Search Results (107)

Introduction: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor muscle training (PFMT), followed by pharmacological or minimally invasive therapies, such as neuromodulation. However, the combined effects of PFMT and neuromodulation have not been well established. This study aimed to evaluate the impact of combining pelvic floor exercises with neuromodulation versus PFMT with sham neuromodulation or standard physiotherapy after a 12-week intervention in individuals with OAB and UI. Methods/Materials: A double-blind, randomized controlled trial was designed with three groups: PFMT + neuromodulation, PFMT + sham, and conventional physiotherapy (control) in a 1:1:1 ratio. This study followed the CONSORT guidelines and was registered at ClinicalTrials.gov (NCT06783374). The sample size was calculated using GPower^® software, assuming a Cohen’s effect size of 1.04, a power of 0.80, an alpha of 0.05, and a 15% dropout rate, totaling 63 participants (21 per group). Participants attended 24 sessions over 12 weeks (2 sessions per week). The interventions were based on previously validated protocols. Outcomes: The primary outcomes included health-related quality of life, pelvic floor muscle function, pain, adherence, and general health. The secondary outcomes included Incontinence Quality of Life questionnaire, 3-day bladder diary, International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, kinesiophobia, and electromyographic data. Full article

Background: The aim of this review was to analyze training interventions used and their effectiveness in improving pelvic floor muscle function related to urinary continence in postmenopausal women. We then characterized the recommended pelvic floor muscle training programs used in experimental studies based on four training components: frequency, intensity, duration, and type of pelvic floor muscle exercise. Methods: For this purpose, we conducted a literature review of works published up until the end of 2024, available in the Web of Science, PubMed, MEDLINE, and SPORTDiscus with Full Text databases. We used the keywords “pelvic floor muscle”, “training”, and “postmenopausal women”. Initially, we identified 205 articles published between 1997 and 2024. Then, based on specific criteria, we qualified 15 for analysis. Results: Thirteen studies included only PFMT, while three of them combined PFMT with other physical activity. In two studies, training was conducted in the form of a virtual video game using a pressure platform. We have noted that researchers most often use a 1 h pad test, digital palpation, and surface electromyography to assess the function of pelvic floor muscles. In improving pelvic floor muscle function related to urinary incontinence, 14 out of the 15 analyzed studies showed improvement. In only eight of the fifteen articles, researchers characterized all components of the implemented PFMT that enable full replication of the training intervention. In four of the studies, only one of the required components, namely intensity, was missing. The recommended number of training sessions was 2 to 7 per week, on average 3 ± 2 (M ± SD). Training interventions lasted from 2 to 24 weeks, on average 10 ± 6 weeks. Conclusions: Regardless of the chosen form of training intervention, PFMT is an effective method in improving the function of pelvic floor muscles in postmenopausal women. Full article

Background: Stress urinary incontinence (SUI) is frequently underrecognized in late pregnancy, with limited tools for effective risk assessment. This study aimed to evaluate the predictive value of clinical and pelvic floor ultrasound parameters for SUI and construct a validated risk model. Methods: Clinical, obstetric, and pelvic floor ultrasound findings were collected from a total of 521 women in late pregnancy who were enrolled in the study. Based on follow-up results, participants were categorized into SUI and non-SUI groups. Logistic regression analyses were used to identify independent risk factors for SUI, which were incorporated into a nomogram. Results: Four independent predictors were identified: vaginal delivery history (odds ratio [OR] = 2.320), bladder neck funneling (OR = 2.349), bladder neck descent (OR = 1.891), and pubococcygeus muscle contraction strain rate (OR < 0.001). The nomogram achieved an AUC of 0.817 (95% CI: 0.770–0.863) in the training set and 0.761 (95% CI: 0.677–0.845) in the test set. Conclusions: The nomogram based on clinical and pelvic floor ultrasound parameters accurately predicts the risk of SUI during late pregnancy, offering a useful tool for early identification and personalized management. Full article

