L’incontinence urinaire d’effort (IUE) est une condition fréquente en période postnatale pouvant affecter jusqu’à 77% des femmes. Neuf femmes sur dix souffrant d’IUE trois mois après l’accouchement, vont présenter une IUE cinq ans plus tard. Le traitement en physiothérapie de l’IUE par le biais d’un programme d’exercices de renforcement des muscles du plancher pelvien est reconnu comme étant un traitement de première ligne efficace. Les études ont prouvé l’efficacité de cette approche sur l’IUE persistante à court terme, mais les résultats de deux ECR à long terme n’ont pas démontré un maintien de l’effet de traitement. L’effet d’un programme en physiothérapie de renforcement du plancher pelvien intensif et étroitement supervisé sur l’IUE postnatale persistante avait été évalué lors d’un essai clinique randomisé il y a sept ans. Le but principal de la présente étude était d’évaluer l’effet de ce programme sept ans après la fin des interventions de l’ECR initial. Un objectif secondaire était de comparer l’effet de traitement à long terme entre un groupe ayant fait seulement des exercices de renforcement du plancher pelvien et un groupe ayant fait des exercices de renforcement du plancher pelvien et des abdominaux profonds. Un troisième objectif était d’explorer l’influence de quatre facteurs de risques sur les symptômes d’IUE et la qualité de vie à long terme. Les cinquante-sept femmes ayant complétées l’ECR initial ont été invitées à participer à l’évaluation du suivi sept ans. Vingt et une femmes ont participé à l’évaluation clinique et ont répondu à quatre questionnaires, tandis que dix femmes ont répondu aux questionnaires seulement. L’évaluation clinique incluait un pad test et la dynamométrie du plancher pelvien. La mesure d’effet primaire était un pad test modifié de 20 minutes. Les mesures d’effets secondaires étaient la dynamométrie du plancher pelvien, les symptômes d’IUE mesuré par le questionnaire Urogenital Distress Inventory, la qualité de vie mesurée par le questionnaire Incontinence Impact Questionnaire et la perception de la sévérité de l’IUE mesuré par l’Échelle Visuelle Analogue. De plus, un questionnaire portant sur quatre facteurs de risques soit, la présence de grossesses subséquentes, la v présence de constipation chronique, l’indice de masse corporel et la fréquence des exercices de renforcement du plancher pelvien de l’IUE, venait compléter l’évaluation. Quarante-huit pour-cent (10/21) des participantes étaient continentes selon de pad test. La moyenne d’amélioration entre le résultat pré-traitement et le suivi sept ans était de 26,9 g. (écart-type = 68,0 g.). Il n’y avait pas de différence significative des paramètres musculaires du plancher pelvien entre le pré-traitement, le post-traitement et le suivi sept ans. Les scores du IIQ et du VAS étaient significativement plus bas à sept ans qu’en prétraitement (IIQ : 23,4 vs 15,6, p = 0,007) et (VAS : 6,7 vs 5,1, p = 0,001). Les scores du UDI étaient plus élevés au suivi sept ans (15,6) qu’en pré-traitement (11,3, p = 0,041) et en post-traitement (5,7, p = 0,00). La poursuite des exercices de renforcement du plancher pelvien à domicile était associée à une diminution de 5,7 g. (p = 0,051) des fuites d’urine observées au pad test selon une analyse de régression linéaire. Les limites de cette étude sont ; la taille réduite de l’échantillon et un biais relié au désir de traitement pour les femmes toujours incontinentes. Cependant, les résultats semblent démontrer que l’effet du traitement à long terme d’un programme de renforcement des muscles du plancher pelvien qui est intensif et étroitement supervisé, est maintenu chez environ une femme sur deux. Bien que les symptômes d’IUE tel que mesuré par les pad test et le questionnaire UDI, semblent réapparaître avec le temps, la qualité de vie, telle que mesurée par des questionnaires, est toujours meilleure après sept qu’à l’évaluation initiale. Puisque la poursuite des exercices de renforcement du plancher pelvien est associée à une diminution de la quantité de fuite d’urine au pad test, les participantes devraient être encouragées à poursuivre leurs exercices après la fin d’un programme supervisé. Pour des raisons de logistique la collecte de donnée de ce projet de recherche s’est continuée après la rédaction de ce mémoire. Les résultats finaux sont disponibles auprès de Chantale Dumoulin pht, PhD., professeure agrée à l’Université de Montréal. / Stress urinary incontinence is a common condition in the postpartum period affecting up to 77% of women. Nine women out of ten still suffering from SUI three months after giving birth will have symptoms of SUI five years later. Physiotherapy treatment via pelvic floor muscles strengthening exercises is recognized as an efficient first line of treatment for SUI. Although studies have shown good short term cure rates for persistent SUI, two long term follow-ups RCT’s have demonstrated that the effect was not maintained through time. The effect of an intensive and supervised physiotherapy pelvic floor strengthening program was evaluated in a previous randomized controlled trial (RCT) seven years ago. The main objective of the present study was to evaluate the effect of this program seven years after cessation of treatment. A secondary objective is to investigate the influence of four possible predictors of long term SUI symptoms and quality of life. The 57 women who completed the initial trial were contacted by telephone and invited to participate in a 7 year follow-up. Twenty-one participants underwent the clinical evaluation and answered four questionnaires while 10 participants answered only the questionnaires. The clinical evaluation included a provocative pad test and dynamometry of the pelvic floor muscles. The main outcome measure was the 20-minute modified pad test. Secondary outcomes were pelvic floor muscle strength measure by the Montreal dynamometer, symptoms of