The purpose of this study was to explore the relationship between urinary incontinence and self-esteem and also social participation. A convenience sample of 25 women 60 years of age and older participated. Forty-eight percent of the women had urinary incontinence at the time of the study. No significant differences were found in the level of self-esteem between those women with urinary incontinence and those women without urinary incontinence. Two subjects with urinary incontinence reported refusing social participation due to urinary incontinence. However, no difference in the overall level of social participation was found when comparing those with to those without urinary incontinence. A nonsignificant correlation was found between self-esteem and the overall level of social participation. In addition, the relationship between self-esteem and the level of social participation for women with urinary incontinence was nonsignificant. Only two of the 12 subjects with urinary incontinence reported receiving treatment.

Syfte: att beskriva distriktsköterskans/sjuksköterskans (DSK/SSK) uppfattning om den information som ges till kvinnor med urininkontinens (UI), vid första kontakten med vårdcentral. Metod: Semistrukturerade enskilda intervjuer med fem distriktssköterskor och en sjuksköterska, gjordes med hjälp av en intervjuguide. En fenomenografisk kvalitativ ansats valdes till studien där materialet har analyserats utifrån från fem steg enligt Larsson & Knutsson-Holmström (2014). Resultat: Kvinnan med UI hamnar oftast hos en telefonrådgivningssköterska vid första kontakten med vårdcentral. Deltagare i studien upplever osäkerhet från telefonsköterskan. Mycket information ges både vid telefonkontakt och vid mottagningsbesök. Deltagarna i studien har olika rutiner men lämnar ut samma information. Informationen anpassas beroende på ålder, förkunskaper, språkhinder eller svårigheter att ta emot informationen. Deltagare i studien upplever att det är tidskrävande att ge information. Samarbete med annan vårdpersonal saknas och förståelse av UI eller vikten av information angående UI saknas bland annan vårdpersonal. Samtliga deltagare upplever att ett bra stöd finns för att ge information. Tidsbrist uppgavs som ett hinder när det gäller att förtydliga informationen till kvinnan eller fördjupa sin egen kunskap och reflektera över informationen som ges. Konklusion: Viktigt är att tid finns för att kunna ge information och för att DSK/SSK ska kunna förtydliga informationen för kvinnor med UI, utveckla informationen som ges och fördjupa sin egen kunskap i UI. Flera yrkesgrupper på vårdcentral behöver bli insatt i UI. Behov finns att öka medvetenheten, erkännandet och förståelse av arbetet med UI. UI behövs lyftas fram i ljuset hos politiker, vårdpersonal och samhälle för att nå ut till fler kvinnor med UI. / Aim: to describe the district nurse/nurse perception of the information given to women with urinary incontinence at first contact with health center. Methodology: Semistructured individual interviews with five district nurses and one nurse were carried out with an interview guide. A phenomenographic qualitative approach was chosen for the study and the material was analysed by five steps developed by Larsson & Knutsson-Holmström, (2014). Result: Woman with UI usually end up with a nurse counseling by phone at the first contact of the health center. Participants in the study feel uncertain from the telephonecounseling nurse. Much information is given both in telephone contact and at clinic visits. Participants have different routines but leave out the same information. The information is customized depending on age, knowledge, language barriers or difficulties to receive information. Participants in the study feel that it often can be time consuming to give information. Collaboration with other health professionals are missing and lack of understanding of the UI or the importance of information about the UI is missing among other health professionals. All participants feel that there is good support when they provide information to the women. Lack of time is to clarify the information to the woman, deepen their own knowledge or reflect on the information given. Conclusion: Importantly is that time is available for district nurse /nurse to clarify information for women with UI, developing the information provided and deepen their own knowledge of UI. Several professionals in health care centers need to become familiar with UI. There is a need to increase awareness, recognition and understanding of the work on UI. UI needs to be brought to light by politicians, health professionals and the community to reach out to more women with UI.

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...

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.

