ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA
Obezite, Geniş Genital Hiatus ve Aşırı Aktif Mesane Sendromlu Postmenopozal Kadınlarda Pelvik Taban Kas Egzersizi ve Mesane Eğitiminin Kısa Dönem Etkinliği
Short-Term Efficacy of Pelvic Floor Muscle Training and Bladder Training in Postmenopausal Women with Obesity, Wide Genital Hiatus and Overactive Bladder Syndrome
Received Date : 21 Mar 2021
Accepted Date : 16 Jun 2021
Available Online : 18 Jun 2021
Özet PDF Benzer Makaleler
İrem ŞENYUVAa, Meryem KÖSEHASANOĞULLARIb, Nihal YILMAZb
aClinic of Obstetrics and Gynecology, Uşak Training and Research Hospital, Uşak, TURKEY bClinic of Physical Medicine and Rehabilitation, Uşak Training and Research Hospital, Uşak, TURKEY
Doi: 10.31609/jpmrs.2021-83246 - Makale Dili: EN
J PMR Sci. 2021;24(3):284-93
ÖZET
Amaç: Bu çalışmada; obez, geniş genital hiatus (GH) ve aşırı aktif mesane (AAM) sendromlu postmenopozal kadınlarda, kısa dönem pelvik taban kas egzersizi (PTKE) ve mesane eğitiminin (ME) tek başına PTKE’ye göre ürogenital semptomlar ve yaşam kalitesi üzerindeki etkinliğini araştırmak amaçlandı. Gereç ve Yöntemler: Çalışmaya, 104 hasta çalışmaya dâhil edildi, 36 hasta (ortalama yaş: 55,22±9,68, ortalama beden kitle indeksi: 30,63±4,41 kg/m2) çalışmayı tamamladı. Hastalar, 8 hafta sadece-PTKE (n=20) ve PTKE+ME (n=16) tedavisi verilmek üzere 2 gruba ayrıldı. Primer sonuçlar, AAM sorgulama formu, Modifiye Oxford Skoru (MOS), ped testi, işeme günlüğü ile sekonder sonuçlar İnkontinans Etki Anketi [Incontinence Impact Questionnaire (IIQ-7)], Pelvik Organ Prolapsusu/Üriner İnkontinans Cinsel Anketi [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] ile değerlendirildi. Bulgular: Her 2 grupta ped testi, AAM skorları ve işeme fonksiyonlarında istatistiksel olarak anlamlı düzelme saptandı (p<0,05). MOS’da iyileşme PTKE+ME grubunda, sadece PTKE’ye göre istatistiksel olarak anlamlı saptandı (p=0,003; p=0,083). İki grupta da IIQ-7 ve PISQ-12 skorlarında istatistiksel anlamlı bir düzelme saptanmadı (p>0,05). Sonuç: Obez, geniş GH’li ve AAM sendromlu kadınlarda, PTKE ve PTKE+ME, kısa dönemde üriner inkontinans semptomlarında ve işeme fonksiyonlarında düzelme sağladığı için önerilebilir. Her 2 tedavi yönteminin, idrar kaçırma ile ilişkili yaşam kalitesi veya cinsel işlevler üzerinde yararlı bir etkisi olmamıştır.
Anahtar Kelimeler: Mesane eğitimi; egzersiz; obezite; aşırı aktif mesane; pelvik taban; postmenopoz
ABSTRACT
Objective: This study aimed to assess the efficacy of short-term pelvic floor muscle training (PFMT) and bladder training (BT) vs. PFMT alone on urogenital symptoms and the quality of life in postmenopausal women with obesity, wide genital hiatus (GH) and overactive bladder (OAB) syndrome. Material and Methods: The study included a total of 104 patients with 36 (mean age: 55.22±9.68 years, mean body mass index: 30.63±4,41 kg/m2) completing the study. The patients were divided into two groups to receive PFMT-alone (n=20) or PFMT+BT (n=16) for 8 weeks. Primary outcomes were assessed using OAB questionnaire form, Modified Oxford Score (MOS), pad test and voiding diary with secondary outcomes being assessed using Incontinence Impact Questionnaire (IIQ-7), Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire (PISQ-12). Results: Statistically significant improvement was observed in OAB scores and voiding functions in both groups (p<0.05). Improvement in MOS was statistically significant in PFMT+BT group compared to the PFMTalone group (p=0.003, p=0.083). No statistically significant improvement was detected in IIQ-7 and PISQ-12 scores in either group (p>0.05). Conclusion: In postmenopausal women with obesity, enlarged GH and OAB syndrome, PFMT-alone and PFMT+BT can be recommended because it improves urinary incontinence symptoms and voiding functions in the short term. Neither treatment method had a beneficial impact on urinary incontinence related quality of life or sexual functions.