incontinence measured by the Urogenital Distress Inventory questionnaire, quality of life measured by the Incontinence Impact Questionnaire and the perceived burden of SUI measured by the Visual Analog Scale. The evaluation was completed by a questionnaire on four potential predictors of SUI: subsequent pregnancies, chronic constipation, body mass index and the frequency of pelvic floor muscle exercises. Forty-eight percent (10/21) of the participants were continent according to the pad test. The mean improvement between baseline and seven year follow-up was 26.9 g. (SD = vii 68.0g.). There was no statistically significant difference in pelvic floor muscle strength between baseline, after treatment and the follow-up (p = 0.74). The IIQ and VAS score were significantly lower at the seven year follow-up than at baseline (IIQ: 23.4 vs 15.6 , p = 0.007 and VAS: 6.7 vs 5.1, p = 0.001). The UDI scores were higher at follow-up (15.6) than baseline (11.3, p = 0.041) and after treatment (5.7, p = 0.00). Maintaining pelvic floor exercise at seven years after treatment had a strong trend towards a decrease of 5.7 g. for pad test results (p = 0.051). Limits of this study are the small sample size and the bias related to treatment seeking behavior amongst women who agreed to participate. Nevertheless, results seem to indicate that an intensive closely supervised pelvic floor training program is effective in the long run for one woman out of two. Although symptoms of SUI, as measured by the pad test and the UDI questionnaire, seem to reappear with time, quality of life is still better seven years after treatment than at baseline. Continuation of pelvic floor exercises seems to decrease the urine leakage upon exertion and thus should be encouraged even after cessation of intense training. For logistic reasons, the data collection for this research project continued after the writing of this thesis. Final results are available from Chantale Dumoulin pht, PhD, professor at the University of Montreal.

Title: Comparison of rehabilitation approaches for female urinary incontinence at different departments in the CR. Objectives: The aim of this thesis was to determine the percentage of physiotherapists who have offices in their encounter with incontinent patients and percentage distinguish whether they are sent to a specialist or incontinence is known only by them. Determine which method of pelvic examination with stress incontinence (diagnosed and undiagnosed) is performed most often. Find out what the age group of women with stress incontinence with physiotherapists meet in their offices often. Determine which method of pelvic examination with stress incontinence (diagnosed and undiagnosed) is usually a percentage, carried out to determine how many of the respondents used physical therapists in the treatment of stress incontinence "Ostrava concept." Another objective of this work is expressed as a percentage of physiotherapists awareness about the new clinical standard for treatment of stress incontinence and technology PELVICORE. Inform the public about female stress urinary incontinence. Methods: The research was conducted using nonstandardized fifteen-page questionnaire. This e-mail questionnaire was distributed to 30 hospitals. We managed to get a total of 54 questionnaires were processed and...

INTRODUÇÃO: Há pouco tempo atrás não havia ferramenta específica para avaliar os sintomas do trato urinário inferior de pacientes com doenças neurológicas. Diversos instrumentos foram desenvolvidos e recomendados para avaliação de sintomas urinários em pacientes com disfunção do trato urinário inferior, porém, por não captarem a especificidade da bexiga neurogênica, apresentam perguntas inaplicáveis ou insuficientes para avaliar os sintomas desta população. Em 2014 foi introduzido o Neurogenic Bladder Symptom Score (NBSS) específico para pacientes com diagnóstico de bexiga neurogênica. Contém questões sobre incontinência urinária, sintomas e métodos de esvaziamento vesical, complicações associadas à disfunção miccional e qualidade de vida. OBJETIVO: este estudo se propôs a realizar a adaptação cultural e validação do questionário de sintomas NBSS para o português do Brasil. MÉTODOS: O questionário de sintomas foi adaptado culturalmente conforme diretrizes internacionais, seguindo os passos de: tradução, harmonização, retrotradução, revisão do comitê de especialistas, e teste da versão pré-final. A versão adaptada para o Brasil foi aplicada em pacientes com diagnóstico de bexiga neurogênica por lesão medular ou esclerose múltipla, que compareceram para consultas médicas com fisiatra ou urologista. Os mesmos pacientes responderam novamente o questionário num intervalo de 7 a 14 dias (reteste). A confiabilidade foi avaliada pela consistência interna, através do alfa de Cronbach, e pela estabilidade (teste-reteste), avaliada pelo Coeficiente de Correlação Intraclasse. Pacientes que não retornaram para a reaplicação do questionário, ou que relataram mudança nos sintomas do trato urinário inferior durante este período, foram excluídos da análise de estabilidade. A validade de critério foi avaliada pela aplicação da versão brasileira do questionário de qualidade de vida Qualiveen-SF e o resultado foi mensurado através do Coeficiente de Correlação Intraclasse. A validade de conteúdo foi determinada pela avaliação e julgamento do comitê de especialistas. A validade de construto foi obtida pela comparação entre o NBSS e a avaliação da função global da bexiga, através da análise de variância. RESULTADOS: Um total de 68 pacientes (57 homens - 83,8%) com idade média de 38,9 (± 14,7) anos participaram do estudo. Observou-se boa consistência interna da versão em português, com alfa de Cronbach de 0,813. A estabilidade (teste/reteste) também foi alta, com um Coeficiente de Correlação Intraclasse de 0,8596 [0,7586-0,9202] (p < 0,0001). Na validade de critério, o