Introdução: A gestação é considerada um fator que favorece o aparecimento de incontinência urinária (IU) e anal (IA), pois pode levar ao enfraquecimento da musculatura do assoalho pélvico. Objetivos: 1. Analisar a força dos músculos do assoalho pélvico (FMAP) de mulheres durante a gestação; 2. Analisar a IU e IA em mulheres durante a gestação; 3. Identificar a interferência da IU na vida da gestante. Método: Coorte prospectiva, realizada com gestantes em um serviço do setor suplementar de saúde, em Guarulhos, SP. Foram incluídas as 500 mulheres que iniciaram o acompanhamento pré-natal e atenderam aos critérios de inclusão, no período ininterrupto entre 21 de novembro de 2012 e 17 de setembro de 2013. A idade gestacional (IG) foi considerada como exposição; a FMAP, IU, IA e interferência da IU na vida da gestante foram consideradas como desfechos. As gestantes foram seguidas em três etapas: Etapa 1, com IG abaixo de 13 semanas; Etapa 2, com IG de 20 a 27 semanas; Etapa 3, com IG de 31 a 38 semanas. A FMAP foi avaliada por meio da perineometria (Peritron) e a IU e IA foram avaliadas por meio de entrevista. Utilizou-se, também, o International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Foi realizada análise descritiva, inferencial e multivariada. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da USP. Resultados: Foram avaliadas 500, 226 e 187 gestantes, nas etapas 1, 2 e 3 da coorte, respectivamente. As perdas de seguimento foram analisadas, indicando que estas foram aleatórias e não influenciaram os desfechos. A FMAP não variou significativamente ao longo da gestação, com média de 30,5 (d.p.=17,3), 29,2 (d.p.=14,9) e 28,7 (d.p.=15,5) cmH2O, nas etapas 1, 2 e 3, respectivamente. Considerando o ponto de corte de 30cmH2O, a maioria das gestantes apresentou FMAP<30cmH2O, em todas as etapas (p=0,055). A incidência de IU na gestação foi 18,6% e a prevalência foi 19,0%, 42,5% e 35,3%, no primeiro, segundo e terceiro trimestres, respectivamente (p<0,001). A incidência de IA foi 5,4% e a prevalência variou de 7,5% a 11,5%. Ao longo da gestação, média do escore do ICIQ-SF variou de 7,8 (d.p.=4,8) a 8,3 (d.p.=4,0). Na análise multivariada, as variáveis que, em conjunto, explicam a variação da FMAP na gestação foram: IG (por semana: r= -0,09; 95%IC -0,16 a -0,02), gestação anterior (por gestação: r= -1,73; 95%IC -3,20 a -0,25), IU prévia (r=-3,03; 95%IC -5,96 a -0,11) e realização de exercícios perineais (r= 2,37; 95%IC 0,48-4,26). Para IU, as variáveis foram: IG (segundo trimestre: OR=5,26; 95%IC 3,44-8,02; terceiro trimestre: OR=3,34; 95%IC 2,09-5,31), IU prévia (OR=5,62; 95%IC 3,93-8,04), FMAP (30cmH2O; OR=0,58; 95%IC 0,41-0,82), realização de exercícios perineais (OR=0,53; 95%IC 0,31-0,89) e idade materna (por ano: OR=1,05; 95%IC 1,02-1,08). Apenas IA prévia (OR=11,13; 95%IC 6,70-18,50) manteve associação com IA na gestação. Conclusão: A realização de exercícios perineais pelo menos duas vezes por semana aumenta a FMAP e reduz a ocorrência de IU na gestação. A FMAP30cmH2O também é um fator protetor contra a IU na gestação. A chance de IU é maior no segundo trimestre da gestação e em mulheres com antecedentes de IU. O impacto da IU na vida da gestante pode ser considerado moderado / Introduction: Pregnancy is considered a factor that favors the onset of urinary (UI) and anal incontinence (AI) as it can weaken the pelvic floor muscles. Objectives: 1. To analyse the pelvic floor muscles strength (PFMS) of women during pregnancy; 2. To analyse the UI and AI of women during pregnancy; 3. To identify the interference of UI in women\'s life. Methods: Prospective cohort study conducted with pregnant women in an insurance health care facility, in Guarulhos, SP. The 500 women who began prenatal care and met the inclusion criteria were included in a continuous period of time, from November 21, 2012 to September 17, 2013. Gestational age was considered the exposure; PFMS, urinary and faecal continence and UI interference in woman\'s life were considered the outcomes. The pregnant women were followed in three steps: Step 1, gestational age below 13 weeks; Step 2, from 20 to 27 weeks; Step 3, from 31 to 38 weeks. The PFMS was evaluated by perineometry (Peritron) and UI and AI by interview. There was adooted the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Descriptive, inferential and multivariate analysis was performed. The Research Ethics Committee of USP School of Nursing approved the project. Results: A total of 500, 226 and 187 pregnant women were respectively evaluated in the steps 1, 2 and 3 of the cohort. The losses to follow-up analysis indicate these