Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The pelvic floor muscles (PFM) contribute to urinary continence and overactive PFM seem to be associated with pelvic pain syndrome (PPS). The literature indicates that ethnic differences regarding symptoms of urinary incontinence may exist. Research is needed to establish relationships between PFM function and symptoms reported by women of different ethnic groups. Objectives: To compare the PFM strength and endurance in black, white and coloured women. To investigate relationships between PFM strength, vaginal resting pressures, risk factors and symptoms associated with PFM dysfunction and PPS. Method: A cross-sectional study assessed the PFM strength and vaginal resting pressures of 122 nulliparous black (n=44), white (n=44) and coloured (n=34) university students. A self-developed questionnaire determined inclusion, demographic variables, factors affecting/factors associated with PFM strength and symptoms related to PPS. Maximum voluntary contraction pressure (cmH2O) and vaginal resting pressure (cmH2O) were measured with the Peritron TM 9300 (Cardio Design, Australia) used with the Camtech AS vaginal balloon sensor (Sandvika, Norway). Two sets of 3 maximum voluntary contractions of the PFM were recorded. Results: The mean age of the group was 22 ± 3.54 years and mean BMI of 23± 4.16 kg/m2. Black women (25 cmH2O ± 13.5) had significantly stronger PFM than white (p=0.02) or coloured (p<0.01) women, but no significant difference (p=0.78) in PFM strength existed between white (18.4 cmH2O ± 9.8) and coloured (15.6 cmH2O ± 8) women. In black women, PFM strength decreased significantly (p=0.02) between the sets, whereas no significant difference between sets was noted in the other ethnic groups. Increased PFM strength was associated with SUI (p=0.03) and amenorrhoea (p=0.01) and decreased PFM strength was associated with decreased frequency of bowel motion (p=0.01). In this sample, increased vaginal resting pressure was associated with menorrhagia (p=0.04). Conclusion: Black nulliparous women had stronger PFM than white and coloured women. There was no difference in PFM strength between white and coloured women. Endurance, as measured in this study, indicates that black women have decreased endurance of the PFM compared to white and coloured women. These findings inform the current research on ethnic differences in the prevalence of urinary incontinence. Preliminary data suggest that there was no relationship between vaginal resting pressures and symptoms of PPS and risk factors for PFM dysfunction, except for menorrhagia. / AFRIKAANSE OPSOMMING: Die bekkenvloer spiere (BVS) dra by tot urinêre kontinensie en ooraktiewe BVS kan moontlik geassosieer wees met pelviese pyn sindroom (PPS). Uit die literatuur blyk dit of daar etniese verskille bestaan in die simptome van urinere inkontinensie gerapporteer deur vroue. Navorsing is nodig om die verwantskap tussen BVS funksie en simptome wat deur pasiënte van verskillende etniese groepe gerapporteer word vas te stel. Doel: Om „n vergelyking te tref tussen BVS sterkte in swart, wit en kleurling vroue. Om vas te stel of daar assosiasies bestaan tussen BVS sterkte, rustende vaginale druklesings en risiko faktore en simptome geassosieer met bekkenvloer disfunksie en PPS. Metodologie: „n Dwarssnit studie het die BVS sterkte en rustende vaginale drukke van 122 nullipareuse swart (n=44), wit (n=44) en kleurling (n=34) universiteit studente geëvalueer. Insluiting, uitsluiting, demografiese veranderlikes, faktore wat kan affekteer/faktore geassosieer met BVS sterkte en simptome geassosier met PPS is deur „n self ontwikkelde vraelys geëvalueer. Maksimale willekeurige spiersametrekking drukke (cmH2O) en rustende vaginale drukke (cmH2O) was gemeet met „n Peritron™9300 perineometer (Cardio Design, Australië) wat saam „n vaginale ballon sensor (Camtech AS, Sandvika, Noorweë) gebruik is. Twee stelle van 3 maksimale willekeurige sametrekkings van die BVS was gemeet. Resultate: Die groep se gemiddelde ouderdom was 22±3.54 jaar en die gemiddelde liggaamsgewig indeks was 23±4.16kg/m2. Swart vroue (25 cmH2O ±13.5) het beduidend sterker BVS gehad as wit (p=0.02) en kleurling (p<0.01) vroue, maar daar was geen beduidende verskil (p=0.78) in BVS sterkte tussen wit (18.4 cmH2O ± 9.8) en kleurling (15.6 cmH2O ± 8) vroue nie. Die BVS sterkte in swart vroue het beduidend (p=0.02) verminder tussen die stelle, maar geen beduidende verskille was waargeneem in die ander etniese groepe tussen stelle. Verhoogde BVS sterkte was geassosieer met druklek (p=0.03), amenorrhoea (p=0.01) en verminderde BVS sterkte was geassosieer met verminderde frekwensie van opelyf (p=0.01). Verhoogde rustende vaginale drukke was geassosieer met menoragie in hierdie steekproef. Gevolgtrekking: Swart nullipareuse vroue het sterker BVS gehad as wit en kleurling vroue, Daar was geen verskil in BVS sterkte tussen wit en kleurling vroue nie. Uithouvermoë soos in hierdie studie getoets toon dat swart vroue verminderde uithouvermoë het i.v.m. wit en kleurling vroue. Hierdie bevindings dra by tot die huidige navorsing oor etniese verskille in die prevalensie van urinêre inkontinensie. Daar was geen verwantskap tussen vaginale rustende drukke en simptome van PPS en risiko faktore vir die ontwikkeling van bekkenvloer disfunksie, behalwe vir menoragie.

