FISIOTERAPIA NA INCONTINÊNCIA URINÁRIA DURANTE O PERÍODO GESTACIONAL E NO PÓS-PARTO: UMA REVISÃO SISTEMÁTICA
DOI:
https://doi.org/10.17058/zc29xd66Palavras-chave:
Pós-parto, Período gestacional, Recursos fisioterapêuticos, Incontinência urináriaResumo
Introdução: tendo como fatores de risco ao surgimento da incontinência urinária feminina o período gestacional e o pós-parto, torna-se relevante analisar e revisar as existentes evidências científicas disponíveis sobre o tema. Objetivo: relacionar os recursos fisioterapêuticos no tratamento da incontinência urinária no período gestacional e no pós-parto. Métodos: foi realizada uma pesquisa sistemática da literatura utilizando a base de dados online PubMed (MEDLINE) durante o período de setembro a novembro de 2024, para que fossem identificadas pesquisas originais. Após a busca e triagem, um total de 10 artigos foram selecionados de acordo com o critério de egibilidade. Resultados: todos os artigos analisados realizaram treinamento dos músculos do assoalho pélvico trabalhando de maneiras diferentes, seis deles obtendo melhorias significativos, enquanto outros quatro não indicaram avanços. Conclusão: o treinamento dos músculos do assoalho pélvico permanece como o principal recurso fisioterapêutico eficaz no manejo da incontinência urinária durante o período gestacional e pós-parto. A combinação do treinamento dos músculos do assoalho pélvico com outras técnicas e recursos fisioterapêuticos representa um campo promissor para investigações futuras sobre o tratamento da IU no período gestacional e pós-parto.
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Referências
Weber-Rajek M, Strączyńska A, Strojek K, Piekorz Z, Pilarska B, Podhorecka M, Sobieralska-Michalak K, Goch A, Radzimińska A. Assessment of the Effectiveness of Pelvic Floor Muscle Training (PFMT) and Extracorporeal Magnetic Innervation (ExMI) in Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial. Biomed Res Int. 2020 Jan 16;2020:1019872. doi: 10.1155/2020/1019872. PMID: 32016111; PMCID: PMC6988664.
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018 Oct 4;10(10):CD005654. doi: 10.1002/14651858.CD005654.pub4. PMID: 30288727; PMCID: PMC6516955.
Fok CS, Gotlieb RJ, Nakib N. Epidemiology, definitions, and cost of incontinence in women. In Female Urinary Incontinence. Springer International Publishing. 2022. p. 3-27 doi: 10.1007/978-3-030-84352-6_1.
Wang K, Xu X, Jia G, Jiang H. Risk Factors for Postpartum Stress Urinary Incontinence: a Systematic Review and Meta-analysis. Reprod Sci. 2020 Dec;27(12):2129-2145. doi: 10.1007/s43032-020-00254-y. Epub 2020 Jul 7. PMID: 32638282.
Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017 Jul 6;3:17042. doi: 10.1038/nrdp.2017.42. Erratum in: Nat Rev Dis Primers. 2017 Nov 16;3:17097. doi: 10.1038/nrdp.2017.97. PMID: 28681849; PMCID: PMC5878864.
Diz-Teixeira P, Alonso-Calvete A, Justo-Cousiño LA, González-González Y, Cuña-Carrera ID. Update on Physiotherapy in Postpartum Urinary Incontinence. A Systematic Review. Arch Esp Urol. 2023 Feb;76(1):29-39. doi: 10.56434/j.arch.esp.urol.20237601.2. PMID: 36914417.
Lacima G, Espuña M. Patología del suelo pélvico [Pelvic floor disorders]. Gastroenterol Hepatol. 2008 Nov;31(9):587-95. Spanish. doi: 10.1157/13128299. PMID: 19091248.
Zhang YY, He ZZ, Zuo LY, et al. Analysis of postpartum early pelvic floor function status in primiparas and its influencing factors of stress urinary incontinence. J Clin Med Pract. 2021;25(10):94–98.
Aedo-Muñoz E, Arriagada Tarifeño D, Torres Moreno M-J, Muñoz Adasme MF. REVISIÓN SISTEMÁTICA DE LAS ALTERACIONES BIOMECÁNICAS EN MUJERES EMBARAZADAS. ODEP. 26 de diciembre de 2017. Disponible en: https://www.revistaobservatoriodeldeporte.cl/index.php/odep/article/view/181
López-López AI, Sanz-Valero J, Gómez-Pérez L, Pastor-Valero M. Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. Int Urogynecol J. 2021 Jul;32(7):1663-1673. doi: 10.1007/s00192-020-04550-8. Epub 2020 Oct 17. PMID: 33068134.