were random and did not influence the outcomes. The PFMS did not vary significantly during pregnancy, with a mean of 30.5 (SD=17.3), 29.2 (SD=14.9) and 28.7 (SD=15.5) cmH2O in steps 1, 2 and 3, respectively. Considering the 30cmH2O as cut off, most of the women had the PFMS under this in all steps (p=0.055). The incidence of UI during pregnancy was 18.6% and the prevalence was 19.0%, 42.5% and 35.3% in the first, second and third trimesters, respectively (p<0.001). The incidence of AI was 5.4% and the prevalence ranged from 7.5% to 11.5%. Throughout pregnancy, ICIQ-SF score averages ranged from 7.8 (SD=4.8) to 8.3 (SD=4.0). In the multivariate analysis, the variables that together explain the variation in the PFMS during pregnancy were gestational age (per week: r= -0.09; 95%CI -0.16 to -0.02), previous pregnancy (each pregnancy: r= -1.73; 95% CI -3.20 to -0.25), previous UI (r= -3.03; 95% CI -5.96 to -0.11) and perineal exercises (r= 2.37; 95% CI 0.48 to 4.26). To explain the variation in the UI, the variables were: gestational age (second trimester: OR=5.26; 95% CI 3.44 to 8.02; third trimester: OR=3.34; 95% CI 2.09 to 5.31), previous UI (OR=5.62; 95% CI 3.93 to 8.04), PFMS >30cmH2O (OR=0.58; 95% CI 0.41 to 0.82), perineal exercises (OR=0.53; 95% CI 0.31 to 0.89) and maternal age (per year: OR=1.05; 95% CI 1.02 to 1.08). Just prior AI (OR=11.13; 95% CI 6.70 to 18.50) is associated with AI during pregnancy. Conclusion: Perform perineal exercises at least twice a week increases the PFMS and reduce the occurrence of UI during pregnancy. The PFMS>30cmH2O is also a protective factor against UI during pregnancy. The chance to have UI is higher in the second trimester of pregnancy and in women with previous UI. The impact of UI on the women\'s life can be considered moderate

Introdução: A incontinência urinária feminina é um problema médico e social de grande impacto na qualidade de vida das pacientes. Não há pesquisas sobre os exercícios resistidos como opção de tratamento da IU através do fortalecimento muscular globalizado, mas já há evidências do aumento de força, contração muscular e propriocepção, proporcionado neste tipo de exercício. Objetivo: Observar o efeito dos exercícios resistidos globalizados nas queixas de perdas urinárias e/ou melhora do controle miccional, de um grupo de mulheres com incontinência urinária. Métodos: Realizamos um estudo clínico, prospectivo não controlado com vinte pacientes que foram submetidas ao treinamento resistido, duas vezes na semana por um período total de três meses. Os instrumentos para avaliação foram o diário miccional, questões subjetivas e o exame urodinâmico (todos com intervenção pré e pós tratamento para análise comparativa). Resultados: os resultados obtidos revelaram uma melhora estatisticamente significante nos episódios de perda urinária, volume e troca de protetor/ dia (p<0,001), além da melhora referida em 85% das participantes e todas fariam novamente o treinamento. Porém, não houve resultados estatisticamente significativos no exame urodinâmico Conclusão: Os exercícios resistidos mostraram-se seguros e eficazes na melhora clínica das pacientes, podendo ser uma opção de tratamento mais barato e acessível, podendo diminuir o índice de desistência apresentado pelas pacientes que se submetem aos tratamentos com exercícios perineais habituados. Porém é necessária a realização de novas pesquisas na área / Introduction: Incontinence is a medical problem of great impact on quality of life of patients. There is no research on resistance exercise as a treatment option through the UI muscle strengthening globalization, but there is already evidence of increased strength, proprioception and muscle contraction, providing this type of exercise. Objective: To observe the effect of globalized resistance training in complaints of urinary incontinence and / or bladder control improvement in a group of women with urinary incontinence. Methods: We performed a clinical, prospective, uncontrolled study with twenty patients who were subjected to resistance training twice a week for a total period of three months. The measurement tools were the voiding diary, urodynamic and subjective questions (all with pre and post treatment intervention for comparative analysis). Results: The results revealed a statistically significant improvement in episodes of urinary leakage, and volume change of guard / day (p <0.001) than the improvement reported in 85% of all participants and would re-training. However, no statistically significant urodynamic. Conclusion: The resistance exercises were shown to be safe and effective in clinical improvement of patients and may be a cheaper and more accessible option of treatment, which may reduce the dropout rate presented by patients who undergo the treatments with perineal exercises used. However, it is necessary to conduct further research in the area

