Orientadores: Cássio Luis Zannettini Riccetto, Simone Botelho Pereira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T03:58:07Z (GMT). No. of bitstreams: 1 Lanza_AnaHelenaBarbosa_M.pdf: 1640627 bytes, checksum: c135a5857fcde47208c0a3c7f837045b (MD5) Previous issue date: 2011 / Resumo: Objetivo. Avaliar o efeito de um programa supervisionado de cinesioterapia sobre a contratilidade do assoalho pélvico, e sua eventual correlação com a função orgásmica feminina. Sujeito e Métodos. Para este estudo clínico, prospectivo, randomizado, controlado e cego, foram inclusas 20 mulheres, com média de idade de 26,6 ± 6,1 anos, com queixa de falta de orgasmo durante a atividade sexual, as quais foram divididas aleatoriamente em dois grupos. Grupo 1 (G1): 10 mulheres; avaliadas quanto à função orgásmica e quanto à contratilidade muscular do assoalho pélvico; realizaram um protocolo de exercícios cinesioterapêuticos (12 sessões individuais, com duração de 30 minutos, duas vezes por semana), focado no fortalecimento muscular pélvico; e reavaliada quanto à função orgásmica e quanto à contratilidade muscular; Grupo 2 (G2): 10 mulheres; avaliadas quanto à função orgásmica e quanto à contratilidade muscular do assoalho pélvico; não realizaram o protocolo de exercícios cinesioterapêuticos; foram reavaliadas quanto à função orgásmica e quanto à contratilidade muscular simultaneamente às mulheres do G1, sendo denominado G2-Controle. Após uma semana, esse grupo realizou o mesmo protocolo de exercícios cinesioterapêuticos, foi reavaliado quanto à função orgásmica e quanto à contratilidade muscular, sendo denominado G2-Tratado. A função orgásmica foi avaliada por meio do domínio orgasmo do questionário validado para língua portuguesa Female Sexual Function Index (FSFI), e por meio do cálculo do Coeficiente de Capacidade Orgásmica (CCO). As avaliações da contratilidade muscular do assoalho pélvico foram realizadas por segundo pesquisador, o qual não tinha conhecimento do programa de tratamento, através de palpação digital (PD) e de eletromiografia de superficie (EMGs - com sensor intravaginal), enquanto que, o programa de exercícios cinesioterapêuticos foi elaborado e supervisionado por pesquisador, o qual não participou das avaliações da contratilidade muscular do assoalho pélvico. O questionário International Consultation on Incontinence Questionnaire Short-Form, validado para a língua portuguesa, foi aplicado na avaliação inicial, no intuito de verificar a coexistência da incontinência urinária. Para análise estatística foram utilizados o Teste t de Student, o Teste de Correlação de Pearson, e o Teste Regressão Linear Simples, com nível de significância de 5%. Resultados. Em contraste com o grupo controle (G2-Controle), os grupos que realizaram o programa de exercícios cinesioterapêuticos proposto (G1 e G2-Tratado) apresentaram aumento significativo na contratilidade do assoalho pélvico, tanto a avaliada pela PD (p<0,001), quanto a mensurada pela EMGs (p<0,001), e este aumento de contratilidade se correlacionou de forma significativa com a melhora no escore do domínio orgasmo do FSFI (p<0,001), e no escore do Coeficiente de Capacidade Orgásmica (p=0,001). Conclusão. O programa de exercícios cinesioterapêuticos proposto promoveu aumento na contratilidade do assoalho pélvico, com concomitante melhora da função orgásmica, indicando que essa abordagem terapêutica possa ser adjuvante no tratamento da disfunção orgásmica feminina / Abstract: Objective. Evaluate the effect of a protocol supervised of the kinesiotherapy on the contractility of the pelvic floor, and its possible correlation with female orgasmic function. Subjects and methods. For this clinical, prospective, randomized, controlled, blind study, were included 20 women, mean age 26.6 ± 6.1 years, complaining of lack of orgasm during sexual activity, which were randomly divided into two groups. Group 1 (G1): 10 women, evaluated for orgasmic function and on the contractility of the pelvic floor, made a kinesiotherapy protocol (12 sessions, lasting 30 minutes, twice a week), focused on muscle strengthening, and reassessed as the orgasmic function and the contractility of the pelvic floor; Group 2 (G2): 10 women, evaluated for orgasmic function and on the contractility of the pelvic floor, did not realize the kinesiotherapy protocol, were reassessed on the orgasmic function and on