三种方法治疗240例盆底功能障碍的疗效分析

[目的]比较盆底肌肉训练、生物反馈-电刺激治疗、盆底肌肉锻炼-生物反馈-电刺激联合治疗盆底功能障碍的疗效.[方法]选择本院2010年7月至2011年1月收治的240例产后6周发生盆底功能障碍的患者,随机分为自然恢复组(对照组)、盆底肌肉锻炼组(手动组)、生物反馈-电刺激治疗组(仪器组)、盆底肌肉锻炼-生物反馈-电刺激联合治疗组(联合组),每组各60例.手动组和联合组每天进行30～60 min的盆底肌肉锻炼,仪器组和联合组每周给予2次上机治疗,6个周为一个疗程.比较一个疗程治疗后四组盆底的综合肌力、压力性尿失禁发生率.[结果]对照组盆底肌力完全恢复率为10％,手动组为11.7％,仪器组为58.3％,联合组为85％,四组比较均有统计学意义(P＜0.05);对照组、手动组、仪器组、联合组产后12个月压力性尿失禁发生率分别为21.7％、8.3％、3.3％、1.7％,压力性尿失禁疗效与盆底肌力恢复情况一致.[结论]三种方法均能提高盆底肌力,降低压力性尿失禁发生率,但盆底肌肉锻炼-生物反馈-电刺激联合治疗、生物反馈-电刺激治疗效果更明显.     

生物反馈电刺激引导盆底抗阻肌力训练治疗女性压力性尿失禁的临床分析

目的:分析和评估生物反馈电刺激引导盆底抗阻肌力训练治疗女性压力性尿失禁的临床疗效。方法:选择本院在2013年2月-2016年4月间门诊治疗的98例女性压力性尿失禁患者为研究主体。分成A组和B组,每组74例。A组利用盆底刺激仪给予生物反馈电刺激治疗,B组利用凯格尔盆底肌锻炼。对比盆底肌肌力变化、ICIQ-SF(女性下尿路症状-国际尿失禁标准)评估与临床疗效。结果:治疗后,两组的盆底肌肌力与ICIQ评分与治疗前相比,均有明显改善,且A组明显优于B组(P0.05)。A组的治疗总有效率明显高于B组(95.92%vs 83.67%,P0.05)。结论:在治疗女性压力性尿失禁的过程中,采用生物反馈电刺激引导盆底抗阻肌力训练相比于单纯的盆地肌锻炼而言,具有更为显著的临床疗效,可以大幅改善女性患者的盆底肌肌力水平,缓解尿失禁症状,值得推广。     

老年女性尿失禁盆底康复治疗的临床分析

目的探讨联合生物反馈和电刺激技术的盆底肌肉锻炼法治疗老年女性压力性尿失禁近期和远期疗效。方法 110例老年女性轻中度压力性尿失禁患者按随机抽样法分为两组,每组55例,分别用联合生物反馈电刺激加盆底肌肉锻炼法以及单独的盆底肌肉锻炼法治疗3月,随访2年。分别在治疗前后、随访期间每6月观察两组患者的治愈率、尿失禁症状评分及生活质量评分的变化。结果试验组治疗后收缩期盆底肌电位值较治疗前显著提高(P 0. 05)。试验组在治疗后、随访6月及随访12月时的治愈率分别为89. 1%(49/55)、83. 6%(46/55)、85. 5%(47/55),对照组的治愈率分别为56. 4%(31/55)、65. 5%(36/55)、67. 3%(37/55),试验组显著高于对照组(P 0. 05)。试验组在治疗后及随访期间的尿失禁症状评分较同时期的对照组均显著降低(P 0. 05),尿失禁生活质量问卷评分较同时期的对照组均显著增高(P 0. 05)。结论联合生物反馈电刺激技术的盆底康复治疗对老年女性压力性尿失禁有着良好的近期疗效,并且在较长时期内明显缓解患者的症状,显著提高老年女性患者的生活质量。     

生物反馈盆底肌康复疗法联合经皮穴位电刺激治疗老年女性压力性尿失禁的疗效观察

目的 观察生物反馈盆底肌康复疗法联合经皮穴位电刺激治疗老年女性压力性尿失禁的临床疗效.方法 将90例老年女性压力性尿失禁患者随机分为对照组和观察组,每组45例.对照组采用生物反馈盆底肌康复治疗,观察组在对照组基础上采用经皮穴位电刺激,2组均持续治疗4周.比较2组临床疗效、治疗前后漏尿量、尿失禁生活质量问卷(I-QOL)...     