Wesnes SL, Seim E. Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X. 2020 Sep 4;8:100115. doi: 10.1016/j.eurox.2020.100115. PMID: 32954252; PMCID: PMC7486687.
Dai S, Chen H, Luo T. Prevalence and factors of urinary incontinence among postpartum: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023 Oct 28;23(1):761. doi: 10.1186/s12884-023-06059-6. PMID: 37898733; PMCID: PMC10612348.
Bascur-Castillo C, Carrasco-Portiño M, Valenzuela-Peters R, Orellana-Gaete L, Viveros-Allende V, Ruiz Cantero MT. Effect of conservative treatment of pelvic floor dysfunctions in women: An umbrella review. Int J Gynaecol Obstet. 2022 Nov;159(2):372-391. doi: 10.1002/ijgo.14172. Epub 2022 Mar 21. PMID: 35246849.
Hagen S, McClurg D, Bugge C, Hay-Smith J, Dean SG, Elders A, Glazener C, Abdel-Fattah M, Agur WI, Booth J, Guerrero K, Norrie J, Kilonzo M, McPherson G, McDonald A, Stratton S, Sergenson N, Grant A, Wilson L. Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL randomised trial. BMJ Open. 2019 Feb 19;9(2):e024153. doi: 10.1136/bmjopen-2018-024153. PMID: 30782895; PMCID: PMC6411252.
Alves FK, Riccetto C, Adami DB, Marques J, Pereira LC, Palma P, Botelho S. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015 Jun;81(2):300-5. doi: 10.1016/j.maturitas.2015.03.006. Epub 2015 Mar 14. PMID: 25862491.
Alouini S, Memic S, Couillandre A. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. Int J Environ Res Public Health. 2022 Feb 27;19(5):2789. doi: 10.3390/ijerph19052789. PMID: 35270480; PMCID: PMC8910078.
Luginbuehl H, Lehmann C, Koenig I, Kuhn A, Buergin R, Radlinger L. Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2022 Mar;33(3):531-540. doi: 10.1007/s00192-021-04701-5. Epub 2021 Feb 10. PMID: 33566173; PMCID: PMC8885550.
Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil. 2021 Dec 27;17(6):379-387. doi: 10.12965/jer.2142666.333. PMID: 35036386; PMCID: PMC8743604.
Hagen S, Elders A, Stratton S, Sergenson N, Bugge C, Dean S, Hay-Smith J, Kilonzo M, Dimitrova M, Abdel-Fattah M, Agur W, Booth J, Glazener C, Guerrero K, McDonald A, Norrie J, Williams LR, McClurg D. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ. 2020 Oct 14;371:m3719. doi: 10.1136/bmj.m3719. PMID: 33055247; PMCID: PMC7555069.
Yang SJ, Liu YT, Lo SS, Tsai CC, Pan PJ. Effect of a Comprehensive Rehabilitation Program for Community Women with Urinary Incontinence: A Retrospect Cohort Study. Healthcare (Basel). 2021 Dec 6;9(12):1686. doi: 10.3390/healthcare9121686. PMID: 34946412; PMCID: PMC8701398.
Reisenauer C, Naumann G. AWMF-Leitlinie Harninkontinenz, Registernummer 015-091, 2022. https://register.awmf.org/assets/guidelines/015-091l_S2k_Harninkontinenz-der-Frau_2022-03.pdf.
Ghaderi F, Oskouei AE. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014 Sep;26(9):1493-9. doi: 10.1589/jpts.26.1493. Epub 2014 Sep 17. PMID: 25276044; PMCID: PMC4175265.
Ahlund S, Nordgren B, Wilander EL, Wiklund I, Fridén C. Is home-based pelvic floor muscle training effective in treatment of urinary incontinence after birth in primiparous women? A randomized controlled trial. Acta Obstet Gynecol Scand. 2013 Aug;92(8):909-15. doi: 10.1111/aogs.12173. Epub 2013 Jun 10. PMID: 23672520.
Wang X, Qiu J, Li D, Wang Z, Yang Y, Fan G, Mao X, Wang J, Gao S, Zhu X, Xu T, Sun Z. Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence: A Randomized Clinical Trial. JAMA Netw Open. 2024 Nov 4;7(11):e2442925. doi: 10.1001/jamanetworkopen.2024.42925. PMID: 39499517; PMCID: PMC11539013.