Title: The biomechanical effects of levator ani muscle laceration injuries after vaginal delivery Objectives: The aim of this thesis is to sum up current knowledge about the normal structure and function of levator ani muscle and findings about dysfunctions of a pelvic floor. By means of biomechanical instruments to analyse how the lower part of levator ani muscle closes (puborectalis muscle) during unilateral avulsion lesion. On the basis of computer simulation of biomechanical properties of the pelvic floor during avulsion lesion to describe the theoretical solutions for the therapy of the main types of dysfunctions of the pelvic floor. Methods: Biomechanical analysis was used with a help of computer model of muscular pelvic floor with a help of the ABAQUS model. This model with matched properties of muscular tissue was influenced by the standard pressure which influences the pelvic floor for a person of 80 kilos standing at rest. This model simulated unilateral avulsion lesion and biomechanical variables were observed during compensatory activation of uninjured parts of levator with the activity 100%, 50% and 10%. The map of the muscular tone and the rate of movement of the muscles of the pelvic floor were evaluated. Results: Only minimal movement is observed in the intact pelvic floor during...

Made available in DSpace on 2016-06-02T20:19:13Z (GMT). No. of bitstreams: 1 2873.pdf: 1742791 bytes, checksum: 47d9a0ace2c120efe792f6fd0fd840c2 (MD5) Previous issue date: 2010-03-03 / Financiadora de Estudos e Projetos / The purpose of this study was to evaluate the effects of a kinesiotherapy protocol in a group-based for strengthen the pelvic floor muscles (KGSPF) for the pelvic floor muscle (PFM) function and pressure level, quality of life (QOL) and isometric and isokinetic hip adductors peak torque (PT) among women with urinary incontinence (UI) that was not sedentary. Fifteen women (mean age 60,20 ± 8,16) were enrolled in this study. They were evaluated, at beginning and after 12 weeks, by a clinical evaluation; one hour pad test; three-day voiding diary; a QOL with King Health Questionnaire (KHQ); PFM function (digital and perioneometer) and isometric and isokinetic hip adductors PT. The KGSPF protocol consisted of 12 sessions of one hour, once a week. The KGSPF protocol included exercises to strengthen PFM, information and guidance for UI. The data were analyzed by non-parametric Wilcoxon test and Spearman coefficient correlation. The significance level was 5%. After 12 weeks, the group presented a significant improvement of QOL and PFM function and pressure. It was presented a significant decrease for isometric hip adductors PT, one hour pad test (p=0,03), urgency episodes (p=0,04), and UI (p=0,02). It was found moderate negative correlation between age and the isokinetic hip adductors PT for dominant side (r= -0,53; p=0,04) and non-dominant side (r= -0,57; p=0,03); between the PFM contraction pressure and isokinetic hip adductors PT for dominant side (r= -0,62; p=0,03) and nondominant side (r= -0,64;p= 0,02); and between contraction force of PFM fast fibers and isometric hip adductors PT for dominant side (r= 0,60; p=0,03) and non-dominant side (r=-0,59; p=0,04). In conclusion, the KGSPF protocol was effective to decrease UI and isometric hip adductors PT, and to improve QOL. / O objetivo deste estudo foi avaliar os efeitos de um protocolo de cinesioterapia para o fortalecimento dos músculos do assoalho pélvico em grupo (CFAPG) sobre a função e nível de pressão dos músculos do assoalho pélvico (MAP), qualidade de vida e pico de torque (PT) isométrico e isocinético de adutores de quadril, em mulheres com perda urinária e não sedentárias. Participaram deste estudo 15 mulheres, com média de idade de 60,20 ± 8,16, que realizaram, no início e ao final do protocolo, a avaliação clínica; teste do absorvente de uma hora; diário miccional de três dias; avaliação da qualidade de vida, por meio do questionário King Health Questionnaire (KHQ); avaliação da função dos MAP digital e com o perineômetro, e avaliação do PT isométrico e isocinético de adutores de quadril. O protocolo de CFAPG teve duração de 12 sessões com uma hora, uma vez por semana, sendo realizados os exercícios para fortalecimento dos MAP, além de informações e orientações para a incontinência