生物反馈电刺激联合盆底肌锻炼对绝经后压力性尿失禁患者URA、盆底肌力及尿动力学的影响

压力性尿失禁是指人体腹腔压力增加时,如咳嗽、大笑等动作,导致尿液从尿道口外口不受控制流出.压力性尿失禁常见于女性绝经后,有研究表明女性发病率约为 49％[1,2].本次研究探讨生物反馈电刺激联合盆底肌锻炼改善绝经后压力性尿失禁患者尿道旋转角(urethral rotation angle,URA)、盆底肌力及尿动力学的...     

盆底肌康复治疗产后压力性尿失禁的临床观察

目的探讨盆底肌肉锻炼和功能性电刺激-生物反馈治疗产后压力性尿失禁的临床效果。方法将53例产后压力性尿失禁患者随机分为对照组27例和治疗组26例,2组均常规进行压力性尿失禁康复指导及盆底肌肉锻练,治疗组在此基础上予以功能性电刺激-生物反馈相结合治疗1疗程（10~15次）,并用康复器（阴道哑铃）结合家庭锻炼盆底肌肉及实施一对一的指导,连续随访、分段锻炼、6个月后随访。结果2组治疗效果比较,治疗组有效率明显高于对照组,差异有统计学意义（P＜0.05）。结论产后压力性尿失禁单纯进行盆底肌肉锻炼治疗只可以改善妇女压力性尿失禁的症状,治愈率较低;而接受电刺激-生物反馈、盆底康复器相结合治疗可以使患者的盆底肌肉收缩压力显著提高,尿失禁程度显著下降,较单一的盆底肌肉锻炼更加持久有效。     

盆底肌强化生物反馈联合家庭锻炼治疗老年女性真性压力性尿失禁的近期疗效分析

目的：观察盆底肌强化生物反馈联合家庭锻炼治疗老年女性真性压力性尿失禁（GSUI）疗效。方法：依据症状分别收集轻、中和重度GSUI患者各20例,进行12周治疗。结果：轻度组治疗后LT和ICI-Q-SF显著低于中度和重度组,而功能性膀胱容量、PVLP和PMUC显著高于中度和重度组。结论：盆底肌强化生物反馈联合家庭锻炼是轻度老年女性GSUI患者理想治疗方法。     

盆底肌锻炼联合温肾助阳手法按摩减轻女性压力性尿失禁的效果观察

目的观察盆底肌锻炼联合温肾助阳手法按摩减轻女性压力性尿失禁的效果。方法将100例年龄50岁的女性压力性尿失禁患者,按随机数字表分为观察组(50例)和对照组((50例)。对照组进行盆底肌锻炼,观察组在对照组基础上辅以温肾助阳手法按摩。在干预后3个月及6个月采用尿垫试验评价干预效果。结果干预6个月时观察组尿失禁严重程度明显低于对照组(P0.05)。结论盆底肌锻炼联合温肾助阳手法按摩治疗压力性尿失禁效果更优。     

蒸汽热敷贴联合盆底肌生物反馈训练治疗老年女性压力性尿失禁的效果观察

目的探讨蒸汽热敷贴联合盆底肌生物反馈训练治疗老年女性压力性尿失禁的效果,以便为临床提供一种新的有效治疗方法。方法选择上海市某三级甲等综合医院2017年9月至2018年9月就诊于妇科、泌尿外科、老年科门诊的60例老年女性患者为研究对象。按简单随机数字表法将患者分为对照组与试验组,每组分别30例。对照组患者采用单纯盆底肌生物反馈训练治疗,试验组采用盆底肌生物反馈训练联合蒸汽热敷贴治疗。治疗3个月后比较两组患者尿失禁严重程度、1h尿垫试验漏尿量、国际尿失禁咨询委员会尿失禁问卷表简表(International Consultation on Incontinence questionnaire-short form,ICI-Q-SF)评分及尿失禁生活质量量表(incontinence quality of life instrument,I-QOL)评分。结果干预后,两组患者尿失禁严重程度、1h尿垫试验漏尿量、ICI-Q-SF评分及I-QOL评分比较,差异具有统计学意义,试验组患者各项指标均优于对照组(均P0.05)。结论采用蒸汽热敷贴联合盆底肌生物反馈训练可有效改善老年女性压力性尿失禁的症状及生活质量,值得临床推广应用。     