Hilde G, Stær-Jensen J, Siafarikas F, Ellström Engh M, Bø K. Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2013 Dec;122(6):1231-8. doi: 10.1097/AOG.0000000000000012. Erratum in: Obstet Gynecol. 2014 Sep;124(3):639. PMID: 24201679.
Wang X, Xu X, Luo J, Chen Z, Feng S. Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial. Int J Nurs Stud. 2020 Apr;104:103527. doi: 10.1016/j.ijnurstu.2020.103527. Epub 2020 Jan 21. PMID: 32058140.
Lange S, Lange R, Tabibi E, Hitschold T, Müller VI, Naumann G. Comparison of Vaginal Pessaries to Standard Care or Pelvic Floor Muscle Training for Treating Postpartum Urinary Incontinence: a Pragmatic Randomized Controlled Trial. Geburtshilfe Frauenheilkd. 2024 Mar 6;84(3):246-255. doi: 10.1055/a-2243-3784. PMID: 38455997; PMCID: PMC10917606.
Dinc A, Kizilkaya Beji N, Yalcin O. Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Oct;20(10):1223-31. doi: 10.1007/s00192-009-0929-3. Epub 2009 Aug 1. PMID: 19649552.
Kim EY, Kim SY, Oh DW. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clin Rehabil. 2012 Feb;26(2):132-41. doi: 10.1177/0269215511411498. Epub 2011 Aug 17. PMID: 21849373.
Kinouchi K, Ohashi K. Smartphone-based reminder system to promote pelvic floor muscle training for the management of postnatal urinary incontinence: historical control study with propensity score-matched analysis. PeerJ. 2018 Feb 9;6:e4372. doi: 10.7717/peerj.4372. PMID: 29441244; PMCID: PMC5808312.
Moossdorff-Steinhauser HFA, Bols EMJ, Spaanderman MEA, Dirksen CD, Weemhoff M, Nieman FHM, Berghmans B. Long-term effects of motherfit group therapy in pre-(MOTHERFIT1) and post-partum women (MOTHERFIT2) with stress urinary incontinence compared to care-as-usual: study protocol of two multi-centred, randomised controlled trials. Trials. 2019 Apr 25;20(1):237. doi: 10.1186/s13063-019-3331-6. PMID: 31023381; PMCID: PMC6485130.
Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil. 2010 Jul;91(7):1059-63. doi: 10.1016/j.apmr.2010.03.006. PMID: 20537314.
Davies GAL, Wolfe LA, Mottola MF, MacKinnon C. No. 129-Exercise in Pregnancy and the Postpartum Period. J Obstet Gynaecol Can. 2018 Feb;40(2):e58-e65. doi: 10.1016/j.jogc.2017.11.001. PMID: 29447726.
García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Nov 8;16(22):4358. doi: 10.3390/ijerph16224358. PMID: 31717291; PMCID: PMC6887794.
Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003 Feb;37(1):6-12; discussion 12. doi: 10.1136/bjsm.37.1.6. PMID: 12547738; PMCID: PMC1724598.
Kucukkaya B, Kahyaoglu Sut H. Effectiveness of pelvic floor muscle and abdominal training in women with stress urinary incontinence. Psychol Health Med. 2021 Jul;26(6):779-786. doi: 10.1080/13548506.2020.1842470. Epub 2020 Oct 30. PMID: 33125272.
Kamel DM, Thabet AA, Tantawy SA, Radwan MM. Effect of abdominal versus pelvic floor muscle exercises in obese Egyptian women with mild stress urinary incontinence: A randomised controlled trial. Hong Kong Physiotherapy Journal. 2013 Feb 14;31(1):12–8.
Hung HC, Hsiao SM, Chih SY, Lin HH, Tsauo JY. An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010 Jun;15(3):273-9. doi: 10.1016/j.math.2010.01.008. Epub 2010 Feb 24. PMID: 20185357.
Fritel X, Ringa V, Quiboeuf E, Fauconnier A. Female urinary incontinence, from pregnancy to menopause: a review of epidemiological and pathophysiological findings. Acta Obstet Gynecol Scand. 2012 Aug;91(8):901-10. doi: 10.1111/j.1600-0412.2012.01419.x. Epub 2012 May 22. PMID: 22497363.
Villalobos VU, Solera S. Rehabilitación del piso pélvico. Revista Clínica Escuela de Medicina UCR-HSJD. 2017 Jan 30;7(1).
Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th. ed. Paris: European Association of Urology. 2012.
Pellín D, Martínez S, Toro Merlo J, Sánchez P, Briceño W. Protocolos de atención en uroginecología y piso pélvico. Ateproca: Caracas. 2013.