the contractility of the pelvic floor while the women in the G1, and called G2- Control. After one week, this group received the same kinesiotherapy protocol, was reassessed as the orgasmic function and on the contractility of the pelvic floor, and called G2- Treaty. Orgasmic function was assessed using the orgasm domain of the validated questionnaire to portuguese Female Sexual Function Index (FSFI), and by calculating the Coefficient of Orgasmic Capacity (COC). The assessments of the pelvic floor muscle contractility were performed by the second researcher, which was not aware of the treatment program, by digital palpation (DP) and surface electromyography (sEMG - with intravaginal sensor), while kinesiotherapy program was drafted and supervised by a researcher no involved in the assessments of contractility of the pelvic floor. The International Consultation on Incontinence Questionnaire, validated for the portuguese language was used in the initial assessment, in order to verify the coexistence of urinary incontinence. Statistical analysis was performed using the Student t Test, the Pearson Correlation Test, and the Simple Linear Regression Test, with a significance level of 5%. Results. In contrast to the control group xvi (G2-control), groups that performed kinesiotherapy (G1 and G2-Treaty) showed a significant increase in contractility of the pelvic floor, assessed by PD (p <0,001), and measured by EMG (p <0.001), and this increase in contractility was positively correlated with the improvement in the orgasm domain score of the FSFI (p <0,001), and the score of the Coefficient Orgasmic Capacity (p = 0,001). Conclusion. The kinesiotherapy exercises program promoted increase in contractility of the pelvic floor, with concomitant improvement in orgasmic function, indicating that this therapeutic approach could be an adjunct in the treatment of female orgasmic dysfunction / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências da Cirurgia

Contexte : Le cancer de l'endomètre est le plus fréquent des cancers gynécologiques. Il a été suggéré que les traitements oncologiques entraînent des dysfonctions des muscles du plancher pelvien. Ces dysfonctions pourraient contribuer au développement de conditions débilitantes comme la douleur lors des relations sexuelles (dyspareunie) qui atteint plus de la moitié des survivantes. Or, à l'heure actuelle, aucune étude n'a investigué la fonction des muscles du plancher pelvien en lien avec la dyspareunie chez des survivantes d'un cancer de l'endomètre. Objectifs : L'objectif principal vise à explorer les différences quant à la fonction des muscles du plancher pelvien entre des survivantes d'un cancer de l'endomètre atteintes de dyspareunie et des femmes sans douleur ayant subi l'hystérectomie totale pour des raisons bénignes. L'objectif secondaire est d'explorer les différences entre les deux groupes quant aux variables urogynécologiques, sexuelles, psychologiques et sociales. Méthodologie : Dans cette étude comparative exploratoire bicentrique, des survivantes d'un cancer de l'endomètre atteintes de dyspareunie (n=7) et des femmes asymptomatiques (n=7) ont assisté à une séance d'évaluation menée par une physiothérapeute. Les deux groupes ont été équilibrés selon l'âge, l'indice de masse corporelle et le nombre d'accouchements par voie vaginale. La fonction des muscles du plancher pelvien, y compris le tonus, la force maximale, la vitesse de contraction, la coordination et l'endurance, a été évaluée à l'aide du spéculum dynamométrique. Des questionnaires validés ont permis d'évaluer les variables secondaires. Des tests de Mann-Whitney ont été employés pour comparer les deux groupes quant à la fonction des muscles du plancher pelvien et les variables urogynécologiques, sexuelles, psychologiques et sociales (!