电刺激生物反馈联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

目的探究电刺激生物反馈联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法选取收治的产后盆底功能障碍患者60例,根据治疗方法分为对照组和研究组各30例,对照组采用盆底肌锻炼治疗,研究组采用电刺激生物反馈联合盆底肌锻炼治疗,观察两组尿失禁、盆腔脏器脱垂出现率、阴道肌电压、盆底肌纤维疲劳度、患者满意评分。结果治疗后,研究组盆底肌纤维肌电压、满意评分高于对照组(P0.05);尿失禁、盆腔脏器脱垂出现率均低于对照组(P0.05)。结论与盆底肌锻炼相比,产后盆底功能障碍采用电刺激生物反馈联合盆底肌锻炼治疗更利于改善阴道肌电压、盆底肌纤维疲劳度与尿失禁、盆腔脏器脱垂症状,提升患者满意度,值得临床推广应用。     

Effects of Co-contraction of Both Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized Controlled Trial

[Purpose] The purpose of this study was to devise a new urinary incontinence exercise using co-contraction of both the transverse abdominal muscle (TA) and pelvic floor muscle (PFM) and examine the intervention effect in middle-aged women with stress urinary incontinence (SUI). [Subjects] The subjects were fifteen women with SUI who were divided into two groups: the TA and PFM co-contraction exercise group (n=9) and the control group (n=6). [Methods] Participants in the exercise group performed TA and PFM co-contraction exercise. The thickness of the TA was measured before and after 8 weeks of exercise using ultrasound. The thickness of the TA was measured under 4 conditions: (1) at rest, (2) maximal contraction of the TA, (3) maximal contraction of the PFM, and (4) maximal co-contraction of both the TA and PFM. [Results] There were no significant differences among the results of the control group. In the exercise group, the cure rate of SUI was 88.9% after the intervention. There were significant differences in the thickness of the TA during maximal co-contraction of both the TA and PFM after the intervention. [Conclusion] The TA and PFM co-contraction exercise intervention increases the thickness of the TA and may be recommended to improve SUI in middle-aged women.Key words: Stress urinary incontinence, Transverse abdominal muscle, Exercise     

Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcomes in women with stress urinary incontinence

BACKGROUND AND PURPOSE: Pelvic-floor muscle (PFM) exercises are effective in reducing stress urinary incontinence (SUI), but few studies have investigated the effect of specific exercise variables on treatment outcomes. This study explored the effect of exercise position on treatment outcomes in women with SUI. SUBJECTS AND METHODS: Forty-four women were randomly assigned to exercise in the supine position only or in both supine and upright positions. Bladder diary, pad test, urodynamic test, quality-of-life (Incontinence Impact Questionnaire [IIQ]), and PFM strength outcomes were obtained at baseline and after treatment. RESULTS: Exercise position did not affect outcomes. After data from both groups were collapsed, statistically significant improvements with treatment were observed in bladder diary, IIQ, PFM strength, and urodynamic test results. DISCUSSION AND CONCLUSION: Exercise position did not differentially affect treatment outcomes. However, women in this study achieved a mean 67.9% reduction in the frequency of SUI episodes and improvements in other study outcomes.     

Rehabilitation of pelvic floor muscles utilizing trunk stabilization

The pelvic floor muscles (PFM) are part of the trunk stability mechanism. Their function is interdependent with other muscles of this system. They also contribute to continence, elimination, sexual arousal and intra-abdominal pressure. This paper outlines some aspects of function and dysfunction of the PFM complex and describes the contribution of other trunk muscles to these processes. Muscle pathophysiology of stress urinary incontinence (SUI) is described in detail. The innovative rehabilitation programme for SUI presented here utilizes abdominal muscle action to initiate tonic PFM activity. Abdominal muscle activity is then used in PFM strengthening, motor relearning for functional expiratory actions and finally impact training.     

