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Aims To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM). Methods A double-blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire - Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry. Results Fifty-two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference -1.5 cmH₂0 [95% confidence interval [CI] -4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH₂0 [25%-75% interquartile range 0.0-5.6; p = 0.12]) after the intervention period. Conclusions Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.

To date, no study has investigated the correlation between pelvic floor muscle function and urinary incontinence in female runners. The aim of the study was to investigate the relationship between pelvic floor muscle function and to correlate urinary leakage as measured by the modified pad test with kinematic variables of running. The sample consisted of 11 incontinent and 17 continent runners. On day 1, they performed a maximum velocity test on a treadmill using an incremental protocol. Their pelvic floor muscles were evaluated using vaginal palpation and manometry, and the adapted pad test was used to evaluate the severity of urinary incontinence. Then, running kinematics were evaluated on a treadmill using a circuit camera to capture vertical displacement, knee flexion during the load response phase, and the initial contact of the foot with the ground for subsequent analysis. The pad test was performed during the kinematic evaluation. The vaginal squeeze pressure of the continent group (mean = 43.40 mmHg, SD = 21.75) was higher in descriptive terms than that of the incontinent group (mean = 38.94 mmHg, SD = 31.08), but the difference was not statistically significant (p = 0.66). There was an association between the weekly training load and urinary leakage. No associations were found between pelvic floor muscle function or urinary leakage and the kinematic variables. Despite the correlation between the weekly training load and the severity of urinary leakage, no relationships were found between pelvic floor muscle functioning and the kinematics of running.

Aim To verify which one improves better stress urinary incontinence (SUI) symptoms: abdominal hypopressive technique (AHT) or pelvic floor muscle training (PFMT). Methods Randomized controlled trial. Women with SUI who had not participated of physiotherapy program before were invited. The outcome measures were 7-day bladder diary, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and pelvic floor muscles (PFM) function measured by Modified Oxford grading System with vaginal palpation and manometry with Peritron. Intervention consisted by 12 weeks of exercises program including PFMT or AHT program, in groups of maximum three women, twice a week, with physiotherapist supervision. Results AHT and PFMT groups reduced urinary leakage episodes in 7 days, -0.64 and -1.91, respectively, but PFMT was superior, whit mean difference -1.27 (95% confidence interval [CI]: -1.92 to -0,62) and effect size was 0.94 in favor to PFMT. Regarding to total score of ICIQ-SF, both groups improved, with mean difference between groups -4.7 (95% CI: -6.90 to -2.50) and effect size was 1.04 in favor to PFMT. Manometry also presented improvement after treatment for both groups with mean difference between them of 11 (95% CI: 6.33-15.67) and effect size was 1.15 also in favor to PFMT. Conclusion Regarding to SUI symptoms, quality of life impact and PFM function both groups presented improvement, however, PFMT was superior to AHT among all of them.

Aims To verify if hypopressive exercises (HEs) can improve pelvic organ prolapse (POP) symptoms equally or better than pelvic floor muscle training (PFMT). Methods Randomized controlled trial. Symptomatic women with untreated stage II POP according to the Pelvic Organ Prolapse Quantification System (POP-Q) having the ability to contract their pelvic floor muscles were invited. The outcome measures were POP symptoms as measured by specific questions and Prolapse Quality of Life (P-QoL); POP severity as measured by POP-Q; and PFM function. Intervention consisted by 12 weeks of PFMT or an HE home exercise program with bimonthly sessions with a physiotherapist. The protocol consisted of three initial sessions to learn how to perform the exercises correctly, followed by 3 months of exercise with monthly progression. Volunteers filled out exercise diaries to record their compliance. Results PFMT presented better results in terms of the following symptoms: a bulge/lump from or in the vagina, heaviness or dragging on the lower abdomen, and stress incontinence. PFMT also presented better results regarding the Prolapse impact and role, social and personal limitations of P-QoL. Regarding the total number of symptoms at the end, the PFMT group presented a mean of 1.7 (±1.2), and the HE group presented a mean of 2.8 (±1,1); the effect size was 1.01 in favor of the PFMT group (95%CI = 1.002-1.021). Conclusion Both groups exhibited improvements in POP symptoms, quality of life, prolapse severity, and PFM function. PFMT was superior to HE for all outcomes.