urinária. Os dados foram analisados no programa Statistica utilizando o teste não paramétrico de Wilcoxon e coeficiente de correlação de Spearman, adotou-se um nível de significância de 5%. Ao final do protocolo ocorreu melhora significativa da qualidade de vida, função e pressão de contração dos MAP e diminuição significativa no PT isométrico de adutores de quadril, teste do absorvente de uma hora (p=0,03), nos episódios de urgência (p=0,04) e perda urinária (p=0,02). Houve correlação negativa moderada entre a idade e o PT isocinética de adutores de quadril do membro dominante (r= -0,53; p=0,04) e não dominante (r= -0,57; p=0,03); entre a pressão de contração dos MAP e o PT isocinética de adutores de quadril do membro dominante (r= -0,62; p=0,03) e não dominante (r= -0,64;p= 0,02); e entre a força de contração das fibras rápidas dos MAP com PT isométrico de adutores de quadril do membro dominante (r= 0,60; p=0,03) e não dominante (r=-0,59; p=0,04). Desta forma, conclui-se que o protocolo de CFAPG foi eficaz para diminuir a perda urinária e o PT isométrico de adutores de quadril e melhorar a qualidade de vida.

Bakgrund: Urininkontinens är ett stort folkhälsoproblem i världen och det definieras som ofrivilligt urinläckage. Vid en graviditet är risken stor att drabbas av urininkontinens och många återhämtar sig inte utan får kvarstående problem. Bäckenbottenträning är den vanligaste behandlingsmetoden för urininkontinens.  Syfte: Denna litteraturstudie syftade till att utvärdera effekten av bäckenbottenträning som intervention hos kvinnor som lider av postnatal urininkontinens. Metod: En litteraturstudie med systematisk sökning i databasen PubMed. Studiernas kvalitet granskades med PEDros granskningsmall och evidensgradering genomfördes med GRADEstud. Resultat: Totalt inkluderades sju studier i studien, varav fyra var av god kvalitet och tre var av måttlig kvalitet. Fem av sju studier visade signifikanta skillnader i effekten av bäckenbottenträning på urininkontinens. Tre av fem studier visade signifikanta skillnader i effekten av bäckenbottenträning på styrka samt två av fem på uthållighet i bäckenbottenmuskulaturen. Evidensstyrkan bedömdes som låg och mycket låg, både gällande effekten på förekomsten av urininkontinens och muskelstyrkan och uthålligheten i bäckenbotten. Konklusion: Resultatet i denna litteraturstudie visar på att bäckenbottenträning postpartum har effekt på både förekomst av urininkontinens samt muskelstyrkan i bäckenbotten. Då tillförlitlighet var låg till mycket låg har dock inte resultatet någon klinisk relevans. Gällande uthållighet i bäckenbottenmuskulatur är resultatet ovisst och även här med låg tillförlitlighet. Den genomgående låga tillförlitligheten tyder på att det krävs fler fysioterapeutiska högkvalitativa studier för att kunna dra några större slutsatser. / Background: Urinary incontinence is a major public health problem in the world and is defined as involuntary leakage of urine. During pregnancy, there is a high risk of urinary incontinence, and many suffer from persistent problems. Pelvic floor training is the most common treatment for urinary incontinence. Objective: This review aimed to evaluate the effect of pelvic floor training for women suffering from postnatal urinary incontinence. Method: A systematic literature search was carried out in the database PubMed. The study quality was reviewed with the PEDro-scale and the certainty of evidence was evaluated with GRADEstud. Results: Seven studies were included in the study, of which four were of good quality and three were of moderate quality. Five of seven studies showed significant effect of pelvic floor training on urinary incontinence. Three out of five studies showed significant effect of pelvic floor training on strength and two out of five on endurance in the pelvic floor muscles. The certainty of evidence was assessed as low to very low. Conclusion: The review showed that pelvic floor training has a positive effect on both the occurrence of urinary incontinence and the muscle strength of the pelvic floor muscles. Regarding endurance, no significant difference could be established. However, as reliability was low to very low, the result has no clinical relevance, and thus, more high-quality physiotherapeutic studies are needed in order to come to further conclusions.