Background/Objectives: Urinary incontinence (UI) is a frequent and distressing complication after radical prostatectomy (RP). Pelvic floor muscle training (PFMT) is widely recommended as first-line rehabilitation, yet the clinical factors influencing its effectiveness remain incompletely understood. Methods: This prospective cohort study included 182 men undergoing RP who completed a standardized physiotherapy program involving pelvic floor muscle exercises, biofeedback (BFB), and ultrasound-guided training. UI severity was assessed using the 1-h pad test and recorded absorbent product use. Outcomes were evaluated at three time points: one month, three months, and six months post-catheter removal. A multiple linear regression model was used to identify the predictors of continence improvement, defined as the change in pad test result between baseline and six months. Results: Pad test results and absorbent use decreased significantly across all UI severity stages (p < 0.0001). The greatest absolute improvement was observed in patients with severe incontinence at baseline (UI stage 3: mean reduction from 130.8 g to 23.7 g). Regression analysis revealed that only the baseline pad test result was significantly associated with the magnitude of improvement (β = 0.91; 95% CI: 0.85–0.97, p < 0.001; R² = 0.89). Age, BMI, and time to rehabilitation were not significant predictors. Conclusions: Pelvic floor rehabilitation after RP is effective in improving continence, including in patients with severe baseline symptoms. The baseline pad test value emerged as the strongest predictor of rehabilitation response, highlighting the importance of initial assessment. These findings support the use of PFMT in clinical practice and emphasize the need for individualized treatment planning based on baseline UI severity. Full article

The number of people suffering from urinary incontinence increases every year. Along this trend, the knowledge of society increases regarding the various methods available for treating this ailment. Both patients and researchers are constantly looking for new treatments for urinary incontinence. One of the new solutions is sonofeedback of the pelvic floor muscles, which may help to strengthen them and thus reduce the problem. The aim of this study was to evaluate the effectiveness of sonofeedback and transvaginal electrostimulation in increasing the bioelectrical activity of pelvic floor muscles in postmenopausal women with stress urinary incontinence. Sixty women with stress urinary incontinence were enrolled in the study. The patients were divided into two groups: A, where sonofeedback was used, and B, where electrostimulation of the pelvic floor muscles was performed with biofeedback training. In patients, the resting bioelectrical activity of the pelvic floor muscles was assessed using an electromyograph. The assessment of the resting bioelectrical activity of the pelvic floor muscles was performed before the therapy, after the 5th training, and after the therapy. It was observed that after the end of the therapy, the average bioelectrical potential increased by 1.1 µV compared with the baseline in group A. It can be suggested that the sonofeedback method is comparatively effective in reducing symptoms that are associated with urinary incontinence as an electrostimulation method with biofeedback training. Full article

The most common anorectal disorders are fecal incontinence, functional anorectal pain, and functional defecation disorders. They are often presented by overlapping symptoms with various degrees of severity. Therefore, a personalized approach to the patient is crucial for diagnosing and determining the prognosis of the disease. Biofeedback training is appropriate to consider when the motoric function disorder is known, the patient could learn voluntary control of response, and this could further lead to an improvement in the condition. Biofeedback is recommended for short-term and long-term treatment of constipation in adults and fecal incontinence in adults. It could also be considered for treatment of specific cases of anorectal pain. As office biofeedback is often time-consuming and comes with a substantially high cost, there is an emerging trend of home biofeedback administration. However, only a few significant studies have been published on this new approach. Although comprehensive data are needed to evaluate the proper strategy and development of various treatment protocols for different types of defecation disorders, home biofeedback therapy offers a potentially effective tool in the personalized treatment of defecation disorders. Full article

Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological repercussions of surgeries such as hysterectomies, pelvic organ prolapse repairs, radical prostatectomies, and rectal cancer resections. These procedures often lead to complications like dyspareunia, erectile dysfunction, and altered body image, necessitating comprehensive re-educational approaches. The review emphasizes the importance of tailored interventions, including pelvic floor muscle training (PFMT), biofeedback, manual therapy, and advanced techniques like botulinum toxin injections and sacral neuromodulation. For men, strategies such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), intracavernosal injections, and penile prostheses are explored for their efficacy in restoring erectile function. Psychological support, including cognitive–behavioral therapy and couples counseling, is underscored as essential to addressing emotional and relational aspects of recovery. A multidisciplinary approach involving physiatrists, urologists, gynecologists, physiotherapists, psychologists, and sexual health counselors is advocated for to optimize outcomes. Integrating physical therapy modalities, as well as psychological and relational therapies, into individual rehabilitation projects is crucial for improving sexual function and overall QoL post-surgery. Future research should focus on refining these established strategies and investigating the potential of innovative therapeutic modalities. Full article

Background/Objectives: Urinary incontinence (UI) is particularly prevalent in women of all ages, but especially in older women, due to risk factors that contribute to pelvic floor muscle weakness. Urinary incontinence can have a significant psychosocial impact and compromise the quality of life of affected women. It is reported that physical activity seems to be inversely associated with UI. The aim is to summarize the impact of different modalities of physical exercises in management of older women with UI. Methods: Searches were performed in the databases PubMed, Web of Science, EMBASE and Scopus. The searches were performed on 10 December 2024. Only randomized clinical trials were included. Ninety-three papers were initially screened, and five full papers reached all the inclusion criteria describing the effects of exercise on urinary incontinence. The studies included a total of 352 elderly participants aged 60 years or older. Of these participants, 268 lived in nursing homes and 84 lived in a local community. The intervention period varied among the selected studies from 6 weeks to 12 months, and in general, the pelvic floor training was used. Results: Improvements in the quality of life and in the physical performance of the older women with UI were reported, although the risk of bias was classified as “some concerns”. Conclusions: Moreover, it is revealed that different types of exercises are used to “work” the pelvic floor muscle and contribute, in general, to reducing the symptoms, and improving the quality of life of older women with UI due to the positive impact of the exercises. Full article

Background: The impact of muscle-training treatment on quality of life and functional outcomes in people with pelvic floor dysfunction may be related to adherence rates. Methods: Nine electronic databases were searched for studies published up to 15 October 2024. A qualitative synthesis was used to describe the relationship between adherence or compliance with treatment, quality of life, and symptomatic severity. A meta-analysis of data from selected studies was performed that assessed quality of life and symptomatic severity in the short term. Results: Seven studies with 2190 participants were included. Of these studies, 42% showed rates greater than 80% in terms of adherence. A beneficial effect was found in terms of urinary incontinence severity without statistical differences between the groups (p = 0.813), while quality of life showed statistically significant improvements favoring the experimental group (p = 0.036). The quality of the evidence was collected or measured from low to high. Conclusions: People with pelvic floor disorders show high rates of adherence to pelvic floor muscle exercise and experience an improved quality of life in the short term, but more research is needed on the design of homogeneous systems to measure compliance and adherence to exercise-based treatments. Full article