Aims We aimed to compare pelvic floor muscle (PFM) strength and sexual function in primigravid and non-pregnant women and compare PFM strength between those who exhibited and did not exhibit sexual dysfunction. Methods A cross-sectional observational study was conducted. The sample consisted of 154 women, including 76 primigravid and 78 non-pregnant women. The inclusion criteria were as follows: non-pregnant nulliparous women or primigravid women who were pregnant with a single foetus at least 14 weeks of gestational age and reported having sexual intercourse at least once during the last 4 weeks. The exclusion criteria were as follows: inability to contract the PFMs and prior urogynaecologic surgery. PFM strength was assessed via vaginal palpation (using the Modified Oxford Scale) and vaginal squeeze pressure (using the Peritron™ manometer). Sexual function was assessedusing the Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was identified based on low FSFI scores.The data were analyzed using the Mann-Whiney and Spearman correlation tests. Results To discussion, primigravid women had lower FSFI scores and lower PFM strength than non-pregnant women. Women with sexual dysfunction had lower PFM strength than women without sexual dysfunction, as indicated by vaginal palpation (scores of 2 out of 5 and 4 out of 5, respectively; P

This study aimed to evaluate the levator hiatus area (LHA) at rest and during the performance of maximal pelvic floor muscle (PFM) contractions, during the abdominal hypopressive technique (AHT), and during the combination of PFM contractions (PFMCs) and the AHT. The study included 17 healthy nulliparous women who had no history of pelvic floor disorders. The LHA was evaluated with the patients in the lithotomy position. After a physiotherapist instructed the patients on the proper performance of the PFM and AHT exercises, 1 gynecologist performed the 3-dimensional translabial ultrasound examinations. The LHA was measured with the patients at rest. The PFMC alone, the AHT alone or the AHT in combination with a PFMC with 30 seconds of rest between the evaluations were performed. Each measurement was performed 2 times, and the mean value was used for statistical analysis. The Wilcoxon test was used to test the differences between the 2 maneuvers. Similar values were observed when comparing the LHA of the PFM at rest (12.2 ± 2.4) cm and during the AHT (11.7 ± 2.6) cm (P = 0.227). The AHT+ PFMC (10.2 ± 1.9) cm demonstrated lower values compared with AHT alone (11.7 ± 2.6) cm (P = 0.002). When comparing the PFMC (10.4 ± 2.1) cm with the AHT + PFMC (10.2 ± 1.9) cm, no significant difference (P = 0.551) was observed. During PFMC, the constriction was 1.8 cm; during the AHT, the constriction was 0.5 cm; and during the AHT + PFMC, it was 2 cm. The LHA assessed by 3-dimensional ultrasound did not significantly change with AHT. These results support the theory that AHT does not strengthen PFM.

Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs. Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate. Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p

The objective was to evaluate the pelvic floor muscles (PFM) in primigravidae and compare them with those in nonpregnant nulliparous women. The sample consisted of 141 women with a mean age of 22.8 years, divided into four groups: 36 nonpregnant nulliparous (C), 31 primigravidae in the first trimester (1T), 42 primigravida in the second trimester (2T), and 32 primigravidae in the third trimester (3T). The participants were examined by digital palpation for pelvic floor muscle contraction using the Modified Oxford Scale, by measuring maximal vaginal squeeze pressure with a vaginal perineometer, and by measuring PFM maximal strength using a vaginal dynamometer. The best value of three maximal strengths was considered for analysis, the Kruskal–Wallis and Mann–Whitney U tests were used and differences were considered significant at p ≤ 0.05. The mean values for group C were 3.2 (digital palpation), 45.6 cmH2O (perineometry), and 11.7 N (dynamometry); for group 1T the corresponding values were 2.5, 21.1 cmH2O, and 8.8 N; for group 2T: 2.8, 22.9 cmH2O, and 7.8 N; and for group 3T: 2.1, 17.3 cmH2O, and 6.8 N. Groups were compared in pairs for digital palpation, perineometry, and dynamometry. There were significant differences between group C and group 1T, and between group C and group 3T. There was a significant difference between group C and group 2T with regard to perineometry and dynamometry, but not digital palpation. Dynamometry demonstrated a difference between groups 1T and 3T, digital palpation between groups 2T and 3T. Pelvic floor muscles in primigravidae are not as strong as those in nonpregnant nulliparous women.