Title: An examination of pelvic floor activity following the application of special exercises Objectives: The aim of this thesis is to validate the usefulness of carrying out local pelvic floor muscle examinations as an indication and education for therapy. A second objective is for the women involved in the research to subjectively evaluate the examination methods and therapy. Furthermore, the thesis aims to establish an example of a comprehensive and detailed local examination of the pelvic floor muscles. Methods: We measured the pelvic floor activity per vaginam using an EMG biofeedback device on clients with a pelvic floor dysfunction and grade I stress incontinence symptoms. Based on the results of the examination, therapy using the vaginal device was recommended and in six weeks a follow-up examination was carried out. The changes in pelvic floor activity were evaluated by comparing the initial and follow-up examinations. Thus the usefulness of carrying out an examination of the local pelvic floor muscles before indicating a therapy was validated. At the end of the examination an interview with participating clients was conducted in order to subjectively evaluate the method. Results: All of the women participating in the research had previously undergone a different method of pelvic floor...

The thesis deals with primary dysmenorrhea (PD) in relation to the locomotor system. The aim of the the sis was to compare the frequency of selected joint blocks and the incidence of constitutional hypermobility in PD patients in comparison with the control group. The patient group included 9 women with PD symptoms and the control group consisted of 10 women without these symptoms. The incidence of atlanto - occipital joint block within the patient group was significantly higher than within the control group (p < 0,05). The total number of stuck ribs was also considerably higher in PD patients (p < 0,01). Pain on palpation on the top of the coccygeum apex was significantly higher within the patient group (p < 0,001). Patients with PD did not show significantly different results in Beighton score test for constitutional hypermobility assessment when compared with the control group. Another aim of the thesis was to judge the effect of physical therapy on PD symptoms. For three months, the group of 9 patients had been encouraged to do regular exercises with the impact on postural stability and diagnosed functional disorders of the locomotor system by means of physical therapy. As was shown after the therapy, the reduction of the total number of stuck ribs was statistically significant (p < 0,001). Furthermore,...

Title: Dysmenorrhea and its possible treatment by physiotherapy Objectives: The aim of this thesis has been to assess the effect of simple feet exercises along with the practice of pelvic floor activation and relaxation on women struggling with dysmenorrhea. Subsequently, it also deals with the issue of whether the pelvic floor treat- ment per rectum together with the exercises is more effective than just plain exercising. Methods: This research has been based on an experiment. This thesis includes both a the- oretical part and a practical part. The methods used for the practical part are as follows: questionnaire (specifically Menstrual Symptom Questionnaire), simple feet exercises, ex- ercises used for the activation and relaxation of the pelvic floor as well as the pelvic floor treatment per rectum and final processing of the gathered data into statistics. Results: The menstrual cycle of every woman is completely individual and every woman perceives it quite differently. The result of the research was that simple feet exercises along with the practice of pelvic floor activation, relaxation and the pelvic floor treatment per rectum help women struggling with dysmenorrhea. We didn't discover any data that confirms whether the pelvic floor treatment per rectum, together with the exercises, is more...