=0,050). Résultats : Concernant la fonction des muscles du plancher pelvien, les survivantes atteintes de dyspareunie ont démontré un tonus à une ouverture vaginale minimale supérieur (p=0,018) et une endurance inférieure (p=0,048) aux femmes asymptomatiques. Les survivantes ont également présenté plus d'incontinence fécale (p=0,005) et une fonction sexuelle inférieure (p=0,004) comparativement aux femmes asymptomatiques. Aucune différence n'a été détectée pour les variables psychologiques et sociales. Conclusion : Les résultats de cette étude exploratoire suggèrent des dysfonctions des muscles du plancher pelvien, notamment un tonus supérieur et une endurance inférieure, chez les survivantes d'un cancer de l'endomètre atteintes de dyspareunie. D'autres études sont nécessaires afin de confirmer ces résultats. Ces constats préliminaires pourraient servir d'assises pour mieux comprendre les dysfonctions des muscles du plancher pelvien impliquées dans la dyspareunie chez cette population. / Abstract : Context: Endometrial cancer is the most common cancer in gynecological cancers. Oncological treatments are suggested to cause pelvic floor muscle dysfunction that could contribute to the development of debilitating conditions such as pain during sexual intercourse (dyspareunia), which affects more than half of survivors. However, to date, no study investigated pelvic floor muscle function in relation to dyspareunia in endometrial cancer survivors. Objectives: The main objective is to explore differences in pelvic floor muscle function between endometrial cancer survivors with dyspareunia and women without pain who underwent a total hysterectomy for benign conditions. The secondary objective is to explore differences between the two groups on urogynecological, sexual, psychological and social variables. Methodology: In this exploratory, bicentric comparative study, endometrial cancer survivors with dyspareunia (n=7) and asymptomatic women (n=7) attended one evaluation session conducted by a physiotherapist. The two groups were balanced in terms of age, body mass index and number of vaginal deliveries. The pelvic floor muscle function, including tone, maximal strength, contraction speed, coordination and endurance, was assessed with the dynamometric speculum. Validated questionnaires were used to evaluate secondary variables. Mann-Whitney tests were used to compare the two groups on muscular, urogynecological, sexual, psychological and social variables (!=0.050). Results: Concerning pelvic floor muscle function, survivors with dyspareunia demonstrated higher tone at a minimal vaginal aperture (p=0.018) and lower endurance (p=0.048) compared to asymptomatic women. Survivors also presented more fecal incontinence (p=0.005) and lower sexual function (p=0.004) compared to asymptomatic women. No differences were detected for psychological and social variables. Conclusion: The results of this exploratory study suggest impaired pelvic floor muscle function, notably higher tone and lower endurance, in endometrial cancer survivors with dyspareunia. Further studies are needed to confirm these findings. This preliminary evidence can be used as empirical data to better understand pelvic floor muscle impairments implicated in dyspareunia in this population.

INTRODUÇÃO: A incontinência urinária de esforço (IUE) é definida como a queixa de perda involuntária de urina em situações de esforço ou esforço físico, espirros ou tosse. O fortalecimento dos músculos do assoalho pélvico (MAPs) tem nível A de evidência científica no tratamento da IUE, mas não há respostas sobre o efeito de uma intervenção envolvendo o sinergismo muscular entre os MAPs e os músculos do quadril. OBJETIVOS: Avaliar se o fortalecimento dos MAPs associado ao fortalecimento dos músculos adutores de quadril, glúteo máximo e glúteo médio é mais eficaz do que o fortalecimento isolado dos MAPs, em relação à frequência de perda urinária, força do assoalho pélvico, perineometria e qualidade de vida. METODOLOGIA: Ensaio clínico randomizado e cego, com 43 mulheres (média de idade 50,09 ± 8,35) com diagnóstico de IUE. Após a avaliação inicial, as pacientes foram randomizadas para o grupo que realizava somente exercícios para fortalecimento dos músculos do assoalho pélvico (AP, n= 21) ou para o grupo de exercícios para fortalecimento dos músculos do assoalho pélvico, adutores de quadril, glúteo máximo e médio (APQ, n= 22). Como medida primária foi considerada a frequência de perda urinária avaliada pelo diário miccional de três dias e pela ficha de acompanhamento por sessão. As medidas secundárias foram: avaliação bidigital da força dos MAPs, a perineometria, e a avaliação da qualidade de vida realizada pelo International Consultation on Incontinence Questionnarie - Short Form (ICIQ-SF) e pelo King\'s Health Questionnaire (KHQ). As avaliações foram realizadas antes e após 20 sessões de fisioterapia. RESULTADOS: Na análise do diário miccional, entre