Spatial distribution of vaginal closure pressures of continent and stress urinary incontinent women

Clinically the strength of the contraction of the female pelvic floor is qualitatively evaluated by vaginal tactile palpation. We therefore developed a probe to enable the quantitative evaluation of the closure pressures along the vagina. Four force sensors mounted on the four orthogonal directions of an intra-vaginal probe were used to measure the vaginal pressure profile (VPP) along the vaginal wall. Clinical experiments on 23 controls and 10 patients with stress urinary incontinence (SUI) were performed using the probe to test the hypothesis that the strength of pelvic floor muscle (PFM) contractions, imposed by voluntary contraction, is related to urinary continence. The results show that VPPs, characterized in terms of pressure distribution on the anterior and posterior vaginal walls, are significantly greater than those in the left and right vaginal walls. When the PFM contracted, the positions of the maximum posterior pressures in continent females and SUI patients were 0.63+/-0.15 cm and 1.19+/-0.2 cm proximal from their peak points of anterior pressure, which are 1.52+/-0.09 cm and 1.69+/-0.13 cm proximal from the introitus of vagina, respectively. The statistical analysis shows that the maximum posterior vaginal pressures of the controls were significantly greater than those of the SUI patients both at rest (continent: 3.4+/-0.3 N cm(-2), SUI: 2.01+/-0.36 N cm(-2), p<0.05) and during PFM contraction (continent: 4.18+/-0.26 N cm(-2), SUI: 2.25+/-0.41 N cm(-2), p<0.01). In addition, the difference between the posterior and anterior vaginal walls is significantly increased when the controls contract the PFM. By contrast, there are no significant differences in the SUI group. The results show that the VPP measured by the prototype probe can be used to quantitatively evaluate the strength of the PFM, which is a clinical index for the diagnosis or assessment of female SUI.     

Ultrasound evaluation of dynamic responses of female pelvic floor muscles

Ultrasound imaging of the pelvic floor carries diagnostically important information about the dynamic response of the pelvic floor muscles (PFM) to potentially incontinence-producing stress, which cannot be readily captured and assimilated by the observer during the scanning process. We presented an approach based on motion tracking quantitatively to analyze the dynamic parameters of PFM on the ano-rectal angle (ARA). Perineal ultrasonography was performed on 22 asymptomatic females and nine stress urinary incontinent (SUI) patients with a broad age distribution and parity. The ventral-dorsal and cephalad-caudad movements of the ARA were resolved and kinematic parameters, in terms of displacement, trajectory, velocity and acceleration, were analyzed. The results revealed the possible mechanisms of PFM responses to prevent the urine from incontinence in fast and stress events such as coughs. The statistical analyses showed that the PFM responses of the healthy subjects and the SUI patients are significantly different in both the supine and standing experiments.     

Pelvic floor muscle activity in different sitting postures in continent and incontinent women

Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women.

Objective

To determine whether resting activity of the pelvic floor muscles (PFMs) and abdominal muscles varied in different sitting postures in parous women with and without stress urinary incontinence (SUI).

Design

PFM and abdominal muscle activity was recorded in 3 sitting postures: slump supported, upright unsupported, and very tall unsupported. Spinal curves were measured in slump supported and upright unsupported.

Setting

A research laboratory.

Participants

Women (N=17) with a history of vaginal delivery, 8 who were symptomatic of SUI and 9 who were asymptomatic.

Interventions

Not applicable.

Main Outcome Measures

Electromyographic activity of (1) the resting PFM recorded per vaginam with surface electrodes and (2) superficial abdominal muscles using surface electrodes. Changes in spinal curves were measured with a flexible ruler.

Results

Electromyographic activity of the PFM increased significantly from slump supported to upright unsupported postures in both groups (P<.001) but with lower levels of activity in women with SUI (P<.05). PFM activity increased further in very tall unsupported sitting in comparison with slump supported sitting (P<.001). Obliquus internus abdominis electromyographic activity was greater in upright unsupported than in slump supported sitting (P<.05), and electromyographic activity of other abdominal muscles was greater in very tall unsupported than slump supported. Women with SUI had a trend for greater activity in the abdominal muscles in upright unsupported than asymptomatic women. Asymptomatic women had a greater depth of lumbar lordosis in upright unsupported sitting than women with SUI (P=.04).