Thesis advisor: Katherine Hutchinson / Lower urinary tract (LUTS) storage symptoms, including overactive bladder (OAB) and urinary incontinence (UI), are common conditions among women with significant health and economic consequences. Much of the existing literature on LUTS focuses on older, often postmenopausal women, and there is limited research available about prevalence, incidence and severity of LUTS in young women. For many young women in the United States, the period from the late teens through early twenties coincides with the period of emerging adulthood and college enrollment. The unique factors influencing women at this stage of development may be influential in understanding prevalence and correlates of OAB and UI later in the life-course. The purpose of this cross-sectional descriptive survey-based study was to explore and describe the experience of urinary storage symptoms, specifically OAB and UI, among female undergraduate college students, and to identify associated factors. Qualtrics online platform was used to create and distribute the survey to a sample of 1,800 female college undergraduate students at a private Catholic university in the northeast. Two instruments previously used to assess LUTS, the ICIQ-FLUTS and LUTS Tool, were combined into the Urinary Symptoms Scale with a one-week recall. Twelve items assessed LUTS storage symptoms of OAB and UI. The final sample consisted of 456 female undergraduate college students with a mean age of 20.3-years-old. The sample was predominantly White non-Hispanic. Most commonly reported symptoms included urgency (47.6%), frequency (52.6%), urinary incontinence (21.3%), stress urinary incontinence (28.8%), and urge urinary incontinence (16.4%). Total severity scores were low and highly skewed towards the lower range (M = 3.31; SD = 3.91). Participants with symptoms, most commonly reported experiencing symptoms rarely or sometimes during the past week. Perceived bother from urinary symptoms mean scores were low (M = 1.77) but extended the full range on a 0 to 10 scale. In this study, perceived bother from urinary symptoms as well as perceived impact of urinary symptoms on activities of daily life (ADLs) were significantly associated with care-seeking and use of self-management strategies. Interestingly, LUTS storage symptom severity was not significantly associated with care-seeking, but it was related to use of self-management strategies in this population. Perception of overall health, history of constipation/IBS, sexual activity, delayed toileting behaviors, and premature toileting behaviors were significant in multivariate analyses when controlling for other factors. Further research on the relationship of these factors and LUTS storage symptoms is needed. This study represented a first step in understanding college women’s experiences with LUTS storage symptoms and identifying the unique personal, behavioral and environmental factors associated with LUTS. The study found that OAB and UI symptoms are common among female college undergraduates. In addition, a number of personal and behavioral factors were found to be associated with LUTS storage symptoms. Given that many health-related behaviors established during college years may persist later in adulthood, identifying experiences and influences of young women’s LUTS storage symptoms is important in informing future research and practice recommendations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A capacidade de contração dos músculos do assoalho pélvico (MAP) está diretamente relacionada a viabilidade de realizar o seu treinamento. A literatura até hoje não traz informações a respeito da capacidade das mulheres estimarem sua própria contração dos músculos do assoalho pélvico. Os objetivos deste estudo foram avaliar a auto-percepção de mulheres da contração dos MAP e de sua intensidade, os relatos de sintomas de disfunções dos MAP, e avaliar a correlação entre os relatos de sintomas de disfunção dos MAP e a auto-percepção da contração muscular. Trata-se de um estudo observacional transversal conduzido no Centro de Saúde Escola Dr. Joel Domingos Machado de agosto de 2016 a abril de 2018. Foram recrutadas mulheres residentes em Ribeirão Preto com idades acima de 18 anos. A escala de Oxford modificada (EOM) foi utilizada como medida de desfecho para avaliar a percepção da contração dos MAP pelas mulheres. Uma avaliadora cega em relação a percepção da contração pelas participantes realizou o exame da função dos MAP utilizando o mesmo instrumento. Os sintomas de disfunção dos MAP foram avaliados por meio dos questionários validados International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI- 20). Os seguintes