RESUMO
Alterations to arginine vasopressin (AVP) secretion, the urinary bladder urothelium (UT) and other components of the bladder, and the water homeostasis biosystem may be relevant to the pathophysiology of nocturia and nocturnal polyuria (NP). AVP is the primary hormone involved in water homeostasis. Disruption to the physiological release of AVP or its target effects may relate to several urinary disturbances. Circadian dysregulation and the effects of aging, for example, the development of oxidative stress and mitochondrial dysfunction, may play a role in nocturia voiding symptoms. The urinary bladder UT not only acts as a highly efficient barrier that is maintained during the filling and voiding of the urinary bladder, but is also capable of sensory and transducer function through a network of functional receptors and ion channels that enable reciprocal communication between UT cells and neighboring elements of the bladder mucosa and wall. Functional components of the UT (eg, claudins and receptors or ion channels) play important roles in AVP-mediated water homeostasis. These components and functions involved in water homeostasis, as well as kidney function, may be affected by the aging process, including age-related mitochondrial dysfunction. The characteristics of NP are discussed and the association between NP and circadian rhythm is examined in light of reports that suggest that nocturia should be considered as a type of circadian dysfunction. Many possible pathologic mechanisms that underlie nocturia and NP have been identified. Future studies may provide further insight into pathophysiology with the hope of identifying new treatment modalities.
Assuntos
Noctúria/complicações , Noctúria/fisiopatologia , Poliúria/complicações , Poliúria/fisiopatologia , Fatores Etários , Envelhecimento , Fenômenos Fisiológicos Celulares , Ritmo Circadiano/fisiologia , Homeostase , Humanos , Bexiga Urinária/fisiopatologia , Urotélio/fisiopatologia , Água/fisiologiaRESUMO
INTRODUCTION AND HYPOTHESIS: The objective was to check the effects of two nonpharmacological treatments on the sleep quality of women with nocturia. METHODS: A randomized controlled clinical trial in which 40 women with nocturia were randomized into two groups; one was subjected to tibial nerve stimulation (GTNS) and the other received pelvic floor muscle training associated with behavioral therapy (GPFMT). Both groups were followed for 12 weeks, with one session/week; evaluated by the Pittsburgh Sleep Quality Index (PSQI), King's Heath Questionnaire (KHQ), and Epworth Sleepiness Scale (ESS). The Wilcoxon test was used to compare intra-group data and the Mann-Whitney test for intergroup results. Effect size and confidence interval were calculated, and the level of significance was set at 5%. RESULTS: Both groups showed improvements in quality of sleep, observed by the PSQI total score (GTNS from 9 ± 0.88 to 7 ± 0.94, p = 0.002; GPFMT from 8 ± 0.80 to 5 ± 0.94, p < 0.001) and the sleep/energy domain of the KHQ (GTNS from 66.66 ± 9.03 to 16.66 ± 7.20, p = 0.002; GPFMT from 66.66 ± 9.30 to 0.00 ± 7.26, p = 0.001). CONCLUSIONS: Both nonpharmacological treatments proposed (TNS or PFMT) were equally able to improve quality of sleep of women with nocturia.
Assuntos
Terapia Comportamental/métodos , Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Noctúria/terapia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Noctúria/fisiopatologia , Diafragma da Pelve/fisiopatologia , Sono , Inquéritos e Questionários , Nervo Tibial , Resultado do TratamentoRESUMO
Summary Introduction: Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. Objective: To verify the effects of isolated PFMT on the symptoms of OAB. Method: Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. Results: There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. Conclusion: The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.
Resumo Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) envolve a contração dos músculos puborretal, esfíncteres anal e uretral externo, inibindo a contração do detrusor, o que justifica sua utilização no tratamento dos sintomas da bexiga hiperativa (BH). Objetivo: Verificar os efeitos do TMAP isolado sobre a sintomatologia da BH. Método: Ensaio clínico prospectivo com 27 mulheres com incontinência urinária mista (IUM), com predomínio de sintomas de BH e perda ≥ 2 g no pad test. Avaliaram-se: função dos músculos do assoalho pélvico (MAP) (palpação digital e manometria); sintomas urinários (noctúria, frequência e perda urinária); grau de incômodo dos sintomas de BH (Overactive Bladder Questionnaire [OAB-V8]); e qualidade de vida (Incontinence Quality-of-Life Questionnaire [I-QoL]). O programa de TMAP consistiu em 24 sessões ambulatoriais (2x/semana + TMAP domiciliar). Os testes de Mann-Whitney e Wilcoxon (com nível de significância de 5%) foram utilizados para analisar os dados. Resultados: Observou-se melhora significativa dos sintomas urinários ao pad test (5,8±9,7; p<0,001); ao diário miccional (perda urinária [0,7±1,1; p=0,005] e noctúria [0,8±0,9; p=0,011]). Foram observados redução do grau de incômodo dos sintomas urinários conforme questionário OAB-V8 (10,0±7,7; p=0,001) e significativos resultados na função dos MAP: Oxford (3,6±0,9; p=0,001), Endurance (5,2±1,8; p<0,001), Fast (8,9±1,5; p<0,001) e manometria (26,6±15,8; p=0,003). No mais, a qualidade de vida teve significativa melhora nos três domínios avaliados pelo I-QoL. Conclusão: O TMAP sem quaisquer orientações adicionais melhora a sintomatologia, a função dos MAP e a qualidade de vida de mulheres com sintomas de BH.
