بررسی تأثیر دو نوع روش تمرین درمانی بر روی بهبود بی‌اختیاری ادرار استرسی در زنان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه فیزیوتراپی، دانشکده‌ی توان‌بخشی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 مربی، گروه فیزیوتراپی، دانشکده‌ی توان‌بخشی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشیار، گروه اورولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: بی‌اختیاری ادرار استرسی (SUI یا Stress urinary incontinence) یک مشکل شایع در بین جوامع امروزی به خصوص در زنان می‌باشد. با افزایش سن، تعداد حاملگی و افزایش وزن، شانس ابتلا به این بیماری افزایش می‌یابد. تا کنون درمان‌های غیر جراحی مختلفی برای درمان بی‌اختیاری ادرار استرسی پیشنهاد شده‌اند. هدف از انجام این مطالعه، بررسی تأثیر دو نوع روش تمرین درمانی بر روی بهبود علایم مربوط به بی‌اختیاری ادرار استرسی در زنان بود.روش‌ها: در این کارآزمایی بالینی تصادفی یک سو کور، 41 بیمار مبتلا به بی‌اختیاری ادرار استرسی با دامنه‌ی سنی 65-20 سال انتخاب شدند و به صورت تصادفی در دو گروه Biofeedback و تمرینات شکمی قرار گرفتند. سپس، قبل و بعد از مداخله، کیفیت زندگی افراد با استفاده از پرسش‌نامه‌ی International consultation on incontinence questionnaire (ICIQ)، قدرت عضلات با استفاده از معیار Oxford scale grade (OSG) و شدت بی‌اختیاری با معاینه‌ی بالینی، مورد بررسی و مقایسه قرار گرفت.یافته‌ها: در هر دو گروه، کیفیت زندگی و قدرت عضلات کف لگن، بعد از 12 هفته درمان بهبود یافت (01/0 > P). همچنین، شدت بی‌اختیاری نیز کاهش یافت (01/0 > P)، اما بین دو گروه از نظر آماری تفاوت معنی‌داری بین کیفیت زندگی، قدرت عضلات و شدت بی‌اختیاری مشاهده نشد (05/0 < P).نتیجه‌گیری: به نظر می‌رسد از نظر آماری، اضافه شدن تمرینات شکمی به برنامه‌ی تمرینات کف لگن، تأثیر به‌سزایی روی روند بهبودی بیماران مبتلا به بی‌اختیاری ادرار استرسی ندارد.

کلیدواژه‌ها

عنوان مقاله [English]

The Effect of Two Types of Exercise Therapy on Improvement of Stress Urinary Incontinence in Women

نویسندگان [English]

  • Anahita Torkzadeh 1
  • Abasali Pormomeny 2
  • Mahtab Zargham 3
1 MSc Student, Department of Physical Therapy, School of Rehabilitation Sciences AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Instructor, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Stress urinary incontinence (SUI) is a common problem among adults living in the community and it is more frequent in women. Its incidence increases with age, the number of pregnancy and body mass index (BMI). So far, several conservative treatments have been proposed for the treatment of stress urinary incontinence. The aim of this study was to evaluate the effect of two types of exercise therapy on symptoms of stress urinary incontinence.Methods: In this single-blinded randomized controlled trial (RCT) study, 41 patients with stress incontinence with age range of 20 to 65 years were recruited and randomly assigned to two groups, biofeedback and abdominal exercises. Quality of life and muscle strength were investigated by international consultation on incontinence (ICIQ) questionnaire and standard oxford scale grade (OSG), respectively before and after the intervention.Findings: After 12 weeks of treatment, quality of life improved in both groups (P < 0.01). Pelvic floor muscle strength was also increased after treatment in both group (P < 0.01), but, there was no statistically significant difference between the quality of life and muscle strength between two groups (P > 0.05).Conclusion: It seems that adding abdominal muscle training to pelvic floor muscle training (PFMT) have no statistically significant impact on the rehabilitation of the women with SUI.