Coeficiente de Correlação Intraclasse revelou moderada correlação entre a versão em português do NBSS e o questionário Qualiveen-SF (r=0,6552 [0,423-0.8151]; p < 0,0001). CONCLUSÕES: Os resultados do estudo demonstraram que a versão brasileira do NBSS - Neurogenic Bladder Symptom Score, apresenta boa consistência interna, estabilidade e capacidade de medir o construto correto. O processo de adaptação cultural e validação do questionário NBSS para língua portuguesa, em pacientes com disfunção neurogênica do trato urinário inferior, foi concluído. O instrumento encontra-se apto para uso clínico e em pesquisa / INTRODUCTION: Until recent times, there was no specific tool to evaluate the symptoms of the lower urinary tract of patients with neurological diseases. Several instruments have been developed and recommended for evaluation of urinary symptoms in patients with lower urinary tract dysfunction, but because they do not capture the specificity of the neurogenic bladder, they present questions that are inapplicable or insufficient to evaluate the symptoms of this population. In 2014 it was introduced the Neurogenic Bladder Symptom Score (NBSS), specific for patients with a neurogenic bladder diagnosis. It contains questions about urinary incontinence, symptoms and methods of bladder emptying, complications associated with voiding dysfunction and quality of life. OBJECTIVE: This study aimed to perform the cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese. METHODS: The symptom questionnaire was culturally adapted according to international guidelines, following the steps of: translation, synthesis, back-translation, expert committee review, and pre-final version test. The version adapted for Brazil was applied in patients with neurogenic bladder diagnosis due to spinal cord injury or multiple sclerosis, who attended for medical appointments with physiatrist or urologist. The same patients answered the questionnaire again within 7 to 14 days (retest). Reliability was assessed by internal consistency, using Cronbach\'s alpha, and stability (test-retest), as assessed by Intraclass Correlation Coefficient. Patients who did not return for questionnaire reapplication or who reported changes in lower urinary tract symptoms during this period were excluded from the stability analysis. The criterion validity was evaluated by applying the Brazilian version of the Qualiveen-SF quality of life questionnaire and the result was measured using the Intraclass Correlation Coefficient. The validity of content was determined by the evaluation and judgment of the committee of experts. The construct validity was obtained by the comparison between the NBSS and the evaluation of the global function of the bladder, through analysis of variance. RESULTS: A total of 68 patients (57 men - 83.8%) with an average age of 38.9 (± 14.7) years participated in the study. There was good internal consistency of the Portuguese version, with Cronbach\'s alpha of 0.813. Stability (test / retest) was also high, with a Intraclass Correlation Coefficient of 0.8596 [0.7586-0.9202] (p < 0.0001). For criterion validity, the Intraclass Correlation Coefficient revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.6552 [0.423-0.8151]; p < 0.0001). CONCLUSIONS: The results of the study demonstrated that the Brazilian version of the NBSS - Neurogenic Bladder Symptom Score shows good internal consistency, stability and ability to measure the correct construct. The process of cultural adaptation and validation of the NBSS questionnaire for Portuguese language in patients with neurogenic lower urinary tract dysfunction was concluded. The instrument is suitable for clinical and research use

INTRODUÇÃO: A Bexiga Hiperativa é uma síndrome de alta prevalência que acomete negativamente a qualidade de vida das mulheres. Os sintomas clínicos se manifestam por urgência miccional, com ou sem incontinência de urgência, frequência e nocturia. O diagnóstico é definido a partir dos sintomas clínicos, sendo o diário miccional um bom instrumento de avaliação. O tratamento fisioterapêutico da bexiga hiperativa tem como opções a eletroestimulação transcutânea do nervo tibial ou eletroestimulação vaginal. OBJETIVO: verificar se a adição da eletroestimulação vaginal à eletroestimulação transcutânea do nervo tibial é mais eficaz do que somente a eletroestimulação no nervo tibial para o tratamento de mulheres com bexiga hiperativa. MÉTODO: Estudo controlado aleatorizado com 106 mulheres, maiores de 18 anos, com diagnóstico de bexiga hiperativa ou incontinência urinária mista com predomínio dos sintomas de bexiga hiperativa. As pacientes foram distribuídas em dois grupos: Grupo 1: eletroestimulação transcutânea do nervo tibial (n=52) e Grupo 2: eletroestimulação vaginal mais eletroestimulação transcutânea do nervo tibial (n=54). Ambos os grupos foram orientados quanto à terapia comportamental. Os instrumentos de avaliação utilizados foram: Diário Miccional de três dias, avaliação funcional do assoalho pélvico, King´s Health Questionnaire e Overactive Bladder Questionnaire, todos aplicados por um avaliador cego, antes e após o tratamento que teve duração de 12 semanas, 1x/semana. O desfecho primário foi a frequência urinária em 24 horas. Os desfechos secundários foram os outros sintomas da bexiga hiperativa, o impacto na qualidade de vida e a funcionalidade do assoalho pélvico. RESULTADO: a frequência urinária no grupo 2 diminuiu em 1,5 vezes em relação ao grupo 1. Contudo este resultado não foi clinicamente relevante pois foi inferior a 3 micções. As outras variáveis do diário miccional bem como como o impacto na qualidade de vida, não apresentaram diferenças entre os grupos. CONCLUSÃO: a adição da eletroestimulação vaginal à eletroestimulação transcutânea do nervo tibial não apresentou resultados mais efetivos na melhora dos sintomas ou na qualidade de vida das pacientes com BH / INTRODUCTION: