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Amanda Almeida Gomes Dantas,1 Alianny Raphaely Rodrigues Pereira,2 Shamyr Sulyvan de Castro,3 Thaissa Hamana de Macedo Dantas,1 Caroline Wanderley Souto Ferreira,1,2 Isabelle Ribeiro Barbosa,1,2 Saionara Maria Aires da Câmara,1,2 Diego de Sousa Dantas1,2 1Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil; 2Physiotherapy Department, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; 3Physiotherapy Department, Universidade Federal do Ceará, Fortaleza, Ceará, BrazilCorrespondence: Diego de Sousa DantasFaculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Street Teodorico Bezerra, Santa Cruz, RN 59200-000, BrazilTel +55 8432912411Email diegodantas1@gmail.comObjective: The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil.Materials and Methods: This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann–Whitney U-test, and the effect size was determined by eta squared (η2). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤ 0.20 in the bivariate. A statistical significance level of p< 0.05 was considered.Results: Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p < 0.001), mobility (p < 0.002), self-care (p < 0.001), and participation (p < 0.001) domains, as well as the total score (p < 0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p < 0.001), in which this condition increases the score by nine points.Conclusion: The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score.Keywords: constipation, functioning classification, disability and health

Purpose: The International Continence Society and the International Urogynecological Association have not yet standardized the definition of de novo stress urinary incontinence. Recent studies define the development of stress urinary incontinence as occurring after surgical repair of pelvic organ prolapse in previously continent women. The mechanisms that cause de novo stress urinary incontinence are not yet clear. Knowledge of the predictive factors for this outcome after surgical correction of pelvic organ prolapse would be useful for assessing whether a concomitant anti-incontinence procedure should be performed., Materials and Methods: The aim of this systematic review and meta-analysis was to identify some of the risk factors for de novo stress urinary incontinence: high body mass index, pelvic organ prolapse stage before surgery, presence of occult urinary incontinence, type of surgery, and the presence of diabetes mellitus. The present study was registered in the PROSPERO database under number CRD42021293764, and the systematic review was carried out according to the MOOSE recommendations and with the PRISMA 2020 guidelines., Results: A total of 2429 articles were identified. Nine cohort studies were included in the systematic review and seven in the meta-analysis. The risk of bias was assessed via the Newcastle-Ottawa scale and the certainty of evidence was assessed using the GRADE approach for each outcome. In the meta-analysis, associations were identified between de novo stress urinary incontinence and occult urinary incontinence (n: 422; OR: 2.01; 95% CI: 1.26-3.22; p = 0.004), diabetes (n: 1213; OR: 2.35; 95% CI: 1.30-4.26; p = 0.005), and advanced pelvic organ prolapse (n: 1003; OR: 1.94; 95% CI: 1.14-3.30; p = 0.01). Consulting a meta-analysis for the type of surgery was deemed impossible. A previous study comparing abdominal sacrocolpopexy with minimally invasive sacrocolpopexy revealed that women who underwent abdominal sacrocolpopexy were more likely to develop de novo stress urinary incontinence (n: 77; OR: 4.73; 95% CI: 1.56-14.34; p = 0.005). Another study found that pelvic organ prolapse repair using a transvaginal mesh was associated with higher levels of de novo stress urinary incontinence compared to robot-assisted sacrocolpopexy (n: 76; OR: 6.74; 95% CI: 1.35-33.75; p = 0.02). A meta-analysis of overweight or obesity was not possible due to the different assessment methods used in the studies., Conclusions: This meta-analysis revealed that occult incontinence, diabetes, and advanced pelvic organ prolapse before repair were associated with de novo stress urinary incontinence and these groups may therefore benefit from for anti-incontinence procedures concomitant with pelvic organ prolapse repair., (© 2024 Wiley Periodicals LLC.)

Purpose: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis., Methods: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%., Results: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s., Conclusions: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: to verify the acute effect of running a half marathon on pelvic floor muscle (PFM) function and electromyographic (EMG) activity in female runners with and without urinary incontinence., Methods: This is a cross-sectional pilot study. The sample was divided into two groups: runners with urinary incontinence (with UI) and runners without urinary incontinence (without UI). A semi-structured form and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were used for data collection. The EMG and PFM function were evaluated using the PERFECT method before and immediately after running a half marathon., Results: A total of 14 runners were included (8 with UI; 6 without UI). Runners with and without UI did not show significant differences for EMG and PERFECT. The acute effects of the half marathon on runners without UI were reduced PFM function in terms of strength ( p = 0.00), reduced endurance ( p = 0.02), and reduced repetition ( p = 0.03), and an increase in EMG measured by the median frequency ( p = 0.02). Runners with UI showed reduced PFM function in terms of strength ( p = 0.05) and repetition ( p = 0.01)., Conclusion: there was no difference in the acute effects of the half marathon on PFM function and EMG in women with and without UI.

Objective: This study aimed to assess the prevalence and factors associated with primary dysmenorrhea in a sample of adult women., Methods: A cross-sectional study was carried out with women aged between 19 and 49 years from a city of northeastern Brazil. Sociodemographic, gynecological, and obstetric variables were assessed by questionnaires and interviews. Dysmenorrhea was measured by self-report, and the Numerical Pain Rating Scale measured the intensity of pain. Statistical analyses included χ2 test, ANOVA, and logistic regression., Results: The average age was 33.2±9.1 years and the prevalence of primary dysmenorrhea was 56% for the whole sample. The average duration of symptoms was 2.7±1.8 days and the mean intensity was 6.1±2.6. The previous cesarean section was associated with a higher rate of primary dysmenorrhea (PR=2.33; 95%CI 1.11-4.90) when considering the whole sample. Women who aged 25-39 years and are insufficiently active had higher rates of primary dysmenorrhea (PR=5.24; 95%CI 1.08-27.31)., Conclusion: Primary dysmenorrhea has a high prevalence in young adults, adults, and middle-aged women. Cesarean section and being physically inactive was associated with increased rates of dysmenorrhea among adult women.