A Incontinência Urinária (IU) é um sintoma multifatorial associado ao estilo de vida, sendo uma disfunção anatomopatológica que interfere, principalmente, na saúde da mulher. Objetivo: O estudo teve como objetivo analisar a prevalência de incontinência urinária e fatores associados em profissionais de enfermagem que atuam em um Hospital Universitário de Ribeirão Preto-SP. Materiais e Método: Trata-se de uma pesquisa descritiva e exploratória de corte transversal com abordagem quantitativa, sobre a prevalência e fatores associados à incontinência urinária entre estes profissionais. A população foi composta por 119 profissionais das unidades de Clínica Médica (CM),Clínica Cirúrgica (CC),Ginecologia (GO) e Obstétricia (OBST), nas categorias de enfermeira, técnica de enfermagem e auxiliar de enfermagem; o período de coleta de dados foi de Junho a Outubro de 2010 .Foi solicitada a autorização da Divisão de Enfermagem do HCFMRP-USP e , posteriormente, enviado o projeto para análise do Comitê de Ética em Pesquisa (CEP) da mesma instituição. Este procedimento visa a preservação dos aspectos éticos relacionados à pesquisa envolvendo seres humanos, segundo a resolução 196/96. Resultados: Das 91 mulheres entrevistadas a maioria estava na média de 40 anos e 58 (65,17%) eram de raça branca apresentaram uma prevalência de incontinência urinária de 30,94%. As categorias profissionais que apresentaram sintomas de incontinência urinária foram as técnicas e auxiliares de enfermagem (25,48%), as enfermeiras (5,46%). Entre os tipos de sintomas de perdas de urina mais prevalentes foram perdas pelo menos uma vez ao mês com 34,12%, as perdas por algum motivo 20,24%%, perdas antes de chegar ao banheiro 20,24%. Os sintomas IU causaram algumas alterações na vida das mulheres, tais como, alterações nas atividades ocupacionais, falta de concentração, baixa produtividade, estresse e fadiga, o aumento da perda urina devido às atividades executadas, a não realização de algumas atividades no trabalho para evitar as perdas de urina, o manejo para facilitar as trocas de roupa, o uso de absorvente ou ir ao banheiro, as dificuldades para interromper as atividades para ir ao banheiro. Os sintomas de incontinência urinária foram associados a diversas variáveis qualitativas como hipertensão, menopausa, intestino preso, atividade física e categoria profissional. Indicou que hipertensão (0,049) e menopausa (0,022). Estão associados às perdas de urina quando tossem, espirram ou fazem algum esforço. Os sintomas de incontinência urinária foram associados às diversas variáveis quantitativas como idade, IMC, ingestão de café (número de copos), número de gravidez, peso médio do recém-nascido (RN), tabaco e paridade, e indicou que as pessoas que perdem urina pelo menos uma vez no mês são as que apresentaram maiores índices de massa corporal (0,001) e ingeriam mais café diariamente ( 0,027). Quanto as que perdiam urina quando tossiam, espirravam, levantavam peso ou faziam algum tipo de esforço são as que apresentaram idade (0,036), IMC (0,029), gravidez (0,003) e paridade (0,009). Entre as mulheres que apresentaram perda de urina antes de chegar ao banheiro e as que não apresentaram tal perda quando comparadas às variáveis, estavam associadas ao IMC (0,029) e ingestão de café (0,001). Conclusão: Foi observada uma grande prevalência de sintomas de incontinência urinária entre os profissionais de enfermagem; também, os fatores associados podem influenciar tanto no desenvolvimento de IU quanto na piora dos sintomas. A maioria destas mulheres encontra algumas dificuldades para o manejo das perdas de urina devido às suas atividades laborais. / The Urinary Incontinence (UI), anatomopathological dysfunction, is a multifactorial symptom associated to the lifestyle that interferes, mainly, in the woman\'s health. Objective: This study aimed at analyzing the prevalence of urinary incontinence and factors associated with nursing professionals that wok at a University Hospital of Ribeirão Preto-SP. Materials and Method: This is a descriptive, exploratory, cross-sectional study with quantitative approach, about the prevalence and associated factors to the urinary incontinence among these professionals. The population comprised 119 professionals from the Medical Clinics (MC), Surgery Clinics (SC), Gynecological Clinics (GC) and Obstetrics (OBST) units. These professional