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Medicina (Kaunas, Lithuania) Mar 2022: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of... (Review)
Review
: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of this therapy among pelvic floor physiotherapists, little is known about its effects and effectiveness in pelvic floor disorders. For this reason, the aim of the present review is to assess the effects of non-invasive 300 kHz-1 MHz radiofrequency diathermy in the treatment of pelvic floor disorders. : A literature search was performed in PubMed, Scopus and Web of Science, searching for any type of study that included pelvic floor disorder participants and an experimental group treated with non-invasive nor ablative radiofrequency diathermy. : There were a total of 578 studies after removing duplicates. The inclusion and exclusion criteria were applied, resulting in a total of 15 studies, which were methodologically assessed with PEDro and the Newcastle and Ottawa scale. : Despite the low quality of most of them, the studies showed improvements in urinary incontinence, pelvic pain conditions, pelvic floor muscles strength and sexual function. These findings must be considered with caution until more randomized clinical trials are performed to solve the biases detected.
Topics: Diathermy; Exercise Therapy; Humans; Pelvic Floor; Pelvic Floor Disorders; Urinary Incontinence
PubMed: 35334613
DOI: 10.3390/medicina58030437 -
International Urogynecology Journal Oct 2022Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD.... (Review)
Review
INTRODUCTION AND AIMS
Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes' experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes' experiences of symptoms of PFD.
METHODS
The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes' experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity.
RESULTS
Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions.
CONCLUSIONS
The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.
Topics: Athletes; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Quality of Life; Urinary Incontinence
PubMed: 36040507
DOI: 10.1007/s00192-022-05302-6 -
Physiotherapy Jun 2019Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on...
BACKGROUND
Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription.
OBJECTIVE
To investigate the efficacy of pelvic floor muscle training in treating ED and PE.
DATA SOURCES
A computerized literature search of CINAHL, Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science.
STUDY SELECTION
All studies where participants were males greater than 18years with ED or PE, with no history of neurological injury or previous major urological surgery were included.
STUDY APPRAISAL
Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus.
RESULTS
Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity.
LIMITATIONS
The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling.
CONCLUSION
Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42016047261.
Topics: Erectile Dysfunction; Exercise Therapy; Humans; Male; Pelvic Floor; Premature Ejaculation
PubMed: 30979506
DOI: 10.1016/j.physio.2019.01.002 -
Archivio Italiano Di Urologia,... Dec 2022Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS),... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD), stroke.
OBJECTIVE
The aim of our study was to review the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder.
MATERIALS AND METHODS
We searched two electronic databases (PubMed and EMBASE) for randomized controlled trials focusing on pharmacological and non-pharmacological medical treatments for overactive bladder symptoms associated with neurological diseases published up to 30 April 2022.
RESULTS
A total of 157 articles were retrieved; 94 were selected by title and abstract screening; after removal of 17 duplicates, 77 records were evaluated by full-text examination. Sixty-two studies were finally selected. The articles selected for review focused on the following interventions: anticholinergics (n = 9), mirabegron (n = 5), comparison of different drugs (n = 3), cannabinoids (n = 2), intravesical instillations (n = 3), botulinum toxin (n = 16), transcutaneous tibial nerve stimulation (TTNS) (n = 6), acupuncture (n = 2), transcutaneous electrical nerve stimulation TENS (n = 4), pelvic floor muscle training (PFMT) (n = 10), others (n = 2). Anticholinergics were more effective than placebo in decreasing the number of daily voids in patients with PD (mean difference [MD]- 1.16, 95 % CI - 1.80 to - 0.52, 2 trials, 86 patients, p < 0.004), but no significant difference from baseline was found for incontinence episodes and nocturia. Mirabegron was more effective than placebo in increasing the cystometric capacity in patients with MS (mean difference [MD] 89.89 mL, 95 % CI 29.76 to 150.01, 2 trials, 98 patients, p < 0.003) but no significant difference was observed for symptom scores and bladder diary parameters. TTNS was more effective than its sham-control in decreasing the number of nocturia episodes (MD -1.40, 95 % CI -2.39 to -0.42, 2 trials, 53 patients, p < 0.005) but no significant changes of OAB symptom scores were reported. PFMT was more effective than conservative advice in decreasing the ICIQ symptom score (MD, -1.12, 95 % CI -2.13 to -0.11, 2 trials, 91 patients, p = 0.03), although the number of incontinence episodes was not significantly different between groups.
CONCLUSIONS
The results of the meta-analysis demonstrate a moderate efficacy of all considered treatments without proving the superiority of one therapy over the others. Combination treatment using different pharmacological and non-pharmacological therapies could achieve the best clinical efficacy due to the favorable combination of the different mechanisms of action. This could be associated with fewer side effects due to drug dosage reduction. These data are only provisional and should be considered with caution, due to the few studies included in metaanalysis and to the small number of patients.
Topics: Humans; Cholinergic Antagonists; Nocturia; Pelvic Floor; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Bladder, Neurogenic; Urinary Bladder, Overactive; Urinary Incontinence
PubMed: 36576454
DOI: 10.4081/aiua.2022.4.492 -
Physiotherapy Jun 2023Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown.
OBJECTIVES
To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women.
DATA SOURCES
EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021.
STUDY SELECTION/ELIGIBILITY
Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included.
STUDY APPRAISAL AND SYNTHESIS METHODS
Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis.
RESULTS
Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care.
LIMITATIONS
Three of the 16 trials had a low risk of bias.
CONCLUSION AND IMPLICATIONS
Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).
Topics: Humans; Female; Pregnancy; Rectus Abdominis; Abdominal Muscles; Exercise Therapy
PubMed: 36934466
DOI: 10.1016/j.physio.2023.02.002 -
BMC Women's Health Nov 2023Childbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life,...