Assuntos
Humanos , Feminino , Adulto , Idoso , Diafragma da Pelve/inervação , Terapia por Exercício/métodos , Bexiga Urinária Hiperativa , Qualidade de Vida , Síndrome , Terapia por Estimulação Elétrica , Estudos Prospectivos , Inquéritos e Questionários , Modalidades de Fisioterapia , Resultado do Tratamento , Diafragma da Pelve/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Noctúria/fisiopatologia , Noctúria/terapia , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Williams-Beuren syndrome (WBS) is a genetic condition caused by a microscopic deletion in the chromosome band 7q11.23. Individuals with WBS may present with congenital cardiovascular defects, neurodevelopmental disturbances and structural abnormalities of the urinary tract. Lower urinary tract symptoms (LUTS) seem to be frequent in this population, but studies on this topic are scarce and based on small case series. OBJECTIVE: To systematically evaluate the prevalence of lower urinary tract symptoms (LUTS) and the acquisition of bladder control in a large population with WBS. STUDY DESIGN: A cross-sectional study evaluating 87 consecutive patients with WBS; there were 41 girls and 46 boys. Genetic studies confirmed WBS in all patients. Subjects were clinically evaluated with: a history of LUTS obtained from the parents and child, a structured questionnaire of LUTS, a 3-day urinary frequency-volume chart, a quality of life question regarding LUTS, and physical examination. A history regarding the acquisition of bladder control was directly evaluated from the parents. RESULTS: Mean age of patients was 9.0 ± 4.2 years, ranging from 3 to 19 years. Based on the symptoms questionnaire and the frequency-volume chart, 70 patients (80.5%) were symptomatic. The most common symptom was urgency, affecting 61 (70.1%) patients, followed by increased urinary frequency in 60 (68.9%) patients, and urge-incontinence in 53 (60.9%), as shown in Summary Fig. More than half of the children reported nocturnal enuresis, including 61% of the girls and 52% of the boys. Twenty-three patients (25.6%) had a history of urinary tract infections. The mean age for acquisition of dryness during the day was 4.4 ± 1.9 years. Parents of 61 patients (70.1%) acknowledged that LUTS had a significant impact on the quality of life of their children. DISCUSSION: A high prevalence of LUTS was confirmed with a significant negative impact on quality of life in a large population of children and adolescents with WBS. It was shown for the first time that the achievement of daytime bladder control is delayed in children with WBS. Although LUTS are not recognized as one of the leading features of the syndrome, it is believed that it should be considered as a significant characteristic of the clinical diagnosis of WBS. CONCLUSIONS: LUTS are highly prevalent in children and adolescents with WBS and have a significant negative impact on patient's quality of life.
Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Qualidade de Vida , Inquéritos e Questionários , Síndrome de Williams/complicações , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Noctúria/epidemiologia , Noctúria/etiologia , Noctúria/fisiopatologia , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Urodinâmica , Síndrome de Williams/diagnósticoRESUMO
INTRODUCTION: Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. OBJECTIVE: To verify the effects of isolated PFMT on the symptoms of OAB. METHOD: Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. RESULTS: There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. CONCLUSION: The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.