o início e fim do tratamento, somente o grupo APQ teve redução significante da frequência de perda urinária, porém sem diferença estatisticamente significante entre os grupos no final do tratamento. A frequência diária de perda urinária obtida pela ficha de acompanhamento por sessão, constatou que somente o grupo APQ teve redução significativa da perda urinária ao longo do tratamento (efeito do fator tempo) (p-valor 0,0048), sendo que na comparação entre os grupos, o APQ resultou em maior redução da frequência diária de perda em relação ao grupo AP. Ambos os grupos tiveram aumento significativo da força e endurance dos MAPs, porém sem diferença estatisticamente significante entre os grupos. Não foi detectada diferença significativa na perineometria pré/ pós-tratamento, assim como na comparação entre os grupos. Na análise da qualidade de vida, ambos os grupos tiveram melhora significativa nos escores do ICIQ-SF, porém não apresentaram diferença significativa na comparação entre os grupos. Dos nove domínios do KHQ, seis apresentaram redução estatisticamente significativa no grupo APQ e quatro no grupo AP, porém os escores dos nove domínios não apresentaram diferença significativa entre os grupos no final do tratamento. CONCLUSÕES: Para o tratamento da incontinência urinária de esforço, os exercícios de fortalecimento do assoalho pélvico acrescidos do fortalecimento de músculos como os adutores de quadril, o glúteo máximo e glúteo médio apresentam melhor resultado ao longo do tratamento para a redução da perda urinária do que somente o fortalecimento perineal, ainda que não haja diferença significativa entre os tratamentos em relação à força e perineometria dos músculos do assoalho pélvico e na qualidade de vida / BACKGROUND: Stress urinary incontinence (SUI) is defined as the complaint of involuntary leakage of urine in situations of stress or physical exertion, sneezing or coughing. Strengthening the pelvic floor muscles (PFM) have the level A of scientific evidence in the treatment of SUI, but there are no findings on the effect of an intervention involving muscle synergism between PFM and hip muscles. OBJECTIVES: To evaluate whether the strengthening of PFM associated with the strengthening of the hip adductor muscles, gluteus medius and gluteus maximus is more effective than isolated strengthening of PFM, regarding the frequency of urine loss, strength of pelvic floor perineometry and quality of life. METHODS: This is a blind randomized clinical trial with 43 women (mean age 50.09 ± 8.35) diagnosed with SUI. After initial evaluation, patients were allocated to the group that performed only exercises to strengthen the pelvic floor (PF, n = 21) or to the group of exercises to strengthen the muscles of the pelvic floor, hip adductors, gluteus maximus and gluteus medius (PFH, n = 22). As a primary measure, the frequency of urinary incontinence was considered as assessed by a three-day voiding diary and the accompanying sheet, per session. Secondary measures were: bidigital assessment of the strength of PFM, perineometry, and the assessment of quality of life conducted by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the King\'s Health Questionnaire (KHQ). Evaluations were performed before and after 20 sessions of physiotherapy. RESULTS: In the analysis of the voiding diary, between the beginning and end of treatment, only the PFH group had a significant reduction in the frequency of urinary leakage, although there was no statistically significant difference between groups at the end of treatment. The daily frequency of urinary leakage obtained by the accompanying sheet per session, showed that only the PFH group had significantly reduced urinary loss throughout the treatment (time effect factor) (p-value 0.0048), and in that comparison between groups, the PFH group resulted in greater reduction in daily frequency of loss of urine in relation to the PF group. Both groups had a significant increase in strength and endurance of PFMs, although there was no statistically significant difference between groups. There was no significant difference in perineometry pre / post-treatment, as well as in the comparison between groups. In analyzing the quality of life, both groups had significant improvement in the scores of the ICIQ-SF, but did not show a significant difference between groups. Of the nine KHQ domains, six showed a statistically significant reduction in PFH group and four in the PF group, but the scores of the nine domains showed no significant difference between groups at the end of treatment. CONCLUSIONS: For the treatment of stress urinary incontinence, exercises to strengthen the pelvic floor muscles plus the strengthening of muscles like the hip adductors, gluteus maximus and gluteus medius have a better outcome during treatment for the reduction of urine loss than only the perineal strengthening, although there is no significant difference between treatments with respect to strength and perineometry of pelvic floor muscles, and the quality of life

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T17:34:53Z No. of bitstreams: 1 Karina Moyano Amorim.pdf: 916717 bytes, checksum: 2524cea0e3065649a660dc46e7c08c81 (MD5) / Made available in DSpace on 2018-07-19T17:34:53Z (GMT). No. of bitstreams: 1 Karina Moyano Amorim.pdf: 916717 bytes, checksum: 2524cea0e3065649a660dc46e7c08c81 (MD5) Previous issue date: 2017-12-18 / Changes in pelvic floor muscles (PMF) that occur in stress urinary incontinence (SUI) can be quantified using a transvaginal dynamometer. The objective of this study was to compare and test the accuracy of different parameters obtained by a transvaginal force dynamometer, from contraction of MAP, between healthy and SUI women. Seventeen healthy women (CG) and 17 women with stress urinary incontinence (GSUI) aged 20-60 years were included in this study. The MAP strength was evaluated by means of a transvaginal dynamometer, in a single test session. The data were collected with the patient in lithotomy, and the volunteers were instructed to perform a maximal contraction of the MAP and resist until exhaustion. The test was repeated three times with a 1 minute interval between tests. The dynamometric parameters used to evaluate the MAPs were: peak time (time at which the peak force occurred from the beginning of the MAP contraction), baseline (passive force), maximum force value of MAP contraction, contraction and mean contraction force of the MAP and endurance. The covariance analysis (ANCOVA) with Bonferrone's post hoc test showed that only the endurance variable was different between the groups (F=4.87, P=0.03; p2= 0.14). The accuracy of endurance to identify women with SUI was verified by the receiver operating characteristic curve (ROC). The area on the curve was 0.76 and the sensitivity and specificity were 76.60% for both conditions. In this study it was possible to verify that only the variable muscular resistance has moderate accuracy to identify women with stress urinary incontinence. / As alterações dos músculos do assoalho pélvico (MAP) que ocorrem na incontinência urinária por esforço (IUE) podem ser quantificadas por meio de dinamômetro transvaginal. O objetivo deste estudo foi comparar e testar a acurácia de diferentes parâmetros obtidos por um dinamômetro de força transvaginal, a partir da contração dos MAP, entre mulheres saudáveis e com IUE. Fizeram parte desse estudo, 17 mulheres saudáveis (GC) e 17 com incontinência urinária por esforço (GIUE) com faixa etária de 20 a 60 anos. A avaliação da força dos MAP foi realizada por meio de um dinamômetro transvaginal, em uma única sessão de teste. Os dados foram coletados com a paciente em litotomia, sendo as voluntárias instruídas a realizar uma contração máxima dos MAP e resistir até a exaustão. O teste foi repetido por três vezes com intervalo de 1 minuto entre as coletas. Os parâmetros dinamométricos utilizados para avaliar os MAP foram: tempo do pico (tempo em que ocorreu o pico de força a partir do início da contração dos MAP), linha base (força passiva), valor de força máxima da contração dos MAP, impulso de contração e força média da contração dos MAP e endurance. A análise de covariância (ANCOVA) com teste post hoc de Bonferrone, demonstrou que somente a variável endurance foi diferente entre os grupos (F=4.87, P=0.03; p2= 0.14). A acurácia do endurance para identificar mulheres com IUE foi verificada pela curva de característica de operação do receptor (ROC). A área sobre a curva foi de 0.76 sendo a sensibilidade e especificidade de 76.60% para ambas as condições. Nesse estudo foi possível verificar que somente a variável endurance possui acurácia moderada para identificar mulheres com incontinência urinária por esforço.