Overactive Bladder is a syndrome with a high prevalence that negatively affects women\'s quality of life. The clinical symptoms are manifested as urinary urgency, with or without urgency incontinence, frequency and nocturia. The diagnosis is defined based on the clinical symptoms, and the voiding diary is a good assessment. The physiotherapeutic treatment of OAB has as treatment\'s options the transcutaneous tibial nerve electrical stimulation or vaginal electrical stimulation. OBJECTIVE: to verify if the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation is more effective than only the electrical stimulation in the tibial nerve for the treatment of women with OAB. METHOD: Randomized controlled trial with 106 women over 18 years old with a diagnosis of overactive bladder or mixed urinary incontinence with predominance of overactive bladder symptoms. The patients were distributed into two groups: Group 1: transcutaneous tibial nerve electrical stimulation (n = 52) and Group 2: vaginal electrical stimulation plus transcutaneous tibial nerve electrical stimulation (n = 54). Both groups received instructions about behavioral therapy. The assessments used were: Three-day voiding diary, functional evaluation of pelvic floor, King\'s Health Questionnaire and Overactive Bladder Questionnaire, all of them applied by a blind evaluator, before and after 12-week treatment, once a week. The primary outcome was urinary frequency in 24 hours. Secondaries outcomes were other overactive bladder symptoms, impact in quality of life, and pelvic floor functionality. RESULTS: urinary frequency in group 2 decreased 1.5 times in relation to group 1. However, this result was not clinically relevant since it was less than 3 mictions. The other variables of voiding diary and impact on quality of life did not present differences between groups. CONCLUSION: The addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation did not present more effective results in the improvement of symptoms or quality of life in patients with overactive bladder

INTRODUÇÃO: Disfunções do assoalho pélvico incluem uma variedade de condições interrelacionadas, tais como prolapso de órgãos pélvicos (POP) e distúrbios urinários e defecatórios. Comumente, tais afecções são concomitantes, o que pode causar incômodo de forma significativa. Inúmeros questionários com foco nessas disfunções têm sido desenvolvidos e estão sendo utilizados em pesquisas, fornecendo informações importantes; porém, como geralmente possuem múltiplos itens, são muito complexos para serem utilizados na prática clínica. O \"Pelvic Floor Bother Questionnaire\" (PFBQ) foi delineado de forma a simplificar a identificação e o grau de incômodo relacionados a problemas comuns do assoalho pélvico, podendo ser usado na prática diária e para fins de pesquisa. Trata-se de um questionário de nove itens que avalia sintomas relacionados à incontinência urinária, urgência e frequência urinárias, dificuldade miccional, prolapso de órgãos pélvicos, evacuação obstruída, incontinência fecal e dispareunia. OBJETIVOS: Os objetivos foram validar uma versão do PFBQ adaptada para o português, assim como adapta-lo culturalmente para a língua portuguesa brasileira, atualizá-lo, e avaliar suas propriedades: confiabilidade, validade e capacidade de detectar mudanças. MÉTODOS: O PFBQ foi traduzido para o português (\"Forward Translation\") por dois tradutores independentes (sendo um deles um tradutor juramentado). Após consenso, essa versão foi traduzida para o inglês (\"Backward Translation\") por um terceiro tradutor independente. O questionário foi então testado por profissionais da saúde e em uma amostragem de 10 pacientes. Após estas etapas, a versão final do questionário foi obtida. Testes de validade foram então aplicados: confiabilidade interna, confiabilidade teste-reteste, validade dos itens e capacidade de resposta às mudanças. O PFBQ foi correlacionado com dados obtidos durante a anamnese, diários miccional e defecatório e exame pélvico, incluindo o \"Pelvic Organ Prolapse Quantification\" (POP-Q). Para avaliar a confiabilidade teste-reteste, cada paciente respondeu o PFBQ dentro de 1 semana a 10 dias. A capacidade de resposta às mudanças foi avaliada nas pacientes que completaram o questionário antes e após o tratamento. RESULTADOS: Entre fevereiro de 2014 e agosto de 2015, foram incluídas no estudo 147 pacientes com média de idade de 60,49 anos. As principais queixas foram: 12,2% incontinência urinária de esforço, 19% incontinência urinária mista, 6,1% perda urinária por urgência, 26,5% incontinência fecal, 18,4% evacuação obstruída e 17,7% POP (estádio 3 ou 4). O PFBQ demonstrou boa confiabilidade ( = 0,625, ICC = 0,981). Cada item do questionário apresentou concordância quase perfeita entre as avaliações (k = 0,895-1,00). O PFBQ correlacionou-se com o estadiamento do prolapso (p < 0,01), número de episódios de incontinência urinária e fecal (? = 0,791, p < 0,001; p = 0,780, p < 0,001) e evacuação obstruída (p = 0,875, p < 0,001). CONCLUSÕES O \"Pelvic Floor Bother Questionnaire\" em português é uma ferramenta confiável e válida que pode ser utilizada para a identificação e avaliação da gravidade/incômodo de vários sintomas do assoalho pélvico / INTRODUCTION Pelvic floor disorders include a variety of interrelated conditions, such as pelvic organ prolapse (POP), and urinary and defecatory dysfunction. Commonly, patients have concomitant pelvic disorders, which can significantly cause distress. Numerous surveys focusing on pelvic floor abnormalities have been developed and are being used, mainly in research settings. These instruments are mostly multi-item, and despite providing a rich source of information, are thus difficult to use in a clinical setting. Shorter questionnaires have been also validated, although most of them are specific for each disorder. Pelvic Floor Bother Questionnaire (PFBQ) was designed to