categories were: nurse, nursing technician and nursing auxiliary. Data collection was in the period from June to October 2010. The authorization from of the Nursing Division of HCFMRP-USP was requested and, later, the project was sent to its Research Ethics Committee for informed consent to preserve the ethical aspects related to the research involving human beings, according to the resolution 196/96. Results: Out of the 91 interviewed women; most of them was the mean age of 40 years, and 58 (65.17%) were white race; they presented a 30.94%-urinary incontinence prevalence. The professional categories that presented symptoms of urinary incontinence were the nursing technicians and auxiliaries (25.48%), the nurses (5.46%). The most prevalent types of symptoms of urine losses were: losses at least once a month (34.12%), losses for some reason (20.24%%), losses before arriving to the bathroom (20.24%). The UI symptoms have caused some alterations in the women\'s life, such as, alterations in the occupational activities, lack of concentration, low productivity, stress and fatigue, the increase of the urine loss due performed activities, the non accomplishment of some activities in the work to avoid the urine losses, the handling to ease cloth changes, the absorbent use or to go to the bathroom, the difficulties to interrupt the activities to go to the bathroom. The symptoms of urinary incontinence were associated to several qualitative variables as hypertension, menopause, intestine constipation, physical activity and professional category. indicated that hypertension (0.049) and menopause (0.022). They are associated to the urine losses when they cough, sneeze or make some effort. The symptoms of urinary incontinence were associated to the several quantitative variables as age, IMC, Coffee intake (number of glasses), number of pregnancy, the newborn´s medium weight (NB), tobacco and parity, and it pointed out that the women losing urine at least once in a month were the ones that presented higher indexes of body mass (0.001).moreover, they drink more coffee daily (0.027). While the ones that lost urine when they coughed, sneezed, lifted weight or made some type of effort are the ones aged (0.036), IMC (0.029), pregnancy (0.003) and parity (0.009). The women with urine loss before arriving to the bathroom were associated with BMI (0.029) and coffee intake (0.001). Conclusion: A great prevalence of symptoms of urinary incontinence among the nursing professionals was observed; also, the associated factors can influence either in the UI development or in the worsening of symptoms. Most of these women have found some difficulties to handle the urine losses due to their working activities.

Para avaliar as fibras elásticas na junção vésico-uretral de ratos, em diferentes faixas etárias, realizou-se estudos histológicos, microscopia elêtronica e histomorfometria. O estudo histológico do sistema de fibras elásticas mostrou a presença dos três tipos de fibras elásticas, em todas as faixas etárias, a microscopia eletrônica de transmissão, mostrou as diferenças ultra-estruturais entre as fibras elásticas. A avaliação histomerfométrica revelou diminuição na densidade linear das fibras elásticas e oxitalânicas e aumento na das elaunínicas. Na junção vésico-uretral de animais velhos, há uma queda nas propriedades de elasticidade, recuo elástico e ancoragem, que são compensadas pelas fibras elaunínicas. O processo de envelhecimento das fibras elásticas na junção vésico-uretral não contribui sozinha e diretamente no estado de incontinência urinária, mas compensa e dá suporte a muscular, devido ao aumento das fibras elaunínicas, o que torna o sistema elástico na junção vésico-uretral indiretamente responsável pela manutenção da continência urinária. / To evaluate the elastic fibers in the junctio vesico-urethral of the rat, in different age groups, was accomplished studies histologics, electron microcopy and histomorphometrics. Study histologic showed the presence of the three types elastic fibers in all the studied age groups, electron microcopy showed the ultra-structural differences amoung elastic fibers. Histomorphometric studies revealed a decrease the linear density of the mature elastic fibers and oxytalans and an increase elaunin. In the junction vesico-urethral of the old animals there is a fall the properties elastic, elastic recoil and achorage, but they are compensated by elaunins. Processs aging of the elastic system in this place doesn?t contribute alone or directly in urinary incontinence, but it is indirectly responsible for the maintenance urinary continence.