کلیدواژه‌ها [English]

  • Stress Urinary Incontinence
  • Pelvic floor muscle training
  • Biofeedback
  • Abdominal muscle training

مراجع

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61(1): 37-49.
  2. Doughty DB. Promoting continence: simple strategies with major impact. Ostomy Wound Manage 2003; 49(12): 46-52.
  3. Hunskaar S, Burgio K, Diokno A, Herzog AR, Hjalmas K, Lapitan MC. Epidemiology and natural history of urinary incontinence in women. Urology 2003; 62(4 Suppl 1): 16-23.
  4. Chiarelli P, Brown W, McElduff P. Leaking urine: prevalence and associated factors in Australian women. Neurourol Urodyn 1999; 18(6): 567-77.
  5. Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas 2010; 67(4): 309-15.
  6. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21(1): 5-26.
  7. Hay-Smith EJ, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011; (12): CD009508.
  8. Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M, Eskiyurt N. Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Gynecol Obstet Invest 2003; 56(1): 23-7.
  9. Castro RA, Arruda RM, Zanetti MR, Santos PD, Sartori MG, Girao MJ. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paulo) 2008; 63(4): 465-72.
  10. Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int 2003; 92(1): 69-77.
  11. Imamura M, Abrams P, Bain C, Buckley B, Cardozo L, Cody J, et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 2010; 14(40): 1-188.
  12. Kirby M. Managing stress urinary incontinence -- a primary care issue. Int J Clin Pract 2006; 60(2): 184-9.
  13. Knight S, Laycock J, Naylor D. Evaluation of neuromuscular electrical stimulation in the treatment of genuine stress incontinence. Physiotherapy 1998; 84(2): 61-71.
  14. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 1948; 56(2): 238-48.
  15. Kegel AH. Stress incontinence of urine in women; physiologic treatment. J Int Coll Surg 1956; 25(4 Part 1): 487-99.
  16. National Collaborating Centre for Women's and Children's Health. Urinary incontinence: the management of urinary incontinence in women. London, UK: Royal College of Obstetricians and Gynaecologists (RCOG); 2006.
  17. 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; 31(1): 12-8.
  18. Terlikowski R, Dobrzycka B, Kinalski M, Kuryliszyn-Moskal A, Terlikowski SJ. Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial. Int Urogynecol J 2013; 24(10): 1631-8.
  19. Pages IH, Jahr S, Schaufele MK, Conradi E. Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 2001; 80(7): 494-502.
  20. Sapsford R. The pelvic floor. Physiotherapy 2001; 87(12): 620-30.
  21. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil 2001; 82(8): 1081-8.
  22. Bo K, Stien R. Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, Valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourol Urodyn 1994; 13(1): 35-41.
  23. Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct 2002; 13(2): 125-32.
  24. Sapsford R, Markwell S, Clarke B. The relationship between urethral pressure and abdominal muscle activity. Australian Continence Journal 1998; 4: 102-10.
  25. Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 2001; 20(1): 31-42.
  26. Power RM. Embryological development of the levator ani muscle. Am J Obstet Gynecol 1948; 55(3): 367-81.
  27. Jones RC, Peng Q, Shishido K, Perkash I, Constantinou CE. 2D ultrasound imaging and motion tracking of pelvicfloor muscle (pelvic floor muscles) activity during abdominalmanoeuvres in stress urinary (SUI) women. Neurourol Urodyn 2006; 25(Special Issue): 596-7.
  28. Peng Q, Jones R, Shishido K, Constantinou CE. Ultrasound evaluation of dynamic responses of female pelvic floor muscles. Ultrasound Med Biol 2007; 33(3): 342-52.
  29. Kashanian M, Ali SS, Nazemi M, Bahasadri S. Evaluation of the effect of pelvic floor muscle training (PFMT or Kegel exercise) and assisted pelvic floor muscle training (APFMT) by a resistance device (Kegelmaster device) on the urinary incontinence in women: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2011; 159(1): 218-23.
  30. Nojomi M, Baharvand P, Moradi LM, Patrick DL. Incontinence quality of life questionnaire (I-QOL): translation and validation study of the Iranian version. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20(5): 575-9.
  31. Dumoulin C, Lemieux MC, Bourbonnais D, Gravel D, Bravo G, Morin M. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 2004; 104(3): 504-10.
  32. Sriboonreung T, Wongtra-ngan S, Eungpinichpong W, Laopaiboon M. Effectiveness of pelvic floor muscle training in incontinent women at Maharaj Nakorn Chiang Mai Hospital: a randomized controlled trial. J Med Assoc Thai 2011; 94(1): 1-7.
  33. 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; 15(3): 273-9.
مجله دانشکده پزشکی اصفهان
دوره 34، شماره 378 - شماره پیاپی 378
خرداد و تیر 1395
صفحه 341-346

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سابقه مقاله

  • تاریخ دریافت: 29 شهریور 1394
  • تاریخ بازنگری: 07 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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