Keywords: Bladder training; exercise; obesity; overactive bladder; pelvic floor; postmenopause
REFERENCES
  1. Tomaszewski J. Postmenopausal overactive bladder. Prz Menopauzalny. 2014;13:313-29. [Crossref] [PubMed] [PMC] 
  2. Betschart C, Mol SE, Lütolf-Keller B, et al. Pelvic floor muscle training for urinary incontinence: a comparison of outcomes in premenopausal versus postmenopausal women. Female Pelvic Med Reconstr Surg. 2013; 19:219-24. [Crossref] [PubMed] 
  3. Weber-Rajek M, Radzimińska A, Straczyńska A, et al. A randomised-controlled trial pilot study examining the effect of pelvic floor muscle training on steroid hormone concentrations in elderly women with stress urinary incontinence. Prz Menopauzalny. 2019;18:146-52. [Crossref] [PubMed] [PMC] 
  4. Nygaard CC, Betschart C, Hafez AA, et al. Impact of menopausal status on the outcome of pelvic floor physiotherapy in women with urinary incontinence. Int Urogynecol J. 2013;24: 2071-6. [Crossref] [PubMed] 
  5. Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27:749-57. [Crossref] [PubMed] 
  6. Tsuchiya Y, Ando D, Takamatsu K, et al. Resistance exercise induces a greater irisin response than endurance exercise. Metabolism. 2015;64:1042-50. [Crossref] [PubMed] 
  7. Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol. 2012;206:246.e1-4. [Crossref] [PubMed] 
  8. Kim S, Wong V, Moore KH. Why are some women with pelvic floor dysfunction unable to contract their pelvic floor muscles? Aust N Z J Obstet Gynaecol. 2013;53:574-9. [Crossref] [PubMed] 
  9. ACOG Practice Bulletin No. 155 summary: urinary ıncontinence in women. Obstet Gynecol. 2015;126:1120-2. [Crossref] [PubMed] 
  10. Bettez M, Tu le M, Carlson K, et al. 2012 update: guidelines for adult urinary incontinence collaborative consensus document for the canadian urological association. Can Urol Assoc J. 2012;6:354-63. [Crossref] [PubMed] [PMC] 
  11. European Association of Urology [Internet]. © 2021 Uroweb. Urinary incontinence.Accessed 15 April, 2021. Available from: [Link] 
  12. Ayeleke RO, Hay-Smith EJ, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database Syst Rev. 2015;3;2015: CD010551. [Crossref] [PubMed] [PMC] 
  13. Wyman JF, Fantl JA, McClish DK, et al. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol. 1998; 179:999-1007. [Crossref] [PubMed] 
  14. Kaya S, Akbayrak T, Gursen C, et al. Short-term effect of adding pelvic floor muscle training to bladder training for female urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2015;26:285-93. [Crossref] [PubMed] 
  15. Türk Endokrinoloji ve Metabolizma Derneği. Obezite Tanı ve Tedavi Kılavuzu. 1. Baskı. Ankara: Bayt Basın Yayın ve Tanıtım Ltd. Şti.; 2014. [Link] 
  16. Tarcan T, Mangır N, Özay Özgür M ve ark. OAB-V8 aşırı aktif mesane sorgulama formu validasyon çalışması [OAB-V8 overactive bladder questionnaire validation study]. Üroloji Bülteni. 2012;21:113-6. [Link] 
  17. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238-48. [Crossref] [PubMed] 
  18. Akbayrak T, Özgül S, Pasacı EÜ. Pelvik taban disfonksiyonunda fizyoterapi ve rehabilitasyon. Doğanay M, Aksakal OS, Cavkaytar S, Kokanalı K, editörler. Pelvik Taban Bozuk lukları ve Ürojinekoloji. 1. Baskı. Ankara: Anadolu Tıp Kitab evi; 2019. p.93-137. [Link] 
  19. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10-7. [Crossref] [PubMed] 
  20. Lowder JL, Oliphant SS, Shepherd JP, et al. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol. 2016;214:718. [Crossref] 
  21. Swift S, Morris S, McKinnie V, et al. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17: 615-20. [Crossref] [PubMed] 
  22. Vaz CT, Sampaio RF, Saltiel F, et al. Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial. Braz J Phys Ther. 2019;23:116-24. [Crossref] [PubMed] [PMC] 
  23. Özlü , A. Stres Üriner İnkontinanslı Hastalarda Perianal ve İntravajinal Biofeedback Yardımlı Pelvik Taban Kas Egzersizlerinin Etkinliğinin Karşılaştırılması. Uzmanlık Tezi, Pamukkale Üniversitesi, 2014.