Introdução: A incontinência urinária (IU) acomete um grande contingente de mulheres e é considerada uma das novas epidemias do século XXI. Objetivo: elaborar um material educativo para promover o autocuidado de mulheres com IU. Os objetivos específicos foram explorar as experiências vividas por mulheres com IU; identificar as dúvidas e necessidades dessas mulheres relacionadas à IU; levantar dificuldades e potencialidades no enfrentamento dos problemas relacionados à IU. Referencial Teórico: As premissas interacionistas e dialógico-educativas de Paulo Freire alicerçaram este estudo. Metodologia: Foi desenvolvida uma pesquisa-ação (PA) com dois grupos (G1 e G2) de mulheres portadoras de IU. O G1 composto por 12 mulheres de um hospital do Sistema Único de Saúde, do Município de Macapá-AP. O G2 por dez mulheres da rede privada do mesmo município. As quatro fases da PA foram diagnóstico da realidade; planejamento e execução das ações educativas; elaboração e validação do material educativo; avaliação reflexiva. Os dados do diagnóstico da realidade foram obtidos em oito sessões de grupos focais (GFs). As ações educativas desenvolveram-se em quatro oficinas com os G1 e G2 e a avaliação reflexiva numa única sessão. A análise indutiva e interpretativa dos dados gerou seis categorias. O material educativo, ilustrado com figuras inéditas, teve por base evidências científicas atualizadas. A versão preliminar foi submetida à avaliação de peritos e à apreciação das mulheres. Resultados: Os itens principais do material educativo são: Conheça mais sobre a incontinencia urinária IU); Como descubro se tenho IU?; Conheça os três tipos de IU mais frequentes; A IU e o parto; A IU tem cura?; Tratamentos que existem para a mulher que tem IU; Como a IU pode afetar a vida sexual e amorosa?; As leis brasileiras para a saúde da mulher; Sugestões de mulheres para melhoria da assistência e tratamento da IU. As categorias que descrevem a experiência da IU são: 1. A urina sai sem querer: o processo de descoberta da doença; 2.Variados motivos levam a esta doença: as percepções das mulheres sobre as causas da IU; 3. Uma doença estigmatizante: significados negativos atribuídos à IU; 4. Uma doença que causa reflexos negativos na vida cotidiana: consequências sobre a vida social e a saúde; 5. Sexualidade e vida sexual afetadas: consequências da IU na vida íntima; 6. Desconhecida das mulheres e desconsiderada pelos profissionais: motivos da busca tardia pelo tratamento da IU. Discussão: As categorias reafirmaram resultados de outros estudos. As mulheres com IU sofrem danos físicos e psicológicos, com impactos negativos em sua qualidade de vida, entre outros, a vida sexual e social. Mesmo sendo patologia relevante, a IU está silenciada nas políticas públicas de saúde, por diversas deficiências, impedindo a prevenção e promoção da saúde das mulheres. As deficiências incluem falhas na infraestrutura assistencial, na escuta e tratamento humanizados pelos profissionais de saúde. Considerações finais: Espaços específicos de educação em saúde gerariam o empoderamento das mulheres na busca de estratégias de promoção da sua saúde. Pretende-se que o material educativo auxilie a educação e promoção da saúde das mulheres portadoras de IU. / Introduction: Urinary incontinence (UI) affects a large contingent of women and is considered one of the new epidemics of the 21st century. Objective: to elaborate an educational material to promote the self-care of women with UI. The specific objectives were to explore the experiences of women with UI; Identify the doubts and needs of these women related to UI; Difficulties and potentialities in facing UI-related problems. Theoretical Framework: The interactionist and dialogical-educational premises of Paulo Freire supported this study. Methodology: An action research (AR) was developed with two groups (G1 and G2) of women with UI. The G1 was composed of 12 women from a hospital of the Unified Health System of the city of Macapá-AP. The G2 by ten women from the private network of the same municipality. The four phases of AR were diagnostic of reality; planning and execution of educational actions; rreparation and validation of educational material, and reflective evaluation. Data related to the diagnosis of reality was obtained through eight focus group sessions (FGs). The educative activities were developed through four workshops with the G1 and G2 and the reflexive evaluation in a single session. The inductive and interpretive analysis of the data generated six categories. The educational material, illustrated with original figures, was based on updated scientific evidence. The draft was submitted to expert assessment and to the appreciation of women. Results: The main items of educational material are: Learn more about UI); How do I find out if I have UI?; Know the three most common types of UI; UI and childbirth; Does UI have a cure? ; Treatments that exist for the woman who has UI; How can UI affect sexual and loving life? Brazilian laws for the health of women; Suggestions from women to improve UI care and treatment. The categories that describe the UI experience are: 1. The urine leaves unintentionally: the process of finding the disease; 2. Various reasons lead to this disease: women\'s perceptions about the causes of UI; 3. A stigmatizing disease: negative meanings attributed to UI; 4. A disease that causes negative reflexes in daily life: consequences on social life and health; 5. Sexuality and sexual life affected: consequences of UI on the intimate life; 6. Unknown to women and disregarded by professionals: reasons for the late search for UI treatment. Discussion: These categories reaffirmed results from other studies. Women with UI suffer physical and psychological damages, with negative impacts on their quality of life, among others, sexual and social life. Although it is a relevant pathology, the UI is silenced in public health policies, due to several deficiencies, hindering the prevention and promotion of women\'s health. The deficiencies include failures in healthcare infrastructure, humanized listening and treatment by health professionals. Final considerations: Specific spaces of health education would generate the empowerment of women in search of strategies to promote their health. It is intended that the educational material contributes to the education and health promotion of women with UI.

