[Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient’s quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vaginal stimulation, along with active exercises for the pelvic floor muscles and electrical stimulation of the posterior tibial nerve, behavioral rehabilitation and exercise at home. [Results] After 15 physical therapy sessions, a patient diagnosed with multiple sclerosis and mixed urinary incontinence showed continued satisfactory results after five months. She showed better quality of life, higher strength of pelvic floor muscle and reduced urinary frequency without nocturia and enuresis. [Conclusion] The physical therapy protocol in this patient with multiple sclerosis and mixed urinary incontinence showed satisfactory results reducing urinary incontinence symptomatology and improving the patient’s quality of life.
Objetivo: Avaliação dos resultados da aplicação de um protocolo de fisioterapia aplicado em pacientes mastectomizadas (tipo Madden). Métodos: Foram avaliadas 119 pacientes, com idade entre 29 e 79 anos, submetidas a Mastectomia Modificada Radical Tipo Madden, no Instituto de Mastologia e Ginecologia do Hospital Beneficência Portuguesa - São Paulo, durante o período de maio/2001 a dezembro/2002. Destas 119 pacientes, apenas 44 foram selecionadas de acordo com critérios de inclusão e exclusão. Formaram-se 2 grupos, sendo um grupo com 33 pacientes que foram submetidas a um protocolo fisioterapêutico até a alta e um outro, com 11 pacientes que desistiram do tratamento. A amplitude de movimento (ADM) e uma possível evolução para linfedema foram avaliados em ambos os grupos. Resultados: Todas as pacientes submetidas ao protocolo fisioterapêutico, ao final do tratamento estavam sem limitação de ADM e/ou com pequena limitação, com uma faixa de variação de 150º a 180º, e apenas 3 evoluíram para linfedema. Em relação ao grupo desistente do tratamento, na reavaliação a limitação de ADM variou de 40º a 170º, sendo que 4 pacientes evoluíram para linfedema. Conclusão: O protocolo apresentado neste estudo mostrou-se eficaz para as pacientes pós-mastectomizadas. Conclui-se também que a intervenção precoce da fisioterapia, aplicada ainda no ambiente hospitalar, não só ajuda a prevenir as complicações pós-cirúrgicas, como também reabilita as pacientes mais cedo para as atividades da vida diária (AVDs), e ainda, permite a elas que possam se valer da colaboração e do incentivo da equipe multidisciplinar para o tratamento.
Bladder cancer is a worldwide health problem, due to both its high prevalence and the cost related to the treatment. It is usually identified on the basis of visible blood in the urine or blood found on urine testing, but emergency admission is a common way for bladder cancer to present and is often associated with a poor prognosis. The contracted bladder is a rare and serious complication which is disabling. In these cases, there is a need for a neobladder, which may lead to voiding dysfunction. Physiotherapeutic avenues have demonstrated effectiveness in the treatment of voiding dysfunction; they rehabilitate the individual and improve their quality of life. This study reports the case of a male patient who underwent transurethral resection of a bladder tumour (high-grade T1 carcinoma), which developed complications during treatment with Bacillus Calmette-Guérin. He also underwent cystoprostatectomy with ileal orthotopic neobladder.
Objetivo: Avaliar os efeitos da eletroestimulação transcutânea do nervo tibial e da eletroestimulação sacral para o tratamento de mulheres com diagnóstico de síndrome bexiga hiperativa por meio de uma revisão de literatura. Métodos: Busca eletrônica realizada nas bases de dados Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro) e PubMed para a identificação de artigos científicos publicados no período de janeiro de 2007 a setembro de 2016, utilizando as palavraschave “fisioterapia”, “eletroterapia”, “tratamento”, “eletroestimulação nervosa transcutânea do nervo tibial e da região sacral”, “incontinência urinária mista”, “incontinência urinária de urgência” e “mulheres”. Resultados: Foram achados apenas quatro artigos que relacionavam os tratamentos com a população feminina. Conclusão: Existem poucos estudos sobre a eletroestimulação do nervo tibial posterior e sacral como tratamento para bexiga hiperativa, entretanto os poucos achados, em maior número em eletroestimulação sacral, demonstraram-se eficazes para tratamentos a longo prazo, evidenciando, assim, necessidade de mais pesquisa na área.