Background/Objectives: Urinary incontinence (UI) is a common condition affecting women worldwide, with pelvic floor muscle training exercises (PFMT) recognized as the first-line treatment for UI. Supplementation with bioactive compounds, such as collagen and magnesium, may enhance the effectiveness of PFMT. This study aimed to evaluate the efficacy of combining a food supplement containing collagen and magnesium with PFMT in women experiencing stress (SUI), urge (UUI), or mixed (MUI) urinary incontinence. Methods: A pilot clinical trial was carried out on 44 women with stress, urge, or mixed urinary incontinence. The improvement in urinary incontinence was assessed, before and after 6 weeks (W6) of product use, by the Questionnaire for Urinary Incontinence Diagnosis (QUID) and the clinical assessment of the gynecologist. Quality of life (QoL) was assessed as a secondary endpoint. Results: At Week 6, the baseline median QUID score in the active group was significantly reduced by 64% (p < 0.001), with 76% finishing the study with a negative diagnosis for UI. In contrast, the placebo group showed a reduction in QUID score by only 10% (p < 0.001), with just 25% of participants achieving a negative diagnosis for UI. QoL statistically significantly (p < 0.001) improved by 76% in the active group, while no changes were observed in the placebo group. Conclusions: Supplementation with the (Dermoxen^® PelviPlus™/Dermoxen^® Gynable^® Urocollagen™) tested product significantly improved urinary symptoms and quality of life, demonstrating a greater effect than pelvic floor muscle training (PFMT) exercises alone. Dermoxen^® PelviPlus™/Dermoxen^® Gynable^® Urocollagen™ demonstrated efficacy across all three subtypes of UI. Full article

Background and Objectives: The aim of this study was to compare the effects of pelvic floor muscle contraction training (PFMCT) using verbal education, digital vaginal palpation (DVP), or perineometer on the common errors made during pelvic floor muscle contraction (PFMC) in women. Materials and Methods: A total of 48 women participated, and they were randomly assigned to three groups (Group I: PFMCT with verbal education, n = 16; Group II: PFMCT with DVP, n = 16; and Group III: PFMCT with perineometer, n = 16). Participants who had not previously received PFMCT were evaluated for pelvic floor muscle strength using the Modified Oxford Scale (MOS), and pelvic floor muscle activation was assessed with electromyographic biofeedback (EMG-BF). Possible errors during pelvic floor muscle contraction (gluteal, adductor and/or abdominal muscle contractions, stop breathing (breath holding), enhanced inhaling, and straining) were evaluated through inspection, palpation, or EMG-BF. After pre-training evaluations, all participants received training on pelvic floor. After this general training, each group received PFMCT using the specific training method for their group. After the training, the same evaluations were repeated. The sessions were conducted one-on-one and lasted for an average of one hour. Results: After the training, MOS values increased in Group II and Group III, while EMG-BF values only increased in Group II (p < 0.05). The number of incorrect movements during PFMC decreased after the training in all three groups (p < 0.05). The abdominal muscle contraction value monitored by EMG-BF only decreased in Group II (p < 0.05). Conclusions: Our study demonstrated that the PFMCT applied using the DVP method was more effective in creating more accurate and stronger muscle contractions and reducing common errors when compared to pre- and post-training values. Significant differences were observed between the groups in terms of performance improvements, with Group II showing the most notable progress. These results support the potential for DVP to yield better outcomes when used in PFMT. Full article

Background/Objectives: Female pelvic floor dysfunction (FPFD) is a prevalent condition affecting postpartum women. This study aims to evaluate the effectiveness of a 10-week combined aerobic and resistance training exercise prescription in improving pelvic floor muscle strength and function in postpartum women with FPFD. Methods: Thirty postpartum women diagnosed with FPFD underwent a 10-week exercise intervention. This study adopted a single-group pre–post design. Pelvic floor muscle electromyography assessment indicators were measured before and after the intervention. Results: The exercise intervention significantly improved the maximum value of fast-twitch muscle fibers (type II) and the average value of slow-twitch muscle fibers (type I) while reducing resting tension and variability. Conclusions: A 10-week combined aerobic and resistance training exercise prescription effectively improves pelvic floor muscle strength in postpartum women. It enhances the maximum value of fast-twitch (type II) muscle fibers, reduces rise and recovery times, and improves slow-twitch (type I) muscle fiber function, including increasing the mean value and reducing variability, rise time, and recovery time. Full article