Background: The present study aims to analyse if dysmenorrhea is associated with activity limitations and participation restrictions in experencied by adult women., Methods: This is a cross-sectional study carried out with adult women recruited from primary health services in Brazil between 2016 and 2017. Dysmenorrhea was measured via a self-report and the activity limitation and participation restrictions was assessed by the World Health Disability Assessment Schedule (WHODAS2.0). Pain and level of physical activity were assessed, respectively, by the numerical pain rating scale and International Physical Activity Questionnaire (IPAQ), short version. Associations between groups, dysmenorrhea and without dysmenorrhea (WD), were analysed by the median difference, Mann Whitney test, effect size measures and 95 % confidence interval. Statistical significance was p <0.05., Results: The prevalence of dysmenorrhea was 54 %. The pain lasted an average of three days or more (66 %). The average pain intensity, in the crisis period, was 6.1 ± 2.6, women who presented severe pain complaints were associated with considerable difficulties in their domains of mobility (p = 0.003; 2 = 0.115), participation (p = 0.030; 2 = 0.063) and total score (p = 0.012; 2 = 0.086), with a moderate effect size for all variables., Conclusions: Severe dysmenorrhea was associated with higher scores of disabilities assessed by the WHODAS 2.0, especially in mobility, and participation domains., (© 2021. The Author(s).)

Aims: To assess the strength and electrical activity of the pelvic floor muscles (PFMs) of male-to-female transgender individuals submitted to gender-affirming surgery (GAS)., Methods: A case series study was conducted from October 2016 to August 2018. Transgender women, who were scheduled for GAS, participated in the study. The volunteers were submitted to a clinical evaluation of the PFM followed by digital palpation (PERFECT method) and electromyography in the preoperative, 15, and 30 days after GAS. They responded to the International Consultation on Incontinence Questionnaire-Urinary Incontinence (UI)-Short Form to evaluate the effect of UI on quality of life and to questions related to the urinary, anorectal, and sexual symptoms. Fifteen days after the GAS, patients were instructed to perform perineal exercises at home, twice a day., Results: The study sample consisted of 15 transgender women with an average age of 30.6 (SD = 6.7) years. There was a decline in median strength and sustained muscle contraction duration (PERFECT), in the electrical muscle activity (RMSmean and RMSmax) between pre-GAS and 15 days after GAS (p < 0.05). However, there was an increase in these parameters between 15 and 30 days after GAS (p < 0.05). Moreover, six patients exhibited pre-GAS UI, which continued after surgery, with a worsening of urgency symptoms and improvement in nocturia and postmicturition leakage., Conclusion: Strength, sustained muscle contraction duration, and PFM electrical activity may decline 15 days after GAS, returning to pre-GAS values in the first month after surgery., (© 2021 Wiley Periodicals LLC.)

Background: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature., Objective: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil., Methods: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered., Results: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation., Conclusion: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

Objective: To evaluate the prevalence of urinary incontinence (UI) in female athletes practising high-impact sports and its association with knowledge, attitude and practice (KAP)., Design: Observational study., Methods: A semi-structured evaluation form, KAP survey and the International Consultation on Incontinence Questionnaire - Short Form were used. Univariate and multivariate analyses were performed to verify the association of UI with KAP, sociodemographic, gynaecological and sports-related variables, with significant variables remaining in the model (p < .05), through a stepwise strategy., Results: The prevalence of UI in 118 athletes was 82 (70%), of which 19 (23%) had pure stress UI, 19 (23%) had pure urgency UI and 44 (54%) had mixed UI; with 50 (61%) athletes losing urine during training and 37 (45%) during competitions. Regarding the KAP survey, 37 athletes (31%) demonstrated adequate knowledge, 63 (53%) adequate attitude and zero adequate practice. In the multivariate analysis, a sports practice time of over 8 years and dyspareunia presented significant values, with odds ratios (OR) of 2.66 and 2.99, respectively. Knowledge was significantly associated with UI (OR 0.43). UI had a slight impact on QOL., Conclusions: There is a high prevalence of UI yet low levels of adequate knowledge and practice regarding the occurrence of UI in sports, with sports practice time over 8 years and dyspareunia factors predisposing female athletes to UI by 2.7 and 3 times, respectively. Athletes with adequate knowledge were 57% less likely to develop UI.

Introduction and Hypothesis: Female pelvic organ prolapse is highly prevalent and childbirth has been shown to be an important risk factor. The study was carried out to observe if pelvic organ support deteriorates over time following a first birth., Methods: This is a retrospective review using archived data sets of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone a standardised interview, a clinical examination and 4D translabial ultrasound, 3 months and 2-5 years post-partum. Main outcome measures were pelvic organ descent and hiatal area at maximum Valsalva manoeuvre. Means at the two time points were compared using paired Student's t test. Predictors of change over time in continuous variables were explored using linear modelling methods., Results: A total of 300 women had at least two postnatal follow-ups. They were first seen on average 0.39 (SD 0.2, range 0.2-2.1) years and again 3.1 (SD 1.5, range 1.4-8) years after the index delivery, with a mean interval of 2.71 (SD 1.5, range 0.7-7.7) years, providing a total of 813 (300 × 2.71) woman-years of observation. On univariate analysis, there was a significant decrease in mobility over time of the bladder neck, bladder, and rectal ampulla (P = < 0.004) and hiatal area (P = 0.012). The degree of improvement was less marked in women with levator avulsion., Conclusions: A significant reduction in pelvic organ descent and hiatal area was noted over a mean of 2.7 years after a first birth.