Biofeedback (BF) has been widely used in the treatment of pelvic floor dysfunctions, mainly by promoting patient learning about muscle contraction with no side effects. However, its effectiveness remains poorly understood with some studies suggesting that BF offers no advantage over the isolated pelvic floor muscle training (PFMT). The main objective of this study was to systematically review available randomized controlled trials assessing the effectiveness of BF in female pelvic floor dysfunction treatment. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). Randomized controlled trials assessing the training of pelvic floor muscle (PFM) using BF in women with PFM dysfunction were selected. Outcomes were converted to a scale ranging from 0 to 100. Trials were pooled with software used to prepare and update Cochrane reviews. Results are presented as weighted mean differences with 95 % confidence intervals (CI). Twenty-two trials with 1,469 patients that analyzed BF in the treatment of urinary, anorectal, and/or sexual dysfunctions were included. PFMT alone led to a superior but not significant difference in the function of PFM when compared to PFMT with BF, by using vaginal measurement in the short and intermediate term: 9.89 (95 % CI -5.05 to 24.83) and 15.03 (95 % CI -9.71 to 39.78), respectively. We found a few and nonhomogeneous studies addressing anorectal and sexual function, which do not provide the cure rate calculations. Limitations of this review are the low quality and heterogeneity of the studies, involving the usage of distinct protocols of interventions, and various and different outcome measures. The results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction.

Summary Objective To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI). Methods Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the King's Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05. Results There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed. Conclusion PFM training resulted in significant improvement in the QOL of women with SUI.

Aims The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP). Methods Fifty-eight women with a mean age of 55.4 (±9.8) years old with stage II POP were randomly assigned to participate in the PFMT group, the hypopressive exercises associated with PFMT (HE + PFMT) group or the control group. Each treatment group underwent a 3-month course of treatment. The three groups received lifestyle advice regarding weight loss, constipation, coughing, and the avoidance of heavy lifting. Participants were evaluated before and after the treatment. Maximal voluntary contraction (MVC) and endurance were assessed using the Modified Oxford grading system. To evaluate muscle activation, surface electromyography (SEMG) was used. Results The two treatment group significantly increase pelvic floor muscle function as measured by MVC (P

To determine if Paula method of circular muscles contraction e.g., those surrounding the eyes, mouth and fingers, could increase pelvic floor muscle (PFM) activity.Thirty-four healthy, nulliparous volunteers were included, with an average age of 28 (± 5.9) years and body mass index of 23.8 (± 3.3) kg/m(2). They were assigned to randomly perform the sequence: a PFM maximal voluntary contraction, a contraction of circular muscles, followed by a simultaneous combination of PFM and circular muscle contraction. The PFM were evaluated using surface electromyography.PFM activity at baseline was 22.6 (± 10.9) μv. It was unchanged with Paula method contraction (p=0.322). There were also no differences between values of PFM maximal voluntary contraction alone, 99.8 (± 44.3) μv and in combination with the Paula method, 91.8 (± 35.3) μv (p=0.093).The Paula method seems not to increase PFM activity in nulliparous women.