Background/Objectives: Approximately 30% of women experience pelvic pain one year after vaginal delivery, and this increases to 50% during vaginal intercourse. Multimodal physiotherapy is the first-line treatment for myofascial pain of the pelvic floor muscles (PFM), often incorporating emerging technologies like radiofrequency, despite limited evidence supporting its use. The RASDOP study aims to (i) evaluate the effectiveness of multimodal physiotherapy combining therapeutic education, PFM training, and myofascial pain syndrome (MPS) management with or without radiofrequency, in reducing pain and improving sexual function postpartum; and (ii) explore the barriers and facilitators influencing adherence and perceived self-efficacy towards physiotherapy treatment in women with postpartum pelvic pain. Methods: This study employs a randomized clinical trial with a blinded examiner and two parallel groups, followed by a qualitative phenomenological study. A total of 124 postpartum women with pelvic pain (≥4 cm on the visual analogue scale) will be randomized into two groups: a multimodal physiotherapy group (therapeutic education, MPS treatment, and PFM training) and a radiofrequency + multimodal physiotherapy group (same treatment with additional non-ablative radiofrequency). Both groups will receive 12 supervised individual sessions. Assessments will be conducted pre- and post-intervention, and at 3-, 6-, and 12-month stages post-treatment. Primary outcomes include pain intensity and sexual function, while secondary outcomes involve PFM tone, strength, MPS presence, levator ani length, and distress caused by pelvic floor dysfunction. The qualitative study will utilize semi-structured interviews and focus groups analyzed thematically. Results: Radiofrequency is expected to enhance pain relief, sexual function, and PFM relaxation. Insights into adherence and barriers will aid in personalizing physiotherapy interventions. Conclusions: The RASDOP study will provide evidence on the safety and efficacy of radiofrequency in postpartum pelvic pain treatment and shed light on women’s experiences to improve therapeutic outcomes. Full article

Bioelectrical impedance analysis (BIA) has a wide range of applications. For over 25 years, it has primarily been utilized for assessing body composition. This method is non-invasive, portable, widely available, cost-effective, and user-friendly, offering the advantage of repeatability and minimal dependence on patient cooperation. BIA measures the impedance of the whole body, specifically the body’s resistance to alternating current. In postpartum women, who undergo significant physiological changes following childbirth, BIA can serve as a valuable diagnostic and monitoring tool. It is commonly employed to track body weight and fat reduction, and it facilitates the differentiation of fat mass, muscle mass, and body water content. This enables the customization of nutritional plans and the development of individualized training regimens tailored to the patient’s health status. Additionally, BIA aids in the assessment of hydration status, which is particularly critical during the postpartum period when women often experience fluid retention. Furthermore, optimal hydration is essential for lactation and maintaining favorable conditions for breastfeeding. BIA is also invaluable for evaluating nutritional status, micronutrient balance, and preventing both overweight and malnutrition. Moreover, BIA supports physical recovery by monitoring muscle mass, thereby assisting in the assessment of pelvic floor muscle regeneration following childbirth. Full article

Neurogenic lower urinary tract dysfunction (NLUTD) is a secondary complication of a wide range of neurological disorders, which affects patients’ everyday life and self-efficacy. Some brain imaging studies have shown an overlap between motor activation of the pelvic floor and lower limbs. This systematic review sought to examine the possibility of improving overactive bladder outcomes through a conservative approach based on lower limb training. We conducted a systematic literature review, following the PRISMA guidelines. The following databases were searched: PEDro, PubMed, TRIP, Cochrane Library, EDS base index, Google Scholar, and CINAHL. The PEDro Scale and Cochrane Risk of Bias Assessment Tool were used to assess the overall study quality and sources of bias. A total of 5567 records were retrieved through the systematic search, of which 104 were sought for retrieval; two cohort studies and one randomized controlled trial were finally included. Urodynamics and specific bladder functionality questionnaires showed preliminary evidence of improvement following lower limb stimulation, implemented according to different treatment types (exoskeleton training and weight-suspension walking training). Lower limb-focused exercises showed promising results for improving bladder function, despite the small number of studies and small sample sizes. Future research should confirm this hypothesis using larger samples. Full article