identify the presence and degree of bother related to common pelvic floor problems, and can be used in clinical practice and for research purposes. It is a nine-item questionnaire that includes symptoms and bother related to urinary incontinence, urinary urgency and frequency, dysuria, pelvic organ prolapse, obstructed defecation, fecal incontinence, and dyspareunia. OBJECTIVE We aimed to update and validate a cross-culturally adapted version of the PFBQ in Portuguese. METHODS Translation and validation of the PFBQ was performed as follows: After conceptual analysis of the original questionnaire in English, the PFBQ was translated into Portuguese (\"Forward Translation\") by two independent translators (one certified translator). After a consensus was obtained, this version of the questionnaire was translated back into English (\"Backward Translation\") by an independent translator. The questionnaire was pilot tested on health care professionals and on 10 patients who were questioned about form and clarity of the questions. The final version of the questionnaire was obtained. Validity tests were then applied and included internal reliability, test-retest reliability, validity of the items and responsiveness to change. PFBQ was correlated with a structured clinical interview, bladder and fecal diaries and pelvic exam, including \"Pelvic Organ Prolapse Quantification\" (POP-Q) examination. To assess test-retest reliability, each patient fulfilled a second copy of the PFBQ within 7 to 10 days. Responsiveness to change was accessed in patients who completed the questionnaire before and after treatment. RESULTS A total of 147 patients of a mean age 60,49 years were enrolled in the study between February 2014 and August 2015. Chief complains were as follows: 12,2% of patients had stress urinary incontinence, 19% mixed urinary incontinence, 6,1% detrusor instability, 26,5% fecal incontinence, 18,4% obstructed defecation and 17,7% had POP (stage 3 or 4). PFBQ demonstrated good reliability (alpha = 0,625; ICC = 0,981). There was a strong agreement beyond chance observed for each question (k = 0,895-1,00). PFBQ correlated with stage of prolapse (p < 0,01), number of urinary and fecal incontinence episodes ( = 0,791, p < 0,001; p = 0,780, p < 0,001), and obstructed defecation ( p =0,875, p < 0,001). CONCLUSIONS The PFBQ is a reliable and valid tool that can be easily used for the identification and severity/bother assessment of various pelvic floor symptoms

INTRODUÇÃO: A Bexiga Hiperativa é uma síndrome de alta prevalência que acomete negativamente a qualidade de vida das mulheres. Os sintomas clínicos se manifestam por urgência miccional, com ou sem incontinência de urgência, frequência e nocturia. O diagnóstico é definido a partir dos sintomas clínicos, sendo o diário miccional um bom instrumento de avaliação. O tratamento fisioterapêutico da bexiga hiperativa tem como opções a eletroestimulação transcutânea do nervo tibial ou eletroestimulação vaginal. OBJETIVO: verificar se a adição da eletroestimulação vaginal à eletroestimulação transcutânea do nervo tibial é mais eficaz do que somente a eletroestimulação no nervo tibial para o tratamento de mulheres com bexiga hiperativa. MÉTODO: Estudo controlado aleatorizado com 106 mulheres, maiores de 18 anos, com diagnóstico de bexiga hiperativa ou incontinência urinária mista com predomínio dos sintomas de bexiga hiperativa. As pacientes foram distribuídas em dois grupos: Grupo 1: eletroestimulação transcutânea do nervo tibial (n=52) e Grupo 2: eletroestimulação vaginal mais eletroestimulação transcutânea do nervo tibial (n=54). Ambos os grupos foram orientados quanto à terapia comportamental. Os instrumentos de avaliação utilizados foram: Diário Miccional de três dias, avaliação funcional do assoalho pélvico, King´s Health Questionnaire e Overactive Bladder Questionnaire, todos aplicados por um avaliador cego, antes e após o tratamento que teve duração de 12 semanas, 1x/semana. O desfecho primário foi a frequência urinária em 24 horas. Os desfechos secundários foram os outros sintomas da bexiga hiperativa, o impacto na qualidade de vida e a funcionalidade do assoalho pélvico. RESULTADO: a frequência urinária no grupo 2 diminuiu em 1,5 vezes em relação ao grupo 1. Contudo este resultado não foi clinicamente relevante pois foi inferior a 3 micções. As outras variáveis do diário miccional bem como como o impacto na qualidade de vida, não apresentaram diferenças entre os grupos. CONCLUSÃO: a adição da eletroestimulação vaginal à eletroestimulação transcutânea do nervo tibial não apresentou resultados mais efetivos na melhora dos sintomas ou na qualidade de vida das pacientes com BH / INTRODUCTION: Overactive Bladder is a syndrome with a high prevalence that negatively affects women\'s quality of life. The clinical symptoms are manifested as urinary urgency, with or without urgency incontinence, frequency and nocturia. The diagnosis is defined based on the clinical symptoms, and the voiding diary is a good assessment. The physiotherapeutic treatment of OAB has as treatment\'s options the transcutaneous tibial nerve electrical stimulation or vaginal electrical stimulation. OBJECTIVE: to verify if the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation is more effective than only the electrical stimulation in the tibial nerve for the treatment of women with OAB. METHOD: Randomized controlled trial with 106 women over 18 years old with a diagnosis of overactive bladder or mixed urinary incontinence with predominance of overactive bladder symptoms. The patients were distributed into two groups: Group 1: transcutaneous tibial nerve electrical stimulation (n = 52) and Group 2: vaginal electrical stimulation plus transcutaneous tibial nerve electrical stimulation (n = 54). Both groups received instructions about behavioral therapy. The assessments used were: Three-day voiding diary, functional evaluation of pelvic floor, King\'s Health Questionnaire and Overactive Bladder Questionnaire, all of them applied by a blind evaluator, before and after 12-week treatment, once a week. The primary outcome was urinary frequency in 24 hours. Secondaries outcomes were other overactive bladder symptoms, impact in quality of life, and pelvic floor functionality. RESULTS: urinary frequency in group 2 decreased 1.5 times in relation to group 1. However, this result was not clinically relevant since it was less than 3 mictions. The other variables of voiding diary and impact on quality of life did not present differences between groups. CONCLUSION: The addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation did not present more effective results in the improvement of symptoms or quality of life in patients with overactive bladder