Objective.The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no).Methods.This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores.Results.Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57versus2.06 ± 0.64;P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus35.79 ± 11.66 μV;P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92versus18.05 ± 2.14;P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = -0.193;P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785).Conclusion.The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG).Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM.In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005).In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) CONTEXTO E OBJETIVO: Estudos anteriores mostraram que mulheres com disfunção do assoalho pélvico possuem diminuição da área de secção transversal (AST) do músculo levantador do ânus. Uma forma de avaliar os efeitos de um programa de treinamento é mensurar a AST do músculo por ultrassonografia. O objetivo foi avaliar a eficácia do treinamento da musculatura do assoalho pélvico e de exercícios hipopressivos no aumento da AST do músculo levantador do ânus em mulheres com prolapso de órgãos pélvicos. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, randomizado e controlado realizado no Ambulatório de Uroginecologia da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Cinquenta e oito mulheres com prolapso de órgãos pélvicos estádio II foram divididas em três grupos para tratamento fisioterapêutico: (GI) grupo de treinamento dos músculos do assoalho pélvico, (GII) grupo de exercícios hipopressivos e (GIII) grupo controle. As pacientes se submeteram a avaliação ultrassonográfica transperineal com transdutor de frequência 4-9 MHz. Foi mensurada a AST do músculo levantador do ânus antes e após 12 semanas de tratamento fisioterapêutico. RESULTADOS: Os grupos foram homogêneos no que se refere a idade, número de gestações, número de partos vaginais, índice de massa corpórea e estado hormonal. Diferença significante foi observada na AST de GI e GII antes e após o tratamento (P < 0,001) e isso não ocorreu com o GIII (P = 0,816). CONCLUSÕES: A AST do músculo levantador do ânus aumentou significativamente com tratamento fisioterapêutico em mulheres com prolapso de órgãos pélvicos. Treinamento dos músculos do assoalho pélvico e exercícios hipopressivos são semelhantes no que se refere ao aumento da AST do músculo levantador do ânus. CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo (UNIFESP). METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle. Universidade Federal de São Paulo (UNIFESP) Department of Gynecology Universidade Federal de Uberlândia Department of Gynecology and Obstetrics UNIFESP, Department of Gynecology FAPESP: 2007/08246-8 SciELO

Dear Editor, We are pleased to read that Liebergall-Wischnitzer agrees that pelvic floor muscle training (PFMT) is effective and should be recommended as level A evidence for pelvic floor dysfunction [1]. Although in a previous paper, he and colleagues claim that the Paula method is superior in terms of cure rate (p. 377) [2]. We used surface electromyography to evaluate the pelvic floor muscle (PFM) activation during the contraction of circular muscles (Paula method). In nulliparous women, these exercises did not increase PFM activation. In two previous papers by Liebergall-Wischnitzer et al. [2, 3], patients included in the Paula group practiced, besides contraction of circular muscles, PFM voluntary contraction in a weekly individual 45-minute sessions for 12 weeks and were encouraged to practice daily for 45 min at home (p.378) [2]. Patients included in the PFMT group did structured exercise program in groups of 1–10 people for 30 min once weekly for 4 weeks, followed by two more lessons 4 weeks apart each (overall six lessons) (p.378) [2]. How can one compare so distinct training programs? Actually, the patients in both groups practiced PFMT in different proportions. What is the benefit of adding circular muscle contractions? It is well established that supervised training significantly improves the results of PFMT [4, 5]. The only way to investigate if circular contractions are more effective than the PFMT alone is to do a head-to-head assessor blinded RCT with the same training dosage and therapist contact in both arms, or add the new concept to current practice in one arm. According to Liebergall-Wischnitzer’s letter [1], PFM strength is not a desirable outcome of Paula exercises, but according to Liebergall-Wischnitzer et al. in 2005, exercising the ring muscles in a certain area of the body will result in strengthening the circular muscles in other areas (p. 345) [3]. With this phrase, we understood that strengthening was the main goal of Paula exercises. At first, how can you be sure that any circular muscle contraction leads to contraction of the others? What are the evidences for that? If this is proven, could external sphincter ani contract alone? Or PFM will be recruited too? How could the external sphincter ani be strengthened and not the PFM? Liebergall’s letter also said that when contracting the eyes/mouth and the PFM, co-contraction is not a reflex, but training is required. After a training period, the trainee begins to feel that these muscles can work together and naturally integrate with PFMT. However, in the article they say “The theory that lies behind the Paula method is that all sphincters in the human body work simultaneously, mutually affecting one another possibly mediated by oscillation of the spinal cord” (p. 345) [3]. If they naturally affect one another because of spinal cord oscillation, how could the spinal cord be trained? If it could be trained, how long this training is necessary to these muscles work together? Moreover, if a patient is taught to contract PFM during some exercises such as Pilates and yoga, with some A. P. M. Resende (*) :C. D. Petricelli : S. M. Alexandre : M. U. Nakamura :M. R. D. Zanetti Obstetrics Department, Federal University of Sao Paulo, Rua Napoleao de Barros, 875, Sao Paulo 04024–002, Brazil e-mail: anapaulamrb@gmail.com