  24. Cam C, Sakalli M, Ay P, et al. Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neu rourol Urodyn. 2007;26:129-33. [Crossref] [PubMed] 
  25. Cam C, Sancak P, Karahan N, et al. Validation of the short form of the pelvic organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in a Turkish population. Eur J Obstet Gynecol Reprod Biol. 2009;146:104-7. [Crossref] [PubMed] 
  26. Bo K. Pelvic floor muscle exercise for the treatment of stress urinary incontinence: an exercise physiology perspective. Int Urogynecol J. 1995;6:282-91. [Crossref] 
  27. Shafik A. A study of the continence mechanism of the external urethral sphincter with identification of the voluntary urinary inhibition reflex. J Urol. 1999;162:1967-71. [Crossref] [PubMed] 
  28. Cangöl E, Aslan E, Yalçın Ö. Kadınlarda pelvik taban kas egzersizleri ve hemşirenin rolü [Pelvic floor muscle exercises for women and the nurse's role]. Hemşirelikte Eğitim ve Araştırma Dergisi. 2013;10:49-56. [Link] 
  29. Fitz F, Sartori M, Girão MJ, et al. Pelvic floor muscle training for overactive bladder symptoms- a prospective study. Rev Assoc Med Bras. 2017;63:1032-8. [Crossref] 
  30. Paiva LL, Ferla L, Darski C, et al. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J. 2017;28:351-9. [Crossref] [PubMed] 
  31. Cardozo L. Systematic review of overactive bladder therapy in females. Can Urol Assoc J. 2011;5:S139-42. [PubMed] [PMC] 
  32. Felicíssimo MF, Carneiro MM, Saleme CS, et al. Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010;21: 835-40. [Crossref] [PubMed] 
  33. Demirci N, Coşar F. Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri [Behavioural therapy techniques for urinary incontinence]. S.D.Ü. Tıp Fak Derg. 2009; 16:35-40. [Link] 
  34. Steensma AB, Konstantinovic ML, Burger CW, et al. Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction. Int Urogynecol J. 2010;21:861-7. [Crossref] [PubMed] [PMC] 
  35. Dunivan GC, Lyons KE, Jeppson PC, et al. Pelvic organ prolapse stage and the relationship to genital hiatus and perineal body measurements. Female Pelvic Med Reconstr Surg. 2016;22:497-500. [Crossref] [PubMed] [PMC] 
  36. Borello-France DF, Handa VL, Brown MB, et al; Pelvic Floor Disorders Network. Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther. 2007;87:399-407. [Crossref] [PubMed] 
  37. Resende APM, Bernardes BT, Stüpp L, et al. Pelvic floor muscle training is better than hypopressive exercises in pelvic organ prolapse treatment: an assessor-blinded randomized controlled trial. Neurourol Urodyn. 2019;38: 171-9. [Crossref] [PubMed] 
  38. Fantl JA, Wyman JF, McClish DK, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991;6;265:609-13. [Crossref] [PubMed] 
  39. Bilge C, Beji Kızılkaya N. Kadınlarda üriner semptomları değerlendirmek için kullanılan yaşam kalitesi ölçekleri [Life quality scales used for evaluating urinar symptoms in women]. J Female Funct Urol. 2015;1-2-3-4:41-5. [Crossref] 
  40. Jha S, Walters SJ, Bortolami O, et al. Impact of pelvic floor muscle training on sexual function of women with urinary incontinence and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomised controlled trial. Physiotherapy. 2018;104:91-7. [Crossref] [PubMed] 
  41. Aslan E, Komurcu N, Beji NK, et al. Bladder training and Kegel exercises for women with urinary complaints living in a rest home. Gerontology. 2008;54:224-31. [Crossref] [PubMed] 
  42. Bradley CS, Rahn DD, Nygaard IE, et al. The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing non-surgical therapies for treatment of stress predominant urinary incontinence. Neurourol Urodyn. 2010;29(5):727-34. [Crossref] [PubMed] [PMC] 
  43. Demain S, Smith JD, Hiller L, et al. Comparison of group and individual physiotherapy for female urinary incontinence in primary care. Physiotherapy. 2001;87:235-42. [Crossref] 
  44. Fan HL, Chan SS, Law TS, et al. Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study. Aust N Z J Obstet Gynaecol. 2013;53:298-304. [Crossref] [PubMed] 
  45. Nascimento-Correia G, Santos-Pereira V, Tahara N, et al. Efectos del fortalecimiento del suelo pélvico en la calidad de vida de un grupo de mujeres con incontinencia urinaria: estudio aleatorizado controlado [Effects of pelvic floor muscle training on quality of life of a group of women with urinary incontinence: randomized controlled trial]. Actas Urol Esp. 2012;36:216-21. [Crossref] [PubMed] 
  46. Hay-Smith J, Dean S, Burgio K, McClurg D, Frawley H, Dumoulin C. Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies-2011 ICS State-of- the-Science Seminar research paper III of IV. Neurourol Urodyn. 2015;34(7):622-31. [Crossref] [PubMed] 
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