INTRODUÇÃO: Disfunções do assoalho pélvico incluem uma variedade de condições interrelacionadas, tais como prolapso de órgãos pélvicos (POP) e distúrbios urinários e defecatórios. Comumente, tais afecções são concomitantes, o que pode causar incômodo de forma significativa. Inúmeros questionários com foco nessas disfunções têm sido desenvolvidos e estão sendo utilizados em pesquisas, fornecendo informações importantes; porém, como geralmente possuem múltiplos itens, são muito complexos para serem utilizados na prática clínica. O \"Pelvic Floor Bother Questionnaire\" (PFBQ) foi delineado de forma a simplificar a identificação e o grau de incômodo relacionados a problemas comuns do assoalho pélvico, podendo ser usado na prática diária e para fins de pesquisa. Trata-se de um questionário de nove itens que avalia sintomas relacionados à incontinência urinária, urgência e frequência urinárias, dificuldade miccional, prolapso de órgãos pélvicos, evacuação obstruída, incontinência fecal e dispareunia. OBJETIVOS: Os objetivos foram validar uma versão do PFBQ adaptada para o português, assim como adapta-lo culturalmente para a língua portuguesa brasileira, atualizá-lo, e avaliar suas propriedades: confiabilidade, validade e capacidade de detectar mudanças. MÉTODOS: O PFBQ foi traduzido para o português (\"Forward Translation\") por dois tradutores independentes (sendo um deles um tradutor juramentado). Após consenso, essa versão foi traduzida para o inglês (\"Backward Translation\") por um terceiro tradutor independente. O questionário foi então testado por profissionais da saúde e em uma amostragem de 10 pacientes. Após estas etapas, a versão final do questionário foi obtida. Testes de validade foram então aplicados: confiabilidade interna, confiabilidade teste-reteste, validade dos itens e capacidade de resposta às mudanças. O PFBQ foi correlacionado com dados obtidos durante a anamnese, diários miccional e defecatório e exame pélvico, incluindo o \"Pelvic Organ Prolapse Quantification\" (POP-Q). Para avaliar a confiabilidade teste-reteste, cada paciente respondeu o PFBQ dentro de 1 semana a 10 dias. A capacidade de resposta às mudanças foi avaliada nas pacientes que completaram o questionário antes e após o tratamento. RESULTADOS: Entre fevereiro de 2014 e agosto de 2015, foram incluídas no estudo 147 pacientes com média de idade de 60,49 anos. As principais queixas foram: 12,2% incontinência urinária de esforço, 19% incontinência urinária mista, 6,1% perda urinária por urgência, 26,5% incontinência fecal, 18,4% evacuação obstruída e 17,7% POP (estádio 3 ou 4). O PFBQ demonstrou boa confiabilidade ( = 0,625, ICC = 0,981). Cada item do questionário apresentou concordância quase perfeita entre as avaliações (k = 0,895-1,00). O PFBQ correlacionou-se com o estadiamento do prolapso (p < 0,01), número de episódios de incontinência urinária e fecal (? = 0,791, p < 0,001; p = 0,780, p < 0,001) e evacuação obstruída (p = 0,875, p < 0,001). CONCLUSÕES O \"Pelvic Floor Bother Questionnaire\" em português é uma ferramenta confiável e válida que pode ser utilizada para a identificação e avaliação da gravidade/incômodo de vários sintomas do assoalho pélvico / INTRODUCTION Pelvic floor disorders include a variety of interrelated conditions, such as pelvic organ prolapse (POP), and urinary and defecatory dysfunction. Commonly, patients have concomitant pelvic disorders, which can significantly cause distress. Numerous surveys focusing on pelvic floor abnormalities have been developed and are being used, mainly in research settings. These instruments are mostly multi-item, and despite providing a rich source of information, are thus difficult to use in a clinical setting. Shorter questionnaires have been also validated, although most of them are specific for each disorder. Pelvic Floor Bother Questionnaire (PFBQ) was designed to identify the presence and degree of bother related to common pelvic floor problems, and can be used in clinical practice and for research purposes. It is a nine-item questionnaire that includes symptoms and bother related to urinary incontinence, urinary urgency and frequency, dysuria, pelvic organ prolapse, obstructed defecation, fecal incontinence, and dyspareunia. OBJECTIVE We aimed to update and validate a cross-culturally adapted version of the PFBQ in Portuguese. METHODS Translation and validation of the PFBQ was performed as follows: After conceptual analysis of the original questionnaire in English, the PFBQ was translated into Portuguese (\"Forward Translation\") by two independent translators (one certified translator). After a consensus was obtained, this version of the questionnaire was translated back into English (\"Backward Translation\") by an independent translator. The questionnaire was pilot tested on health care professionals and on 10 patients who were questioned about form and clarity of the questions. The final version of the questionnaire was obtained. Validity tests were then applied and included internal reliability, test-retest reliability, validity of the items and responsiveness