Fitz FF, Stüpp L, da Costa TF, Bortolini MAT, Girão MJBC, Castro RA. Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017 Nov;36(8):2034-2043. doi: 10.1002/nau.23226. Epub 2017 Feb 7. PMID: 28169458.
Wu X, Zheng X, Yi X, Lai P, Lan Y. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther. 2021 Aug;38(8):4163-4177. doi: 10.1007/s12325-021-01831-6. Epub 2021 Jun 27. PMID: 34176082; PMCID: PMC8342347. Wu X, Zheng X, Yi X, Lai P, Lan Y. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther. 2021 Aug;38(8):4163-4177. doi: 10.1007/s12325-021-01831-6. Epub 2021 Jun 27. PMID: 34176082; PMCID: PMC8342347.
Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, McClurg D, Abdel-Fattah M, Agur W, Andreis F, Booth J, Dimitrova M, Gillespie N, Glazener C, Grant A, Guerrero KL, Henderson L, Kovandzic M, McDonald A, Norrie J, Sergenson N, Stratton S, Taylor A, Williams LR. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol Assess. 2020 Dec;24(70):1-144. doi: 10.3310/hta24700. PMID: 33289476; PMCID: PMC7768330.
Höder A, Stenbeck J, Fernando M, Lange E. Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review. BMC Womens Health. 2023 Nov 18;23(1):618. doi: 10.1186/s12905-023-02765-7. PMID: 37980530; PMCID: PMC10657595.
Pires TF, Pires PM, Costa R, Viana R. Effects of pelvic floor muscle training in pregnant women. Porto Biomed J. 2020 Sep 16;5(5):e077. doi: 10.1097/j.pbj.0000000000000077. PMID: 33195869; PMCID: PMC7657576.
McClurg D, Frawley H, Hay-Smith J, Dean S, Chen SY, Chiarelli P, Mair F, Dumoulin C. Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS state-of-the-science seminar research paper i of iv. Neurourol Urodyn. 2015 Sep;34(7):606-14. doi: 10.1002/nau.22769. Epub 2015 May 21. PMID: 25997975.
Sacomori C PT, PhD, Berghmans B PT, MSc, PhD, de Bie R PT, PhD, Mesters I PhD, Cardoso FL PhD. Predictors for adherence to a home-based pelvic floor muscle exercise program for treating female urinary incontinence in Brazil. Physiother Theory Pract. 2020 Jan;36(1):186-195. doi: 10.1080/09593985.2018.1482583. Epub 2018 Jun 4. PMID: 29863450.
Devreese A, Staes F, De Weerdt W, Feys H, Van Assche A, Penninckx F, Vereecken R. Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol Urodyn. 2004;23(3):190-7. doi: 10.1002/nau.20018. PMID: 15098213.
Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004 Feb;9(1):3-12. doi: 10.1016/s1356-689x(03)00131-0. PMID: 14723856.
Hodges PW, Eriksson AE, Shirley D, Gandevia SC. Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005 Sep;38(9):1873-80. doi: 10.1016/j.jbiomech.2004.08.016. PMID: 16023475.
Sigurdardottir T, Steingrimsdottir T, Geirsson RT, Halldorsson TI, Aspelund T, Bø K. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial. Am J Obstet Gynecol. 2020 Mar;222(3):247.e1-247.e8. doi: 10.1016/j.ajog.2019.09.011. Epub 2019 Sep 14. PMID: 31526791.
Riemsma R, Hagen S, Kirschner-Hermanns R, Norton C, Wijk H, Andersson KE, Chapple C, Spinks J, Wagg A, Hutt E, Misso K, Deshpande S, Kleijnen J, Milsom I. Can incontinence be cured? A systematic review of cure rates. BMC Med. 2017 Mar 24;15(1):63. doi: 10.1186/s12916-017-0828-2. PMID: 28335792; PMCID: PMC5364653.
Gibbs CF, Johnson TM 2nd, Ouslander JG. Office management of geriatric urinary incontinence. Am J Med. 2007 Mar;120(3):211-20. doi: 10.1016/j.amjmed.2006.03.044. PMID: 17349439.
Konstantinidou E, Apostolidis A, Kondelidis N, Tsimtsiou Z, Hatzichristou D, Ioannides E. Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: a randomized pilot study. Neurourol Urodyn. 2007;26(4):486-491. doi: 10.1002/nau.20380. PMID: 17245777.
Carrasco G, Aboitiz Cantalapiedra, J. Efectividad del entrenamiento de los músculos del suelo pélvico en la incontinencia urinaria: revisión sistemática. Fisioterapia. 2025;87–95.
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