testes foram utilizados na análise estatística: coeficiente de correlação de concordância de kappa ponderado, o coeficiente de correlação de Pearson e o teste exato de Fisher. As análises estatísticas foram realizadas utilizando o software estatístico SPSS 22. Os valores de p<=0,05 foram considerados estatisticamente significativos. Foram recrutadas 163 mulheres da cidade de Ribeirão Preto, destas 81 não comparecem para avaliação e 82 foram incluídas na pesquisa. A média de idade das mulheres foi de 46,83 (±17,94), 34 (41,5%) eram casadas, 59 (71,9%) brancas, 38 (46,4%) com 8 á 11 anos de escolaridade, multíparas com uma média de 2,17 gestações, 45 (54,9%) não apresentavam sintomas de IU e 77 (93,9%) nunca realizaram o treinamento dos MAP. As mulheres apresentaram uma baixa auto-percepção de contração dos MAP, somente 33% acertou corretamente a intensidade da sua contração. A avaliação da contração dos MAP por meio da palpação vaginal não apresentou uma concordância mínima com a auto percepção(p=0,087/?=0,139). A auto-percepção não apresentou correlação com os sintomas de disfunções através dos questionários PFDI-20, PFIQ-7, ICIQ-SF e PISQ-12. A avaliação da contração muscular apresentou uma correlação fraca negativa com o questionário PFDI-20 nos domínios IU (rs=-0,315/p=0,004), POP (rs=-0,330/p=0,002) e escore total (rs=0,387/p=0,000), uma correlação fraca negativa com o questionário PFIQ-7 nos domínios IU (rs=-0,320/p=0,003), POP (rs=-0,244/p=0,027) e escore total (rs=- 0,329/p=0,003). Uma correlação fraca positiva com o questionário de função sexual PISQ-12 (rs=0,360/p=0,008) e uma correlação negativa moderada com o questionário ICIQ-SF de sintomas de incontinência urinária (rs=-0,406/p=0,000). Concluiu-se que as mulheres dessa amostra apresentaram uma baixa auto-percepção da contração dos MAP, somente 33% estimou corretamente a sua contração muscular. / The ability to perform a pelvic floor muscles (PFM) contraction is directly related to the feasibility of performing their training. To date the literature does not provide information regarding to women\'s ability to estimate their own PFM contraction. This study aims to assess women\'s self-perception of PFM contraction and its intensity, the prevalence of PFM dysfunction symptoms, and to analyse the relation between these symptoms and self-perception of muscle contraction. This is a cross-sectional observational study conducted at Dr. Joel Domingos Machado School Health Center from August, 2016 to April, 2018. Women living in Ribeirão Preto aged above 18 years were recruited. The modified Oxford scale was used as an outcome measure to assess women\'s perception of PFM contraction. A blind evaluator regarding to women\'s self-perception of PFM contraction assessed PFM function using vaginal palpation to classify it with same instrument. PFM dysfunction symptoms were assessed using the following validated questionnaires International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI-20). Weighted kappa concordance correlation coefficient, Pearson\'s correlation coefficient and Fisher\'s exact test were used in the statistical analysis. SPSS 22 statistical software was used and values of p<=0.05 were considered statistically significant. A total of 163 women were recruited, 81 did not attend for evaluation and 82 were included in the study. The mean age of the participants was 46.83 (± 17.94), 34 (41.5%) were married, 59 (71.9%) were white, 38 (46.4%) have from 8 to 11 years of formal education. Most of them were multiparous with an average of 2.17 pregnancies, 45 (54.9%) had no symptoms of urinary incontinence, and 77 (93.9%) had never performed PFM training. The participants had a low self-perception of PFM contraction, only 33% hit correctly the intensity of their contraction. PFM contraction assessed by vaginal palpation did not show a minimum agreement with self-perception (p = 0.087/ ?= 0,139). Self-perception did not correlate with dysfunctions symptoms evaluated by the questionnaires PFDI-20, PFIQ-7, ICIQ-SF and PISQ-12. The PFMfunction presented a weak negative correlation with the PFDI-20 questionnaire in the domains of UI symptoms (rs = -0.315 / p = 0.004), POP (rs = -0.330 / p = 0.002) and total score (rs = 0.387 / p = 0.0002), with PFIQ-7 questionnaire in the IU domains (rs = -0.320 / p = 0.003), POP (rs = -0.224 / p = 0.027) and total score 0.003). A weak positive correlation was found between self-perception and PISQ-12 questionnaire (rs = 0.360 / p = 0.008) and a moderate negative correlation with the ICIQ-SF (rs = -0.406 / p = 0.000). In conclusion women of this sample had a low self-perception of PFM contraction, only 33% correctly estimated their muscle contraction.