A incontinência urinária é um sintoma que atinge predominantemente as mulheres e constitui-se em um problema de saúde pública. O puerpério é uma fase frágil do ciclo grávido?puerperal que nem sempre recebe a devida atenção por parte dos profissionais de saúde e, a literatura nacional sobre sua prevalência neste período é escassa. Dessa maneira, este estudo teve por objetivo geral: estudar a ocorrência da perda involuntária de urina e os fatores obstétricos relacionados em um grupo de puérperas e, como objetivos específicos: identificar a ocorrência e o tipo do sintoma relacionado à perda involuntária de urina em qualquer momento da vida e durante o ciclo grávido-puerperal; descrever a ocorrência dos sintomas urinários no ciclo grávido puerperal, de acordo com: paridade, tipo de parto, uso de fórceps, episiotomia, peso e perímetro cefálico do recém-nascido. Caracteriza-se por ser um estudo epidemiológico, descritivo, de corte transversal, desenvolvido nas dependências de uma maternidade filantrópica de um município paulista. Participaram do estudo 244 puérperas, com idade entre 14-43 anos, que compareceram à consulta de puerpério. Os dados foram coletados nos prontuários da maternidade e por meio de entrevista semi-estruturada. Os resultados apontam uma prevalência de 45,9% de perda involuntária de urina em qualquer momento da vida. Entre as 112 mulheres com o sintoma, 77,8% iniciaram o sintoma durante a gestação índice; 9,8% após o parto índice; 6,3% antes da gestação índice; 3,6% durante outra gestação e 2,7% após outro parto. Em qualquer momento da vida e no ciclo grávido puerperal houve predomínio do sintoma de esforço, seguido por sintoma misto e de urgência. A existência do sintoma no puerpério imediato sugere a necessidade de atenção especial por parte do sistema de saúde e de seus profissionais, a fim de evitar repercussões negativas na saúde da mulher. / Urinary incontinence is a symptom that reaches predominantly women and consists in a public health problem. Puerperium is a fragile phase of all pregnancy and puerperium period that receives scarcely attention from health professionals and the there is a lack of national literature about the prevalence of urinary incontinence. In this way, this study aimed to study the occurrence of involuntary urinary loss in a puerperae group and specifically to identify the occurrence and type of symptoms related to involuntary urinary loss at any life moment and during pregnancy and puerperium period; to describe the occurrence of involuntary urinary loss at pregnancy and puerperium period, according to: number of pregnancy, type of childbirth, use of forceps, episiotomy, weight and newborn?s cefalic perimeter. This is cross-section descriptive study developed in a philantropic maternity in a city from São Paulo State - Brazil. Participated on this study 244 puerperae, with age between 14-43 years, that appeared in puerperium?s consultation. To collection data a half-structuralized interview and maternity?s handbook was used. The results point a prevalence of 45,9% involuntary urinary loss, when considered its occurrence to the little one time, at any moment of life. Between these 112 women, 77,8% had initiated symptoms during index pregnancy; 9,8% after index childbirth; 6,3% before index pregnancy; 3,6% during another pregnancy and 2,7% after another childbirth. At any moment of life and at the current pregnancy and puerperium period had predominance of stress symptoms, following by mixed and urgency symptoms. The existence of symptoms found in the immediate puerperium suggests the need of special attention by the health?s system and the professionals, in order to prevent negative repercussions in woman?s health.