Objetivos: Investigar os fatores preditores relacionados à queixa de incontinência urinária em corredoras.Método: Estudo transversal que incluiu 105 mulheres corredoras com idade entre 18 e 53 anos, valores de índice de massa corporal entre 18 Kg/m2 e 25 Kg/m2,que praticavam corrida há pelo menos doze meses, com volume de treino acima de 15 km por semana há pelo menos 12 meses, exceto em semana regenerativa, e para as mulheres que passaram por gestação, ter pelo menos doze meses de pós-parto. A avaliação dos músculos do assoalho pélvico (MAP) foi feita por meio de palpação vaginal graduada pela escala de Oxford modificada e pela contração voluntária máxima por meio do manômetro da marca Peritron.Resultados: Cento e cinco mulheres corredoras foram incluídas no estudo. A incontinência urinária foi associada a maior tempo da prática de corrida (p= 0,004),maior quilometragem praticada semanalmente (p= 0,005),e a prática de outras modalidades de exercícios além da corrida (p= 0,029).Adicionalmente, a maior força dos MAP foi associada à continência urinária (p= 0,021).Conclusão: Os fatores preditores para a incontinência urinária em corredoras foram o maior tempo de prática de corrida, a alta quilometragem praticada semanalmente, a prática de outro exercício. Objectives:To investigate predictive factors related to urinary incontinence in runners.Method:Cross-sectional study including 105 female runners aged 18 to 53 years, body mass index values between 18 kg / m2 and 25 kg / m2, who had been running for at least twelve months, with training volume above 15 km per week for at least 12 months, except for a regenerative week, and for women who have been pregnant, have at least 12 months postpartum. Pelvic floor muscles (PFM) were assessed by vaginal palpation graded by the modified Oxford scale and by maximum voluntary contraction using the Peritron pressure gauge.Results: One hundred and five female runners were included in the study. Urinary incontinence was associated with longer running time (p = 0,004), higher weekly mileage (p = 0,005), and exercise other than running (p = 0,029). In addition, higher strength MAP was associated with urinary continence (p = 0,021).Conclusion: Predictors of runner urinary incontinence were longer running time, weekly high mileage, and other exercise. Dissertação (Mestrado)

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Introdução As técnicas de preparação do períneo para o parto têm sido procuradas com o objetivo de diminuir a incidência de lacerações durante a fase expulsiva do trabalho de parto. No entanto, não foram encontrados estudos que investigassem os efeitos das técnicas de massagem perineal e EPI-NO® sobre variáveis dos músculos do assoalho pélvico (MAP). Objetivo Avaliar o efeito das intervenções fisioterapêuticas com a massagem perineal e com o EPI-NO® sobre a extensibilidade e a força dos MAP. Método Ensaio clínico controlado randomizado; 20 primigestas foram divididas em grupo de massagem perineal (GMP) e grupo EPINO ® (GEN). Os grupos realizaram oito sessões, duas semanais. O GMP foi submetido a um protocolo de massagem perineal durante 10 minutos e o GEN realizou a intervenção durante 15 minutos, na qual o balão era insuflado lenta e gradualmente, conforme tolerância da participante. Avaliou-se a força por meio da manometria vaginal e a extensibilidade dos MAP por meio da maior circunferência do EPI-NO® antes, após quatro e oito sessões. Para comparação dos grupos em relação às variáveis extensibilidade e força muscular, em suas três avaliações, foi realizada a análise de variância, com correção por covariância considerando a medida pré-intervenção como covariável, com nível de significância de 5%. Resultados Os grupos apresentaram aumento da extensibilidade dos MAP quando comparadas as avaliações antes e após 4 e 8 sessões (p