Assuntos
Terapia por Exercício/métodos , Diafragma da Pelve/inervação , Bexiga Urinária Hiperativa/terapia , Adulto , Idoso , Terapia por Estimulação Elétrica , Feminino , Humanos , Pessoa de Meia-Idade , Noctúria/fisiopatologia , Noctúria/terapia , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Síndrome , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologiaRESUMO
OBJECTIVE: To evaluate the pressure of the pelvic floor muscles in female athletes and the associated signs and symptoms of stress urinary incontinence. DESIGN: A prospective observational study. SETTING: An academic institution, primary level of clinical care. PARTICIPANTS: Forty women between 18 and 30 years of age divided into 4 groups: 10 volleyball players, 10 handball players, 10 basketball players, and 10 nonathletes. METHODS: The measurement of intracavity pressure was performed with use of a perineometer. The volunteers were instructed to perform 3 maximum isometric contractions of the perineum, held for 4 seconds. Data regarding specific training and urinary symptoms were collected through a questionnaire. MAIN OUTCOME MEASUREMENTS: Statistical analysis was performed by analysis of variance, with a significance level of 5%. The Spearman correlation was used to verify the degree of association between variables related to training, urinary symptoms, and perineal pressure. RESULTS: The average (standard deviation) perineal pressure for nonathletes was 6.73 ± 1.91 mm Hg. The average perineal pressure for handball players was 5.55 ± 1.43 mm Hg; for volleyball players, 4.36 ± 1.43 mm Hg; and for basketball players, 3.65 ± 1.35 mm Hg. Statistically significant differences were found in the perineal pressure of volleyball (P = .009) and basketball players (P = .039) compared with nonathletes. The number of games per year, strength training, and on-court workout correlated significantly with perineal pressure (Spearman correlation coefficient [Rs] of -0.512 for the 3 variables). Urine leakage through effort and nocturia correlated moderately with perineal pressure (Rs of -0.51 and -0.54, respectively). A strong correlation was found between urinary frequency and perineal pressure (Rs of -0.85). CONCLUSIONS: Analysis of these data suggests that perineal pressure is decreased in female athletes compared with nonathlete women. A lower perineal pressure correlates with increased symptoms of urinary incontinence and pelvic floor dysfunction.
Assuntos
Atletas , Contração Isométrica/fisiologia , Músculo Esquelético/fisiologia , Diafragma da Pelve/fisiologia , Pressão , Adolescente , Adulto , Análise de Variância , Feminino , Ginecologia/instrumentação , Humanos , Noctúria/fisiopatologia , Períneo/fisiologia , Educação Física e Treinamento , Estudos Prospectivos , Treinamento Resistido , Incontinência Urinária por Estresse/fisiopatologia , Adulto JovemRESUMO
In this article, we provide a concise review of the literature on nocturia and its interference with sleep and, consequently, on quality of life. There are few studies addressing the possible influences of nocturia on sleep disruption. Nocturia is a potential contributor to sleep disorders because affected individuals experience nonrestorative sleep due to frequent interruptions. We also attempted to determine whether individuals with nocturia wake to urinate or, alternately, urinate because they are awake. This review attempts to outline this specific association by examining the possible interactions with other medical conditions and the pathophysiology and prevalence. Most studies have observed a higher prevalence among women; however, the impact on quality of life is higher in men. Nocturia is not necessarily associated with natural aging. The exploration of these topics provides information to clarify the implications of nocturia on sleep, sleep disruption, and other related consequences. Additional evidence is still required to address the question of whether nocturia leads to disordered sleep or whether disordered sleep leads to nocturia.
Assuntos
Noctúria/complicações , Privação do Sono/complicações , Envelhecimento/fisiologia , Feminino , Humanos , Masculino , Noctúria/epidemiologia , Noctúria/fisiopatologia , Noctúria/terapia , Prevalência , Qualidade de Vida , Privação do Sono/epidemiologia , Privação do Sono/fisiopatologia , Privação do Sono/terapia , Bexiga Urinária Hiperativa/complicaçõesRESUMO
AIMS: Evaluate the role of pelvic floor muscle training (PFMT) on the treatment of lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) patients. METHODS: In this randomized controlled trial, twenty seven female patients with a diagnosis of MS and LUTD complaints were randomized, in two groups: Treatment group (GI) (N = 13) and Sham group (GII) (N = 14). Evaluation included urodynamic study, 24-hr Pad testing, three day voiding diary and pelvic floor evaluation according to PERFECT scheme. Intervention was performed twice a week for 12 weeks in both groups. GI intervention consisted of PFMT with assistance of a vaginal perineometer. GII received a sham treatment consisted on the introduction of a perineometer inside the vagina with no contraction required. RESULTS: At the end of the treatment GI was complaining less about storage and voiding symptoms than GII. Furthermore, differences found between groups were: reduction of pad weight (P = 0.00) (Mean: 87,51 grams initial and 6,03 grams final in GI. 69,46 grams initial and 75,88 grams final in GII), number of pads (P = 0.01) (Mean: 3,61 initial and 2,15 final in GI. 3,42 initial and 3,28 final in GII) and nocturia events (P < 0.00) (Mean: 2,38 initial and 0,46 final in GI. 2,55 initial and 2,47 final in GII) and improvements of muscle power (P = 0.00), endurance (P < 0.00), resistance (P < 0.00) and fast contractions (P < 0.00), domains of PERFECT scheme. CONCLUSIONS: PFMT is an effective approach to treat LUTD in female with MS.