O objetivo primário deste estudo foi avaliar a reprodutibilidade inter-examinador, na mensuração da pressão intravaginal em gestantes. Participaram do estudo 41 gestantes baixo risco com capacidade de contrair voluntariamente os MAP. Os MAP (músculos do assoalho pélvico) foram avaliados quanto a sua capacidade de contração por meio da palpação vaginal , e em seguida com uso do perineômetro Peritron®. Foram realizadas três contrações máximas com intervalo de descanso entre cada contração de 10 segundos. As avaliações foram realizadas por dois examinadores distintos e cegos em relação aos resultado da avaliação do outro, em dois dias alternados, com intervalo entre as avaliações de 2 a 7 dias, mantendo o mesmo horário entre as avaliações. As gestantes tinham idade entre 18 e 41 anos (26,07±5,69), índice de massa corpórea (IMC) entre 18,32 e 43,43 Kg/m² (26,46±5,77), com paridade entre 0 e 8 partos (1,09±1,65). Na análise estatística foi utilizado Coeficiente de Correlação de Concordância (CCC) para as medidas entre avaliadores e os limites de concordância de Bland e Altman foram utilizados para observar a concordância. Para medir a reprodutibilidade intra-sessão das três medidas para cada avaliador foi utilizado o Coeficiente de Correlação Intraclasse (ICC). Os resultados foram interpretados de acordo com a seguinte classificação: valores abaixo de 0,50 foram considerados de reprodutibilidade pobre, valores 0,50 a 0,75 foram considerados como moderada reprodutibilidade e valores acima de 0,75 foram considerados de boa reprodutibilidade. Foram encontradas boa concordância nas medidas interexaminadores entre os valores da média do pico no período gestacional (0,81) e essa concordância também ocorreu quando os trimestres foram analisados distintamente (0,81, 0,78, 0,86 para primeiro, segundo e terceiro trimestre respectivamente). Quanto a variável pico de contração os resultados mostraram uma concordância que variou de moderada à boa, para a análise das aferições separadamente, com valores que variaram de 0,54 à 0,88. Já as variáveis média e duração da contração apresentaram valores irregulares. A reprodutibilidade das medidas intra-sessão para a variável pico, para o primeiro, segundo, terceiro trimestre gestacional e para o período gestacional geral mostraram valores de concordância moderada para o avaliador 1 (0,72, 0,75, 0,78, 0,74 respectivamente) e valores de forte concordância para o avaliador 2 (0,95, 0,93, 0,97, 0,94 respectivamente). O presente estudo concluiu que o perineômetro é um método com boa reprodutibilidade inter-examinador para avaliar os músculos do assoalho pélvico (MAP) durante o período gestacional, quando as variáveis de média do pico da contração e pico da contração são utilizadas. Esse estudo não encontrou diferença entre os trimestres gestacionais, sugerindo que a reprodutibilidade da média do pico de contração e pico de contração do AP utilizando-se o perineometro Peritron é variável de moderada a boa. / The primary objective of this study was to evaluate the inter-examiner reproducibility in the measurement of intravaginal pressure in pregnant women. The study included 41 low-risk pregnant women. The ability to contract PFM (pelvic floor muscles) was assessed using vaginal palpation and the PFM strength was measured using the perineometer Peritron. Three maximal contractio ns were performed with an interval of rest between each contraction of 10 seconds. The evaluations were performed by two different examiners who were blinded to each evaluation result of the other, on two alternate days, with an interval between assessment s 2-7 days keeping the same time between assessments. The women were aged between 18 and 41 years (26.07 ± 5.69), body mass index (BMI) between 18.32 and 43.43 kg / m² (26.46 ± 5.77), with parity 0 births and 8 (1.09 ± 1.65). For statistical analysis we used the concordance correlation coefficient (CCC) for measurements between examiners. Bland and Altman limits of agreement was used in the analysis. To measure the intra-session reproducibility of the three measures for each examiner the intraclass correlation coefficient (ICC) was used. The results were interpreted according to the following classification: values below 0.50 were considered poor reproducibility, values from 0.50 to 0.75 were considered moderate reproducibility and values above 0.75 were considered good reproducibility. It was found a good concordance of inter-examiner between the values of mean peak during pregnancy (0.81) and this correlation also occurred when the gestational trimesters were analyzed distinctly (0.81, 0.78, 0.86 for first, second and third trimester respectively). As for variable peak contraction results showed a concordance ranging from moderate to good, for the analysis of the measurements separately, with values ranging from 0.54 to 0.88. The average and durati on of contractions showed irregular values . The reproducibility of intra-session measures for the variable peak, for the first, second, and third trimester of pregnancy for general values showed moderate agreement for evaluator 1 (0.72, 0.75, 0.78, 0 , 74 respectively) and values of concordance for evaluator 2 (0.95, 0.93, 0.97, 0.94 respectively). This study concluded that perineometer is a method with good reproducibility inter -examiner to evaluate the pelvic floor muscles during pregnancy, when th e variables of mean peak contraction and peak contraction are used. This study found no difference between gestational trimesters, suggesting that interrater reproducibility of of mean peak contraction and peak contraction of PFM using Peritron perineomet er is variable from moderate to good.