to change. PFBQ was correlated with a structured clinical interview, bladder and fecal diaries and pelvic exam, including \"Pelvic Organ Prolapse Quantification\" (POP-Q) examination. To assess test-retest reliability, each patient fulfilled a second copy of the PFBQ within 7 to 10 days. Responsiveness to change was accessed in patients who completed the questionnaire before and after treatment. RESULTS A total of 147 patients of a mean age 60,49 years were enrolled in the study between February 2014 and August 2015. Chief complains were as follows: 12,2% of patients had stress urinary incontinence, 19% mixed urinary incontinence, 6,1% detrusor instability, 26,5% fecal incontinence, 18,4% obstructed defecation and 17,7% had POP (stage 3 or 4). PFBQ demonstrated good reliability (alpha = 0,625; ICC = 0,981). There was a strong agreement beyond chance observed for each question (k = 0,895-1,00). PFBQ correlated with stage of prolapse (p < 0,01), number of urinary and fecal incontinence episodes ( = 0,791, p < 0,001; p = 0,780, p < 0,001), and obstructed defecation ( p =0,875, p < 0,001). CONCLUSIONS The PFBQ is a reliable and valid tool that can be easily used for the identification and severity/bother assessment of various pelvic floor symptoms

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = &lt;0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie. / The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = &lt;0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) &lt; 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.

L’incontinence urinaire d’effort (IUE) est une condition fréquente en période postnatale pouvant affecter jusqu’à 77% des femmes. Neuf femmes sur dix souffrant d’IUE trois mois après l’accouchement, vont présenter une IUE cinq ans plus tard. Le traitement en physiothérapie de l’IUE par le biais d’un programme d’exercices de renforcement des muscles du plancher pelvien est reconnu comme étant un traitement de première ligne efficace. Les études ont prouvé l’efficacité de cette approche sur l’IUE persistante à court terme, mais les résultats de deux ECR à long terme n’ont pas démontré un maintien de l’effet de traitement. L’effet d’un programme en physiothérapie de renforcement du plancher pelvien intensif et étroitement supervisé sur l’IUE postnatale persistante avait été évalué lors d’un essai clinique randomisé il y a sept ans. Le but principal de la présente étude était d’évaluer l’effet de ce programme sept ans après la fin des interventions de l’ECR initial. Un objectif secondaire était de comparer l’effet de traitement à long terme entre un groupe ayant fait seulement des exercices de renforcement du plancher pelvien et un groupe ayant fait des exercices de renforcement du plancher pelvien et des abdominaux profonds. Un troisième objectif était d’explorer l’influence de quatre facteurs de risques sur les symptômes d’IUE et la qualité de vie à long terme. Les cinquante-sept femmes ayant complétées l’ECR initial ont été invitées à participer à l’évaluation du suivi sept ans. Vingt et une femmes ont participé à l’évaluation clinique et ont répondu à quatre questionnaires, tandis que dix femmes ont répondu aux questionnaires seulement. L’évaluation clinique incluait un pad test et la dynamométrie du plancher pelvien. La mesure d’effet primaire était un pad test modifié de 20 minutes. Les mesures d’effets secondaires étaient la dynamométrie du plancher pelvien, les symptômes d’IUE mesuré par le questionnaire Urogenital Distress Inventory, la qualité de vie mesurée par le questionnaire Incontinence Impact Questionnaire et la perception de la sévérité de l’IUE mesuré par l’Échelle Visuelle Analogue. De plus, un questionnaire portant sur quatre facteurs de risques soit, la présence de grossesses subséquentes, la v présence de constipation chronique, l’indice de masse corporel et la fréquence des exercices de renforcement du plancher pelvien de l’IUE, venait compléter l’évaluation. Quarante-huit pour-cent (10/21) des participantes étaient continentes selon de pad test. La moyenne d’amélioration entre le résultat pré-traitement et le suivi sept ans était de 26,9 g. (écart-type = 68,0 g.). Il n’y avait pas de différence significative des paramètres musculaires du plancher pelvien entre le pré-traitement, le post-traitement et le suivi sept ans. Les scores du IIQ et du VAS étaient significativement plus bas à sept ans qu’en prétraitement (IIQ : 23,4 vs 15,6, p = 0,007) et (VAS : 6,7 vs 5,1, p = 0,001). Les scores du UDI étaient plus élevés au suivi sept ans (15,6) qu’en pré-traitement (11,3, p = 0,041) et en post-traitement (5,7, p = 0,00). La poursuite des exercices de renforcement du plancher pelvien à domicile était associée à une diminution de 5,7 g. (p = 0,051) des fuites d’urine observées au pad test selon une analyse de régression linéaire. Les limites de cette étude sont ; la taille réduite de l’échantillon et un biais relié au désir de traitement pour les femmes toujours incontinentes. Cependant, les résultats semblent démontrer que l’effet du traitement à long terme d’un programme de renforcement des muscles du plancher pelvien qui est intensif et étroitement supervisé, est maintenu chez environ une femme sur deux. Bien que les symptômes d’IUE tel que mesuré par les pad test et le questionnaire UDI, semblent réapparaître avec le temps, la qualité de vie, telle que mesurée par des questionnaires, est toujours meilleure après sept qu’à l’évaluation initiale. Puisque la poursuite des exercices de renforcement du plancher pelvien est associée à une diminution de la quantité de fuite d’urine au pad test, les participantes devraient être encouragées à poursuivre leurs exercices après la fin d’un programme supervisé. Pour des raisons de logistique la collecte de donnée de ce projet de recherche s’est continuée après la rédaction de ce mémoire. Les résultats finaux sont disponibles auprès de Chantale