muscle strength, but it is known that muscle forces increase the spinal loads to potentially hazardous levels. It has not yet been clarified which exercises cause high spinal forces and thus endanger the surgical outcome. The loads on vertebral body replacements were measured in 5 patients during eleven physiotherapeutic exercises, performed in the supine, prone, or lateral position or on all fours (kneeling on the hands and knees). Low resultant forces on the vertebral body replacement were measured for the following exercises: lifting one straight leg in the supine position, abduction of the leg in the lateral position, outstretching one leg in the all-fours position, and hollowing the back in the all-fours position. From the biomechanical point of view, these exercises can be performed shortly after surgery. Implant forces similar or even greater than those for walking were measured during: lifting both legs, lifting the pelvis in the supine position, outstretching one arm with or without simultaneously outstretching the contralateral leg in the all-fours position, and arching the back in the all-fours position. These exercises should not be performed shortly after spine surgery.
Effect of Kegel Exercises on the Management of Female Stress Urinary Incontinence: A Systematic Review of Randomized Controlled Trials  [PDF]
Seong-Hi Park,Chang-Bum Kang
Advances in Nursing , 2014, DOI: 10.1155/2014/640262
Abstract: Objective. The purpose of this study was to evaluate the effect of Kegel exercises on reducing urinary incontinence symptoms in women with stress urinary incontinence. Methods. Randomized controlled trials (RCTs) were conducted on females with stress urinary incontinence who had done Kegel exercises and met inclusion criteria in articles published between 1966 and 2012. The articles from periodicals indexed in KoreaMed, NDSL, Ovid Medline, Embase, Scopus, and other databases were selected, using key terms such as “Kegel” or “pelvic floor exercise.” Cochrane’s risk of bias was applied to assess the internal validity of the RCTs. Eleven selected studies were analyzed by meta-analysis using RevMan 5.1. Results. Eleven trials involving 510 women met the inclusion criteria. All trials contributed data to one or more of the main or secondary outcomes. They indicated that Kegel exercises significantly reduced the urinary incontinence symptoms of female stress urinary incontinence. There was no heterogeneity in the selected studies except the standardized bladder volumes of the pad test. Conclusion. There is some evidence that, for women with stress urinary incontinence, Kegel exercises may help manage urinary incontinence. However, while these results are helpful for understanding how to treat or cure stress urinary incontinence, further research is still required. 1. Introduction Stress urinary incontinence (SUI), defined as “the complaint of involuntary leakage of urine on effort, exertion, sneezing, or coughing” by the International Continence Society [1], is the most common type of urinary incontinence in women. Although it is not a life-threatening condition [2], SUI affects the quality of women’s lives in many ways and may limit women’s social and personal relationships, as well as limiting physical activity [3]. Much has been written about the prevalence of stress urinary incontinence, which affects up to 40% of community-dwelling women living in the Western world. Furthermore, its prevalence is increasing due to an aging society [4], but only a quarter of all women with this problem seek medical support [3, 5]. Although surgical treatment is the more effective treatment for SUI, conservative treatment is now recommended as first-line treatment in elderly women or those with mild symptoms [6]. Conservative treatments, a nonsurgical therapy, include improving the lifestyle, bladder training, pelvic floor muscle exercises, biofeedback, and the electrical stimulation of pelvic muscles [7]. Kegel exercises are the most popular method of reinforcing pelvic
Fecal incontinence as consequence of anorectal surgeries and the physiotherapeutic approach
Cortez, Kelly Cristina Duque;Mendon?a, Sarah de Souza;Figueiroa, Marina de Souza;
Journal of Coloproctology (Rio de Janeiro) , 2011, DOI: 10.1590/S2237-93632011000300004
Abstract: caused by sphincter injuries in various anorectal procedures, fecal incontinence (fi) is a common complication in some patients undergoing coloproctology surgeries. objective: demonstrate the occurrence of fi as a result of anorectal surgeries, present the physiotherapy resources for the treatment of this disorder and, based on that, propose the inclusion of physiotherapy as a routine postoperative practice for these types of interventions. materials and methods: an integrative review of databases from the virtual health library (vhl) and the physiotherapy evidence database (pedro) published between 2000 and 2010, in english and portuguese. results: thirteen articles (one cross-section cohort, two uncontrolled clinical trials and ten retrospective cohorts), with evidence level between 2c and 4c and published between 2001 and 2009, were selected; review articles were excluded. the review demonstrated that fi is an important complication of anorectal surgeries, causing major impacts on the patients' quality of life and that physiotherapy provides effective resources to treat this disorder. conclusion: further studies are recommended, in the form of systematic reviews, using a higher number of articles and better scientific evidences.
Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence
Castro, Rodrigo A.;Arruda, Raquel M.;Zanetti, Miriam R. D.;Santos, Patricia D.;Sartori, Marair G. F.;Gir?o, Manoel J. B. C.;
Clinics , 2008, DOI: 10.1590/S1807-59322008000400009
Abstract: purpose: to compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. patients and methods: one hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), es (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (i-qol), urodynamic test, voiding diary, and subjective response. results: in the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. no significant difference was found between groups in the urodynamic parameters. in the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. in the control group, only 21% patients were satisfied with the treatment. conclusion: based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.
PHYSICAL TREATMENT OF THE STRESS URINARY INCONTINENCE IN WOMEN
Vesna Petronijevi?,Milica Lazovi?,Marina Vlajkovi?,Olivera Stojanova
Acta Medica Medianae , 2003,
Abstract: The paper presents various methods of the physical treatment used in healing women with the stress urinary incontinence. It is emphasized that the exercises for strengthening the pelvic floor are effective in curing the stress incontinence but the most efficient exercise program has not been determined yet. Likewise, it is pointed out that the biofeedback application, along with the exercise, is no more efficient than the application of the exercises only but, still, much better results are achieved by applying the biofeedback at the beginning of the treatment. In order to evaluate the effects of the vaginal coni, electric and magnetic simulations in treating women with the stress urinary incontinence further explorations are necessary.
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