BACKGROUND
Childbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training).
AIM
The objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback.
METHODS
The literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance.
RESULTS
Eight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient.
CONCLUSION
The scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.
Topics: Pregnancy; Female; Humans; Pelvic Floor; Feedback; Physical Therapists; Exercise Therapy; Biofeedback, Psychology; Delivery, Obstetric; Fecal Incontinence; Urinary Incontinence, Stress; Treatment Outcome
PubMed: 37980530
DOI: 10.1186/s12905-023-02765-7 -
Taiwanese Journal of Obstetrics &... Nov 2019There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females' sexual function and quality... (Meta-Analysis)
Meta-Analysis
There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females' sexual function and quality of life. Some evidences showed that pelvic floor muscle training can strength pelvic muscles and prevent sexual dysfunction. Therefore, current study aimed to review the effect of pelvic floor exercise on female sexual function and quality of life in the postpartum period. PubMed, CINAHL, Medline, Scopus, Google scholar citations, Persian databases including SID and Iran Medex were searched using MeSH-based keywords to find published articles. Experimental and quasi-experimental studies in Persian and English were included. Data extracted was done in pre-defined checklist by two independent researchers. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-Analysis of the data was carried out by "Comprehensive Meta-analysis Version 2" (CAM). The search resulted in 347 titles and abstracts, which were narrowed down to 12 potentially eligible articles. Pooled standardized differences in means (SMD) of sexual function in both pelvic floor exercise and control group were 0.462 [0.117 to 0.806], p = 0.009. The pooled SMD was 1.294 [0.926 to 1.663], p < 0001 for sexual quality of life. The pooled SMD was 0.232 [0.038-0.426], p = 0.019 for general quality of life. Evidences showed that pelvic floor muscle training in primi or multi-parous women can boost sexual function and quality of life in postpartum. Although the majority of studies and the result of meta-analysis reported positive results, more high-quality RCTs are needed in this area. One limitation of our study is significant heterogeneity because of different intervention method.
Topics: Exercise Therapy; Female; Humans; Pelvic Floor; Postpartum Period; Pregnancy; Pregnancy Complications; Quality of Life
PubMed: 31759521
DOI: 10.1016/j.tjog.2019.09.003 -
The Cochrane Database of Systematic... Oct 2018Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014.
OBJECTIVES
To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate.
MAIN RESULTS
The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality.
AUTHORS' CONCLUSIONS
Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
Topics: Biofeedback, Psychology; Exercise Therapy; Female; Humans; Muscle Contraction; Pelvic Floor; Perineum; Quality of Life; Randomized Controlled Trials as Topic; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 30288727
DOI: 10.1002/14651858.CD005654.pub4 -
World Journal of Urology Nov 2022Urinary incontinence remains common in men after prostatectomy. Current guidance suggests early corrective surgery to those that are still incontinent after trying...
PURPOSE
Urinary incontinence remains common in men after prostatectomy. Current guidance suggests early corrective surgery to those that are still incontinent after trying Pelvic Floor Muscle Therapy, however, other treatments are now available. This review aims to evaluate all currently available treatment options for men with post-prostatectomy incontinence (PPI).
METHODS
A search of MEDLINE and CENTRAL databases on 2/2/2021 produced 879 articles. Any study evaluating incontinence before and after a treatment protocol was eligible for inclusion. After screening, 17 randomized control trials were included, and pre-defined data points were collected. Due to heterogeneity, pooled analysis was not possible, and a descriptive synthesis was produced in accordance with PRISMA guidelines. Cochrane Risk of Bias (RoB) tool was used to evaluate all studies. The search protocol and methods for this study was registered on the PROSPERO database before the search began, ID:(CRD42021229749).
RESULTS
3/17(18%) of studies focussed on pharmacotherapy, 2/17(12%) on vibration therapies, 8/17(47%) on pelvic floor muscle therapy (PFMT), 3/17(18%) on electrical stimulation (ES), and 1/17 (6%) on extracorporeal magnetic innervation (ExMI) as their main intervention. The use of Duloxetine, Solifenacin, PFMT, ES, and ExMI all show effective reduction in incontinence in men suffering from PPI. No study in this review evaluated surgical managements for PPI.
CONCLUSION
A large number of treatments are available for PPI using an array of different methods. For this reason, a variety of treatments could be considered before early invasive procedures, to prevent unnecessary surgery and its associated negative complications.
Topics: Male; Humans; Pelvic Floor; Electric Stimulation Therapy; Exercise Therapy; Urinary Incontinence; Prostatectomy
PubMed: 36107210
DOI: 10.1007/s00345-022-04146-5 -
Actas Urologicas Espanolas Nov 2018Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor...
BACKGROUND
Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period.
OBJECTIVE
To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor.
METHODS
We consulted the databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Trip Database and Web of Science. We selected systematic reviews, clinical trials and analytical studies that assessed the efficacy of hypopressive abdominal gymnastics in women. The measured outcomes were the strengthening of the pelvic floor muscles, the incidence of urine incontinence or prolapse and symptom remission. We included 4 clinical trials, whose quality was measured with the PEDro scale.
RESULTS
Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance.
PRACTICAL IMPLICATION
The evidence reviewed does not support the recommendation for hypopressive abdominal gymnastics for strengthening the pelvic floor either during the postpartum period or outside that period. Pelvic floor muscle training remains the first-line treatment for pelvic floor dysfunction.
CONCLUSION
There is a lack of quality clinical trials that have evaluated the efficacy of hypopressive abdominal gymnastics.
Topics: Exercise Therapy; Female; Humans; Pelvic Floor Disorders
PubMed: 29248338
DOI: 10.1016/j.acuro.2017.10.004