Dumoulin pht, PhD., professeure agrée à l’Université de Montréal. / Stress urinary incontinence is a common condition in the postpartum period affecting up to 77% of women. Nine women out of ten still suffering from SUI three months after giving birth will have symptoms of SUI five years later. Physiotherapy treatment via pelvic floor muscles strengthening exercises is recognized as an efficient first line of treatment for SUI. Although studies have shown good short term cure rates for persistent SUI, two long term follow-ups RCT’s have demonstrated that the effect was not maintained through time. The effect of an intensive and supervised physiotherapy pelvic floor strengthening program was evaluated in a previous randomized controlled trial (RCT) seven years ago. The main objective of the present study was to evaluate the effect of this program seven years after cessation of treatment. A secondary objective is to investigate the influence of four possible predictors of long term SUI symptoms and quality of life. The 57 women who completed the initial trial were contacted by telephone and invited to participate in a 7 year follow-up. Twenty-one participants underwent the clinical evaluation and answered four questionnaires while 10 participants answered only the questionnaires. The clinical evaluation included a provocative pad test and dynamometry of the pelvic floor muscles. The main outcome measure was the 20-minute modified pad test. Secondary outcomes were pelvic floor muscle strength measure by the Montreal dynamometer, symptoms of incontinence measured by the Urogenital Distress Inventory questionnaire, quality of life measured by the Incontinence Impact Questionnaire and the perceived burden of SUI measured by the Visual Analog Scale. The evaluation was completed by a questionnaire on four potential predictors of SUI: subsequent pregnancies, chronic constipation, body mass index and the frequency of pelvic floor muscle exercises. Forty-eight percent (10/21) of the participants were continent according to the pad test. The mean improvement between baseline and seven year follow-up was 26.9 g. (SD = vii 68.0g.). There was no statistically significant difference in pelvic floor muscle strength between baseline, after treatment and the follow-up (p = 0.74). The IIQ and VAS score were significantly lower at the seven year follow-up than at baseline (IIQ: 23.4 vs 15.6 , p = 0.007 and VAS: 6.7 vs 5.1, p = 0.001). The UDI scores were higher at follow-up (15.6) than baseline (11.3, p = 0.041) and after treatment (5.7, p = 0.00). Maintaining pelvic floor exercise at seven years after treatment had a strong trend towards a decrease of 5.7 g. for pad test results (p = 0.051). Limits of this study are the small sample size and the bias related to treatment seeking behavior amongst women who agreed to participate. Nevertheless, results seem to indicate that an intensive closely supervised pelvic floor training program is effective in the long run for one woman out of two. Although symptoms of SUI, as measured by the pad test and the UDI questionnaire, seem to reappear with time, quality of life is still better seven years after treatment than at baseline. Continuation of pelvic floor exercises seems to decrease the urine leakage upon exertion and thus should be encouraged even after cessation of intense training. For logistic reasons, the data collection for this research project continued after the writing of this thesis. Final results are available from Chantale Dumoulin pht, PhD, professor at the University of Montreal.

Purpose To evaluate the pelvic floor health knowledge base and presence of pelvic floor dysfunction (PFD) in women working in an office environment, and whether this knowledge significantly increases following a pelvic floor health education session and a re-education session. To assess whether this knowledge-acquisition leads to significant decrease in PFD. Participants Female volunteers (N=161), ages 18-69 years, were randomly allocated to Groups A, B or C. Methods Online surveys were completed by all groups on three occasions and included validated tools (Prolapse and Incontinence Knowledge Quiz, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7) plus sexual function and pelvic floor muscle (PFM) exercise items. On completion of the baseline survey, an education session was given to Groups A and B only (Group C represented the controls). Following this, all participants completed the second survey. Two months later, to allow time for efficacy for the PFM exercises, a re-education presentation was given to Group A only, followed by the final survey administered to all. Analysis Of the 161 volunteers, 16 failed to complete all study requirements, leaving 145 questionnaires (Groups A and B n=48, Group C n=49) available for analysis using ANOVA and Descriptive Analysis. Results The knowledge base of the participants receiving the education showed highly significant improvement compared to the control group, and again for those receiving the re-education session. Although only 14% stated that they had PFD, the surveys revealed that 96% of the participants had PFD. The groups receiving the PFM exercise education and strategies to encourage healthier bladder and bowel habits showed significant decrease in PFD symptoms and increase in QoL. Education was successful in producing highly significant increases in knowledge, importance and commitment toward PFM exercise. Conclusion This study is unique as it evaluated pelvic floor health knowledge and presence of PFD of presumably healthy women within an office setting in contrast to patients seeking PFD medical attention. While further research is required, it is clear that low pelvic floor health knowledge was associated with high prevalence of PFD. Further, as knowledge/awareness significantly increased following education, so did QoL, while PFD significantly decreased.