Study design, materials and methods
This is an experimental study whose population is composed by 12 women who have Mixed Urinary Incontinence and Body Mass Index (BMI) between 25 to 40kg/m². Also who have experienced sexual intercourse; does not exercise their Pelvic Floor Muscles (PFM); have signed an informed consent form; does not experienced urogynecological or bariatric surgery and have Urinary Incontinence diagnosed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and 1 hour Pad-test value above 1g of urine. Were excluded from the survey those women who were incapable to understand simple verbal commands or does not adhered to the given orientations in addition to those who were incapable to contract the PFM separately; who have urinary or vaginal infections; experienced pain during evaluation or does not attended to more than 20% of the treatment appointments. This study was approved by the Ethics Committee under the number 1.867.867. Data were collected into three steps: Initial evaluation (1): Use of an evaluation sheet composing ICIQ-SF and 1 hour Pad-test questionnaires as well as an physical examination; (2) Intervention: Application of a PFM training protocol combined to a weight-loss program; (3) Revaluation: another application of the evaluation sheet, ICIQ-SF, Pad-test 1h e Patient Global Impression Improvement (PGI-I) questionnaires and physical examination past 2 months of intervention. During the intervention period were realized 2 appointments along 8 weeks in a roll, totalling 16 appointments of treatment with 30 minutes each. In the first 5 minutes of each session, PFM warm up was performed in order to prepare the muscles to the following exercises. During the 8 initial appointments the training was composed by 5 rapid and 5 3-seconds-sustained contractions followed by 3 cough simulation performed by the patient positioned in dorsal decubitus with flexed and abducted hips and 8 plantar flexions in standing position associated to hip external rotation. Along the other 8 appointments, PFM contractions number remained the same while cough simulation were increased to 5 and plantar flexion to 12. 30 minutes of resting was carried between the exercises. The treatment was divided into 4 categories: diaphragmatic exercise, bridge exercise, sit-up exercises and pelvic mobility exercise. For each category, training progression was applied over the time. The appointment was individual and the patients received educational orientation regarding the PFM position, its function as well as risk factors and types of Urinary Incontinence, bladder and intestine performance. Besides PFMT, patients received nutritional evaluation and surveillance by a dietician, who used a protocol based on individual characteristics, basal metabolic index, gender, aging and the practice of physical activity. On the basis of further calculation, a dietetic plan prescription aimed to promote a weight-loss of 0,5 to 1kg/week. Nutritional orientations were based on a low-calorie feeding and given by a dietician who contributed to the study evaluating the population group and monitoring them once in a month. Furthermore two orientation sheets were offered in order to clarify how to cook and store food and its nutritional information. The sample data were analysed by the SPSS 20.0 software and the significance level was 5%. Initially, the Shapiro-Wilk test was used to check the data normality. Subsequently, sociodemographic, clinic, anthropometric and obstetric descriptive statistic was carried out intending to characterize the sample and present indicial findings. At the end, T paired and Wilcoxon tests were performed aiming to verify the differences between initial and final measurements. These differences were considered statistically significative as the P significance value was lower than 0,05.
Interpretation of results
The results of this survey concluded that combined treatment has reduced around 6 to 7 points on ICIQ-SF final score. Nystrom et al. 2015 evaluated 214 women with stress Urinary Incontinence both before and after PFM endurance training resulting on a minimal significative difference of ICIQ-SF total score of 2,5 points . Due to this, most of our participants have already indicated improvement on symptoms. Even thought the Pad-test have not presented significative statistic difference comparing initial and final measurements, there was an important decrease reaching a final average of less than 1g of urine, which, according to the ICS, is considered as continence . It may occur due to the weight-loss program which profited reduction on CC measurements. In addition, some stage of urinary symptoms improvement was clear to observe among the patients, which may be a result of the welfare improvement due nutritional surveillance.