Endometriosis is characterised by the presence of endometrial tissue outside the uterine cavity that responds to oestrogen and stimulates local inflammatory processes, adhesions, pelvic pain, and infertility. The treatment of endometriosis includes the use of medications and videolaparoscopy for excision of adhesions or lesions. Some complications are associated with the videolaparoscopy, such as vascular, intestinal, urinary, neurological, and more rarely, vulvar oedema, which makes the rehabilitation difficult in the immediate postoperative period. In relation to the urinary dysfunction and to the vulvar oedema, physiotherapy has resources with demonstrated efficacy in the treatment of such complications after videolaparoscopy; they can rehabilitate the patient and improve their quality of life in a short time. In this study, the authors report the case of a patient treated by the Physical Therapy Service of the Santa Casa de Misericórdia Hospital of São Paulo, São Paulo, Brazil, with urinary retention and vulvar oedema after videolaparoscopy for endometriosis, which showed improvement in vulvar oedema with the application of physiotherapy.
Introduction: Vaginismus is characterized by involuntary recurrent or persistent contraction of the perineum muscles adjacent to the lower third of the vagina when vaginal penetration with penis, finger, tampon or speculum is attempted. However, there may be low adherence to the therapy due to the need of the touch of the perineal region by the therapist. The interferential current can be an alternative, once it can be used externally and superficially. Objective: To evaluate a clinical protocol with the use of interferential current to treat vaginismus and to observe the decrease of pain and the behavior of the electrical activity on the perineal musculature. Methods: The protocol was registered in the Clinical Trials (NCT03176069) and it was approved by the Research Ethics Committee (CAAE: 51995515.4.0000.5479). This will be a controlled clinical trial with a group of patients with Vaginismus (n = 30) and another without (n = 30). All women will be submitted to evaluation and reassessment with algometry, electromyographic biofeedback and visual analogue pain scale. The vaginismus group will perform 10 sessions, twice a week, with the interferential current (frequency = 2000 Hz, modulated amplitude = 80 Hz, pulse width = 200 μs and intensity according to sensory level) for 30 minutes. The evolution of vaginismus group before and after the intervention and the correlations between groups will be statistically analysed with the t Student’s or the Mann-Whitney test with a significance level of 5% (p ≤ 0.05). Hypothesis: This protocol will present a possible alternative for the treatment of vaginismus and it will investigate the electrical activity of the pelvic floor musculature in vaginismus compared to women who do not suffer from this disorder. It is expected to decrease the pain, to measure the muscular electrical activity before and after the intervention in the vaginismus group and to investigate the muscular electrical activity in the group without sexual dysfunction.
Introduction: Some of the factors that may be associated with and influence vaginismus and female sexual function have already been studied, such as repressive education, religious teaching, cultural values, and anatomical changes; however, no studies exist that have analysed the measurement between the external urethral orifice and the vaginal introitus in the search for differences between women with and without the diagnosis of vaginismus. Objective: To verify the urethro-vaginal anthropometric relation in women with and without vaginismus. Method: This was a cross-sectional study, approved by the Ethics Committee and registered in clinical trials, conducted from February to August 2017. Sixty women were evaluated, aged 18–40 years old and all of whom were nulliparous, heterosexual, and sexually active. They were divided into two groups: Group I (women with vaginismus, n=30) and Group II (without vaginismus, n=30). Using an inelastic tape measure, the distance between the external urethral orifice and the inferior border of the vaginal introitus was checked in both groups. Results: In Group I, the mean distance between the urethral orifice and the inferior border of the vaginal introitus was 0.69 cm. In Group II, the mean was 1.46 cm, with p<0.001 demonstrated in the comparison for the difference between the groups. Conclusion: A significant difference was observed in the distance between the external urethral orifice and the inferior border of the vaginal introitus in women with and without vaginismus. This anatomical finding may be involved with the evolution of vaginismus.
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