Introdução: Devido à fatores hormonais e mecânicos, a gestação e o parto provocam alterações que podem gerar disfunções do assoalho pélvico (DAP). Os estudos sobre as DAP no puerpério a curto prazo são escassos e fazem uso assistemático de métodos avaliativos. Objetivo: Identificar e avaliar as DAP no pós-parto imediato, um mês e três meses após o parto, comparando parto vaginal (PV), cesárea eletiva (CE) e cesárea intraparto (CI). Métodos: Estudo observacional longitudinal que avaliou mulheres até 48 horas (fase 1); um mês (fase 2) e três meses após o parto (fase 3). Utilizou-se o International Consultation on Incontinence Questionnaire (ICIQ-SF); o Índice de Incontinência Anal (IA) de Jorge-Wexner; a Escala Análoga Visual (EVA) para dor pélvica; o Pelvic Organ Prolapse Quantification system (POP-Q) e a perineometria dos Músculos do Assoalho Pélvico (MAP), além de questionário estruturado. Resultados: Foram avaliadas 227 pacientes na fase 1 (141 realizaram PV; 28 realizaram CI e 58 realizaram CE); 79 na fase 2 e 41 na fase 3. O escore do ICIQ-SF, índice de IA, EVA e perineometria não apresentaram diferenças significativas em relação ao tipo de parto. O ponto distal do colo uterino apresentou-se mais prolapsado no grupo PV. Conclusão: O tipo de parto não foi um fator significante para o desenvolvimento das DAP no pós-parto a curto prazo. Foi identificado que ocorreu recuperação fisiológica na funcionalidade dos MAP e piora na sustentação da parede vaginal anterior e no impacto da incontinência urinária na qualidade de vida ao longo dos três meses. / Introduction: Due to mechanical and hormonal factors, pregnancy and childbirth triggers changes that can lead to pelvic floor dysfunction (PFD). PFD studies in the immediate postpartum period are scarce and do unsystematic use of evaluation methods. Objective: To identify and evaluate the immediate, one month and three months postpartum PFD, comparing vaginal delivery (VD), elective cesarean (ECS) and cesarean indicating (ICS) during labor. Methods: This was a longitudinal observational study that assessed postpartum women after up to 48 hours (phase 1); one month (phase 2) and three months (phase 3). The study used the International Consultation on Incontinence Questionnaire (ICIQ-SF); Jorge-Wexner's Anal Incontinence (AI) score; the Visual Analogue Scale (VAS) for pelvic pain; the Pelvic Organ Prolapse Quantification System (POP-Q); and a Pelvic Floor Muscles (PFM) perineometer, as well as a structured questionnaire. Results: A total of 227 patients were assessed in phase 1 (141 had VD, 28 ICS and 58 ECS); 79 in phase 2 and 41 in phase 3. The ICIQ-SF, AI, VAS and perineometer index did not present significant differences in relation to the type of delivery. The distal point of the cervix presented more prolapse in VD. Conclusion: The type of delivery was not a significant factor for the development of postpartum PFD in the short term. The study found that there was physiological recovery of the functionality of PFM and worsening prolapse of the anterior vaginal wall and urinary incontinence over the three months.

Bakgrund: Bäckenbotten utsätts för stor påfrestning under graviditet och förlossning. I samband med förlossning kan skador på bäckenbotten uppstå. Dessa skador kan leda till både kort- och långsiktiga besvär som i sin tur kan påverka kvinnors livskvalitet och dagliga liv. Syfte: Syftet med studien var att kartlägga vilka bäckenbottenbesvär kvinnor upplever 6-16 veckor efter vaginal förlossning samt att beskriva dess påverkan på livskvalitet och dagligt liv. Metod: Studien var en kvantitativ tvärsnittsstudie där datainsamling skedde via en webbenkät. Webbenkäten bestod av bakgrundsfrågor utformade av författarna samt två validerade enkäter, PFDI-20 och PFIQ-7. Insamlad data analyserades i statistikprogrammet SPSS. Totalt deltog 135 kvinnor i studien. Resultat: I kartläggningen framkom att en stor andel kvinnor drabbats av bäckenbottenbesvär efter förlossning. Trots det uppgav majoriteten av kvinnorna att de ej hade besvär från sin bäckenbotten som inverkade på deras livskvalitet eller dagliga liv. Bland de kvinnor som upplevde besvär var det främst förmågan att utföra dagliga hushållsarbeten, förmågan till fysisk aktivitet och påverkan på psykisk hälsa som påverkade livskvaliteten. Konklusion: Studiens resultat antyder på att en stor andel kvinnor drabbas av bäckenbottenbesvär efter vaginal förlossning. Det är viktigt att belysa denna problematik så att kvinnor kan få adekvat stöd och behandling vid besvär. Trots att majoriteten av respondenterna ej upplevde att bäckenbottenbesvären inverkade på deras livskvalitet eller dagliga liv är det viktigt att ej normalisera bäckenbottenbesvär eller att se dem som en naturlig följd av graviditet och förlossning. / Background: The pelvic floor is exposed to great stress during pregnancy and childbirth. In connection to childbirth, injuries to the pelvic floor