Search

Functional constipation is a common bowel disorder leading to activity restrictions and reduced health-related quality of life. Typically, this condition is initially managed with prescription of laxatives or fiber supplementation, [...]

Background and Objectives. Few studies have examined the effectiveness of pelvic-floor muscle (PFM) exercises to reduce female stress urinary incontinence (SUI) over the long term. This study: (1) evaluated continence and quality-of-life outcomes of women 6 months following formalized therapy and (2) determined whether low- and high-frequency maintenance exercise programs were equivalent in sustaining outcomes. Subjects and Methods, Thirty-six women with SUI who completed an intensive PFM exercise intervention trial were randomly assigned to perform a maintenance exercise program either 1 or 4 times per week. Urine leaks per week, volume of urine loss, quality of life (Incontinence Impact Questionnaire [IIQ] score), PFM strength (Brink score), and prevalence of urodynamic stress incontinence (USD were measured at a 6-month follow-up for comparison with postintervention status. Parametric and nonparametric statistics were used to determine differences in outcome status over time and between exercise frequency groups. Results. Twenty-eight women provided follow-up data. Postintervention status was sustained at 6 months for all outcomes (mean [SD] urine leaks per week=l.2±2.1 versus 1.4±3.1; mean [SD] urine loss=0.2±0.5 g versus 0.2±0.8 g; mean [SD] IIQ score=17±20 versus 22±30; mean [SD] Brink score=ll±I versus 11 ±1; and prevalence of USI=48% versus 35%). Women assigned to perform exercises once or 4 times per week similarly sustained their postintervention status. Discussion and Conclusions. Benefits of an initial intensive intervention program for SUI were sustained over 6 months. However, only 15 of the 28 women provided documentation of their exercise adherence, limiting conclusions regarding the need for continued PFM exercise during follow-up intervals of ≤6 months., Since the introduction of Kegel exercises in 1948, (1) the efficacy of pelvic-floor muscle (PFM) exercise in the management of stress urinary incontinence (SUO and mixed urinary incontinence (UI) (symptoms [...]

Background and Purpose The purpose of this study was to describe how clinical pelvic-floor muscle (PFM) strength (force-generating capacity) is related to patient characteristics, lower urinary tract symptoms, and fecal incontinence symptoms. Subjects Data were obtained from 643 women who were participating in a randomized surgical trial for treatment of stress urinary incontinence. Methods Patient demographic variables, baseline urinary and fecal incontinence symptom questionnaires, urodynamic data and urinary diary data, pad test results, and standardized assessment of pelvic organ support were compared with PFM strength as described by the Brink scoring system. Bivariate analysis of factors associated with the Brink scale score was done using analysis of variance and linear regression. Multivariate analysis included patient variables that were significant on bivariate analysis. Results The mean Brink scale score was 9 (SD = 2) and did not vary widely in this large, but highly select, patient sample. We found a weak, but statistically strong, relationship between age and Brink score. Brink scores were not related to diary and pad test measures of incontinence severity. Discussion and Conclusion Overall, PFM strength was good in this sample of women with stress incontinence. Scores tended to be similar, and it is possible that the Brink scale does not reflect real clinical differences in PFM strength., The pelvic-floor muscles (PFMs) are considered important in maintaining pelvic organ support and bowel and bladder continence. Several studies with small numbers of subjects have shown that women with urinary [...]

Background and Purpose The purpose of this study was to determine whether pelvic organ prolapse severity, pelvic symptoms, quality of life, and sexual function differ based on pelvic-floor muscle function in women planning to have prolapse surgery. Subjects and Methods Three hundred seventeen women without urinary stress incontinence who were enrolled in a multicenter surgical trial were examined to determine pelvic-floor muscle function (by Brink scale score). The subjects were 61.6±10.2 (X±SD) years of age. Thirteen percent of the subjects had stage II (to the hymen) pelvic organ prolapse, 68% had stage III (beyond the hymen) prolapse, and 19% had stage IV (complete vaginal eversion) prolapse. Subjects with lowest (3-6) and highest (10-12) Brink scale scores were compared on prolapse severity, pelvic symptoms and bother, quality of life, and sexual function. Results Subjects with the highest Brink scores (n=75) had less advanced prolapse, smaller genital hiatus measurements, and less urinary symptom burden compared with those with the lowest Brink scores (n= 56). The results indicated that pelvic-floor muscle function was not associated with condition-specific quality of life or sexual function. Discussion and Conclusion Although modestly clinically significant, better pelvic-floor muscle function was associated with less severe prolapse and urinary symptoms., Pelvic organ prolapse is the descent of the apex of the vagina or cervix (or vaginal vault after hysterectomy), anterior vaginal wall (previously referred to as 'cystocele'), or posterior vaginal [...]

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. Key Words: Exercise, Pelvic floor, Urinary stress incontinence., Stress urinary incontinence (SUI) is the involuntary loss of urine that occurs with physical exertion and a rise in abdominal pressure. (1) Coughing, sneezing, straining, jumping, and running are events [...]

Background and Purpose. People with peripheral vestibular pathology demonstrate motor impairments when responding and adapting to postural platform perturbations and during performance of sit-to-stand and locomotor tasks. This study investigated the influence of unilateral peripheral vestibular hypofunction on voluntary arm movement. Subjects and Methods. Subjects without known neurological impairments and subjects with vestibular impairments performed 3 voluntary arm movements: an overhead reach to a target, a sideward reach to a target, and a forward flexion movement through 90 degrees. Subjects performed these tasks under precued and choice reaction time conditions. During all tasks, body segment motion was measured. Head velocity measurements were calculated for the side task only. Results. Subjects with vestibular loss restricted upper body segment motion within the frontal and transverse planes for the 90-degree and overhead tasks. Average angular head velocity was lower for the group with vestibular hypofunction. Task uncertainty (the introduction of a choice reaction time paradigm) differentially influenced the groups regarding head velocity at target acquisition. Discussion and Conclusion. Individuals with vestibular loss altered their performance of voluntary arm movements. Such alterations may have served to minimize the functional consequences of gaze instability. [Borello-France DF, Gallagher JD, Furman JM, et al. Voluntary upper-extremity movements in patients with unilateral peripheral vestibular hypofunction. Phys Ther. 2002;82:216-227.] Key Words: Vestibular hypofunction, Voluntary movement., People with peripheral vestibular pathology have difficulty maintaining postural stability when visual and somatosensory cues are altered. (1-4) They demonstrate disturbances in the amplitude, selectivity, and adaptability of postural responses [...]