Conclusions

More upright sitting postures recruit greater PFM resting activity irrespective of continence status. Further investigation should consider the effect of sitting posture in rehabilitation.     

Ultrasound measurement of abdominal muscles activity during abdominal hollowing and bracing in women with and without stress urinary incontinence

Synergistic co-activation of the abdominal and pelvic floor muscles (PFM) has been reported in the literature. Considering that PFM dysfunction is present in women with stress urinary incontinence (SUI), altered abdominal muscle activation may also occur in incontinent women. The purpose of this study was to investigate the abdominal muscle activity during abdominal hollowing and bracing maneuver in women with and without SUI using ultrasound. Convenience sample of 20 non-pregnant female participated in the study. Subjects were categorized into two groups: continent females (N = 10) and females with SUI (N = 10). The percentage of change in thickness of right transverse abdominals (TrA) and internal obliques (IO) was measured during abdominal hollowing and bracing maneuver in both groups. The result of two-way mixed-design ANOVA revealed no significant health status by maneuver interaction effect for ultrasound measurement of the percentage of change in thickness of TrA (P = 0.66) and IO (P = 0.36). The main effect of health status on the percentage of the change in thickness of TrA (P = 0.52) or IO (P = 0.84) was not statistically significant. In overall, no significant difference was found in the percentage of changes in thickness of TrA and IO muscles during abdominal hollowing or bracing maneuver between women with and without SUI.     

An alternative intervention for urinary incontinence: Retraining diaphragmatic,deep abdominal and pelvic floor muscle coordinated function

This study was a randomized controlled trial to investigate the effect of treating women with stress or mixed urinary incontinence (SUI or MUI) by diaphragmatic, deep abdominal and pelvic floor muscle (PFM) retraining. Seventy women were randomly allocated to the training (n = 35) or control group (n = 35). Women in the training group received 8 individual clinical visits and followed a specific exercise program. Women in the control group performed self-monitored PFM exercises at home. The primary outcome measure was self-reported improvement. Secondary outcome measures were 20-min pad test, 3-day voiding diary, maximal vaginal squeeze pressure, holding time and quality of life. After a 4-month intervention period, more participants in the training group reported that they were cured or improved (p < 0.01). The cure/improved rate was above 90%. Both amount of leakage and number of leaks were significantly lower in the training group (p < 0.05) but not in the control group. More aspects of quality of life improved significantly in the training group than in the control group. Maximal vaginal squeeze pressure, however, decreased slightly in both groups. Coordinated retraining diaphragmatic, deep abdominal and PFM function could improve symptoms and quality of life. It may be an alternative management for women with SUI or MUI.     

Predictors of Success for Physiotherapy Treatment in Women With Persistent Postpartum Stress Urinary Incontinence

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux M-C. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

Objective

To identify predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence (SUI).

Design

Secondary analysis of data from a single-blind randomized controlled trial comparing 2 physiotherapy intervention programs for persistent SUI in postpartum women.

Setting

Obstetric clinic of a mother and children's university hospital.

Participants

Women, ages 23 to 39 (N=57), were randomized to 1 of 2 pelvic floor muscle (PFM) training programs, 1 with and 1 without abdominal muscle training.

Intervention

Over 8 weeks, participants in each group followed a specific home exercise program once a day, 5 days a week. In addition, participants attended individual weekly physiotherapy sessions throughout the 8-week program.

Main Outcome Measures

Treatment success was defined as a pad weight gain of less than 2g on a 20-minute pad test with standardized bladder volume after 8 weeks' treatment. The relationship between potential predictive PFM function variables as measured by a PFM dynamometer and success of physiotherapy was studied using forward stepwise multivariate logistic regression analyses.

Results

Forty-two women (74%) were classified as treatment successes, and 15 (26%) were not. Treatment success was associated with lower pretreatment PFM passive force and greater PFM endurance pretreatment, but the latter association was barely statistically significant. This model explained between 23% (Cox and Snell R²) and 34% (Nagelkerke R²) of the outcome variability.

Conclusions

The results contribute new information on predictors of success for physiotherapy treatment in women with persistent postpartum SUI.