can occur, so called birth injuries. These injuries can lead to both short- and long term problems for women. These problems can have an impact on womens quality of life and daily life. Aim: The purpose of the study was to chart which pelvic floor disorders women experience 6–16 weeks after vaginal delivery and describe its impact on quality of life and daily life. Method: The study was a quantitive cross-sectionalstudy where the data collection was done through a online questionnarie. The online questionnarie consisted of background questions designed by the authors and two validated questionnaries, PFDI-20 and PFIQ-7. Collected data was analyzed using the statistical program SPSS. A total of 135 women participated in the study. Result: In the survey of pelvic floor disorders, it was found that a large proportion of women suffered from pelvic floor disorders after childbirth. Despite this, the majority of women stated that they did not have problems from their pelvic floor that affected their quality of life or daily life. Among the women who experienced problems it was mainly the ability to perform household chores, the ability for physical activity and the impact on mental health that affected quality of life. Conclusion: The results of the study suggest that a large proportion of women suffer from pelvic floor disorders after vaginal delivery. It is important to shed light on this issue so that women can receive adequate support and treatment for their problems. Despite the fact that the majority of the respondents stated that their pelvic floor disorders did not affect quality of life or daily life, it is important to not normalize or see pelvic floor disorders as a natural consequence of pregnancy and childbirth.

Title: Sexual Dysfunction and Pelvic Floor Dysfunction in Patients with Systemic Rheumatic Diseases Objectives: To assess sexual functions, quality of life and pelvic floor function in female patients with Systemic Sclerosis (SSc) and Idiopathic Inflammatory Myopathies (IIM) compared to age-/sex-matched healthy controls (HC). Methods: In total, 41 women with SSc (mean age: 50.9, disease duration: 5.8 years), who fulfilled the ACR/EULAR 2013 classification criteria for SSc, 41 healthy controls (mean age: 50.9) without rheumatic diseases, 22 women with IIM [mean age: 55.1, disease duration: 7.9 years, dermatomyositis (DM, 8)/ polymyositis (PM, 10)/ necrotizing myopathy (IMNM, 3)/ inclusion body myositis (IBM, 1)], who fulfilled the Bohan/Peter 1975 diagnostic criteria for DM/PM, and 22 healthy controls (mean age: 55.1 years) filled in 12 well-established and validated questionnaires assessing sexual function/quality of life, pelvic floor function, fatigue, physical activity and depression. Results: Compared to HC, patients with SSc and IIM had significantly higher prevalence and greater severity of sexual dysfunction (FSFI, BISF-W: in all subscales as well as total scores), dysfunction of pelvic floor (PISQ-12), and worse sexual quality of life (SQoL-F). Worse scores in SSc patients were associated...

Purpose: The literature indicates that normal healthy women can increase the strength of the pelvic floor muscles (PFMs) by simultaneously contracting the transverse abdominus (TrA) muscle. This study investigated the relationship of the PFMs and the TrA in women with stress urinary incontinence (SUI). Subjects: 15 women with SUI, verified by scores on the Questionnaire of Urinary Incontinence Diagnosis (QUID), were randomly assigned, blocked by age, into 2 exercise groups. The 6 women in the PFM only group had a mean age of 63 years and the 9 women in the PFM+TrA group had a mean age of 49 years. Method: For 2 weeks, all women were trained by rehabilitative ultrasound imaging (RUSI) to correctly contract the TrA or relax the TrA during a PFM contraction depending upon the group assignment. Each woman was examined using the PERFECT scheme and prescribed a patient-specific PFM exercise program. The exercise protocols required 6 weeks of supervised patient specific exercises. Data collection occurred at 3 time periods (before intervention, after intervention, and follow-up) and included: measurement of TrA thickness changes and PFM lift by RUSI, PFM strength and endurance with pressure perineometry, number of incontinence episodes and pad use from bladder diaries, and quality of life (QOL) measurements using the Incontinence Impact Questionnaire (IIQ) and the Patient Specific Functional Scale (PSFS). Results: MANOVA identified no significant difference after interventions between groups. All women significantly improved in PFM strength (PConclusion: PFM exercises done in isolation or with recruitment of the TrA increased PFM strength, endurance, lift and decreased incontinence in women with SUI. Recommendations: Women with SUI can benefit from physical therapists prescribing PFM exercises in isolation or in combination with TrA contractions.

