Effectiveness of Hypopressive Exercises Versus Pelvic-perineal Physiotherapy
Condition: Pelvic Floor Disorders; Urinary Incontinence; Fecal Incontinence; Pelvic Pain
MeSH terms: Fecal Incontinence; Urinary Incontinence; Enuresis; Pelvic Floor Disorders; Pelvic Pain
Study type: Interventional

Summary: 
      Introduction: Hypopressive Exercises are included within a method of physiotherapy which was
      created with the purpose of strengthening the deep muscles of the abdomen without damaging
      ligamentous and muscular structures of the perineum, also strengthening the muscles of pelvic
      floor reflexively. Although this technique has been included as treatment and a prevention
      method of pelvic floor dysfunction, there are few studies supporting its benefits. The
      investigators hypothesis is that the combination of both physiotherapy treatments will
      provided the best results for women who suffer pelvic floor dysfunctions.

      Objective: To determine whether Hypopressive Exercises are an option to include in the
      physiotherapy treatment of women suffer at least one pelvic floor dysfunction and whether the
      results reported are comparable to those provided by pelvic-perineal physiotherapy.

      Subjects and methods: A randomized clinical trial, the examiner being blinded unaware of the
      intervention group to which subjects were assigned. Participants will be randomly assigned to
      three groups:

        1. An experimental group, where the participants will be treated by Hypopressive exercises
           and hygienic and behavioral measures;

        2. Another experimental group where pelvic-perineal physiotherapy will join with
           Hypopressive exercises and hygienic and behavioral advises;

        3. And a third group where will be done pelvic-perineal physiotherapy and hygienic and
           behavioral measures.

      Pre- intervention, immediate post-intervention, 3, 6 and 12 months assessments will be made.
      The selection criteria will be: adult women who present signs and symptoms that indicate a
      pelvic floor dysfunction or have a medical diagnosis to confirm it. All participants must
      understand and sign freely Informed Consent.

      Sample size: Accepting an alpha risk of 0.05 and a beta risk of 0.2 in a bilateral contrast,
      26 subjects were required in each group to detect a difference equal to or greater than 3
      microvolts (Total of 78 subjects). It assumes a standard deviation of 4.8 microvolts and the
      rate of loss to follow up esteem 20% (Magalhães-Resende et al. 2012).

      Data Analysis: A descriptive analysis of all variables was performed. It establish for all
      cases a confidence level of 95% (p <0.05). The effectiveness was assessed by comparing the
      experienced change of the three goups in outcome variables between physicaltherapy
      examinations.
    


Intervention name(s): Hypopressive exercises; Therapeutic education.; Pelvic-perineal physiotherapy; Physical Therapy assessment
Intervention type(s): Other; Behavioral; Other; Other
Intervention description(s): 45 minutes treatment by hipopressive exercises 2 times per week during 8 weeks. They will be doing in different positions: standing, kneeling, sitting and lying. The patient will be teach a total of 30 exercises. In the week number 8 the women with the physical therapist will choose 3 exercises that will be done daily at home during 20 minutes.; The therapeutic education will be doing during the 8 weeks of treatment. In the first day the knowledge and the briefs of the pelvic floor dysfunction will be assessed. Dietary and behavioral habits will also be discussed. In the second day anatomical and physiological explanation of the pelvic girdle will be the priority. In the third day will be explained the signs and symptoms of the different pelvic floor dysfunctions. In the four day will be analyzed the risk factors that may cause or worsen pelvic floor dysfunctions.
In the fifth day will be begun to correct the bad habits. In the last day will be reviewed the knowledge and new habits acquired during the treatment. In all treatment days will be discussed the doubts of the participant.; 45 minutes physical therapy treatment 2 times per week during 8 weeks. There will be done specific exercises of the pelvic floor muscles and coordination exercises of the pelvic floor muscles with other muscles in different positions. Electrostimulation, biofeedbak, cones and dinamometric devices can be employed to improve the muscle performance.; Pre-treatment, post-treatment, 3, 6 and 12 months after physical therapy treatment. Will be done a specific evaluation of pelvic floor muscles using the Modified Oxford Scale, superficial electromyography, perineometry and dynamometer. For the evaluation of the impact, the signs and the symptoms questionnaires will be completed by the participants.
Other intervention name(s): Hypopressive kinesiotherapy; Hygienic and behavioral advises.; Specific physical therapy.; Physiotherapy evaluation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Women; Pelvic floor disorders; Urinary incontinence; Fecal incontinence; Physical Therapy Modalities