Pelvic floor disorder is an emerging research area and is highlighted in many pelvic floor studies. Assessment methods for this type of injury are lacking and new methods for prevention and diagnosis are needed. Pelvic floor disorders are common among women and can lead to suffering for the patient. Levator ani muscle injuries are the main cause for pelvic floor disorders. This muscle group is an anisotropic skeletal muscle that helps support the pelvic viscera. Assessment of this muscle is difficult due to its complex geometry and location. Therefore, two muscle phantoms were constructed to mimic different properties of the levator ani muscle. The muscle phantoms provided more availability and a more controlled setting. The muscle phantoms were examined using ultrasound-based shear wave elastography which is an elastography method that can help determine the elasticity of tissue. A PVA-graphite phantom and a water-based gelatine-graphite phantom, both with fishing lines network as fibers for anisotropy, were constructed in this project. Shear wave elastography results of the PVA phantom indicated no anisotropy but visually resembled a muscle. Although not achieving anisotropy, the shear modulus of the PVA did match the shear modulus of skeletal muscle tissue. Shear wave elastography results of the gelatine phantom indicated anisotropy but visually did not resemble a muscle due to the low shear modulus of the gelatine. A 3D model of the female bony pelvis, that was provided for this project, was measured, and compared with reference value of previous study for future construction and 3D printing of the model. Results of measurements showed similarities between the 3D model and the female pelvis except for the sagittal outlet which had a deviant value. For future work, the muscle phantom can be developed by applying the complex geometry of the levator ani muscle, assembly of the muscle phantom, and the 3D rendering of the pelvis. The combination of these two parts provides a more complete phantom where shear wave elastography can be applied in the same way as in female patients. / Bäckenbottenbesvär är ett framväxande forskningsområde och lyfts fram i många bäckenbottenstudier. Bedömningsmetoder för denna typ av skador saknas och det behövs nya metoder för förebyggande och diagnostik. Bäckenbottenbesvär är vanliga bland kvinnor och kan leda till lidande för patienten. Levator ani muskelskador är den främsta orsaken till bäckenbottensjukdomar. Denna muskelgrupp är en anisotrop skelettmuskel som hjälper till att stödja inälvorna i bäckenet. Bedömning av denna muskel är svår på grund av dess komplexa geometri och läge. Därför konstruerades två muskelfantomer för att efterlikna olika egenskaper hos levator ani-muskeln. Muskelfantomerna gav mer tillgänglighet och en mer kontrollerad inställning. Muskelfantomerna undersöktes med hjälp av ultraljudsbaserad skjuvvågselastografi som är en metod som kan hjälpa till att bestämma vävnadens elasticitet. En PVA-grafitfantom och en vattenbaserad gelatin-grafitfantom, båda med fiskelinsnätverk som fibrer för anisotropi, konstruerades i detta projekt. Resultat från skjuvvågselastografi på PVA-fantomen indikerade ingen anisotropi, men liknade visuellt en muskel. Även då anisotropi inte uppnåddes, så matchade skjuvmodulen för PVA skjuvmodulen för skelettmuskelvävnad. Resultat från skjuvvågselastografi på gelatinfantomen indikerade anisotropi dock visade resultatet ingen visuell liknelse av en skelettmuskel på grund av gelatinets låga skjuvmodul. En 3D modell av bäckenbenet, som förseddes det här projektet, mättes och jämfördes med referensvärde av tidigare studie för framtid 3D friformsframställning av modellen. Resultat av mätningar visade på liknelser mellan 3D modellen och det kvinnliga bäckenbenet förutom sagittal outlet som hade ett avvikande värde. Inför fortsättning av det här projektet kan en utveckling av muskel fantomen ske genom applicering av den komplexa geometrin hos levator ani muskeln samt sammansättning av muskel fantomen och 3D framställningen av bäckenbenet. Sammansättningen av dessa två delar ger en mer komplett fantom där skjuvvågselastografi kan appliceras på samma sätt som hos kvinnliga patienter. / Ja

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.