Introduction and objective: During pregnancy, approximately 50% of women complain of urinary incontinence (UI) symptoms and a third of fecal incontinence (FI). These conditions lead, in addition to a reduced quality of life, also to a high risk of manifesting symptoms after childbirth, determining not only a further worsening of the mother's well-being, but also a greater psychological, social and economic impact. Since both types of incontinence are preventable and treatable, this thesis aims to explore the various physiotherapeutic approaches present in the literature to reduce the risk of onset and possibly the symptomatology of UI and IF in pregnant women. Methods: The search was conducted by consulting two databases, Pubmed and PEDro, including only systematic reviews regarding physiotherapy interventions for the prevention or treatment of urinary or fecal incontinence during pregnancy. The included studies are more recent than 2010 and in English, Italian and Spanish. Furthermore, they present outcomes related to self-reporting of urinary or fecal incontinence during pregnancy or after delivery, the degree of postpartum perineal laceration, the use of episiotomy and the duration of labor. Results: Thirteen systematic reviews were selected and most of them have a low methodological quality. The studies included for the prevention and treatment of UI concern PFMT and aerobic/resistance exercise interventions, performed both individually and in combination and both in groups and alone. To reduce the risk of UI and FI, PFMT and perineal massage are analyzed, while for the prevention and treatment of UI and FI, aerobic/resistance exercise is also evaluated. No review deals exclusively with FI. Conclusion: PFMT is the most studied and effective intervention for the prevention of UI, but when combined with aerobic and/or resistance exercise it achieves better results. The effectiveness of interventions for the treatment of UI during pregnancy is still uncertain. Except for perineal massage and PFMT, which directly or indirectly reduce the risk of onset and symptoms of FI, all other interventions have not been proven valid or have not been investigated in relation to FI. Further studies are needed to confirm the results and investigate further possible interventions for the prevention and treatment of FI and the treatment of UI.
Introduzione ed obiettivo: Durante la gravidanza, circa il 50% delle donne lamenta sintomi di incontinenza urinaria (IU) ed un terzo di incontinenza fecale (IF). Queste condizioni portano, oltre ad una ridotta qualità di vita, anche ad un elevato rischio di manifestare i sintomi dopo il parto, determinando non solo un ulteriore peggioramento del benessere della madre, ma anche un maggior impatto psicologico, sociale ed economico. Dal momento che entrambi i tipi di incontinenza sono prevenibili e trattabili, con questa tesi si vogliono esplorare i vari approcci fisioterapici presenti in letteratura volti a ridurre il rischio di insorgenza ed eventualmente la sintomatologia di IU ed IF in donne incinte. Materiali e metodi: La ricerca è stata condotta consultando due banche dati, Pubmed e PEDro, includendo solo revisioni sistematiche riguardanti interventi fisioterapici per la prevenzione o il trattamento dell’incontinenza urinaria o fecale in gravidanza. Gli studi inclusi sono più recenti del 2010 ed in lingua inglese, italiana e spagnola. Inoltre, presentano outcomes relativi all’autodichiarazione di incontinenza urinaria o fecale durante la gestazione o dopo il parto, al grado di lacerazione perineale post-parto, al ricorso di episiotomia ed alla durata del travaglio. Risultati: Sono state selezionate tredici revisioni sistematiche e la maggior parte di esse hanno una bassa qualità metodologica. Gli studi inclusi per la prevenzione ed il trattamento di IU riguardano interventi di PFMT ed esercizio aerobico/resistenza, eseguiti sia in modo singolo che combinato e sia in gruppo che individualmente. Per ridurre il rischio di insorgenza di IU ed IF vengono invece analizzati il PFMT ed il massaggio perineale, mentre per la prevenzione ed il trattamento di IU ed IF viene valutato anche l’esercizio aerobico/resistenza. Nessuna revisione tratta in maniera esclusiva l’IF. Conclusioni: Il PFMT è l’intervento più studiato ed efficace per la prevenzione di IU, ma se combinato con l’esercizio aerobico e/o di resistenza fa ottenere migliori risultati. L’efficacia degli interventi per il trattamento di IU durante la gravidanza è ancora incerta. Ad esclusione del massaggio perineale e del PFMT, che riducono in maniera diretta o indiretta il rischio di insorgenza e la sintomatologia di IF, tutti gli altri interventi non si sono dimostrati validi o non sono stati investigati in relazione all’IF. Ulteriori studi sono necessari per confermare i risultati emersi ed investigare ulteriori possibili interventi per la prevenzione ed il trattamento di IF ed il trattamento di IU.
Approccio fisioterapico per la prevenzione ed il trattamento dell'incontinenza urinaria e fecale in gravidanza: revisione della letteratura
FRIGO, SOFIA
2023/2024
Abstract
Introduction and objective: During pregnancy, approximately 50% of women complain of urinary incontinence (UI) symptoms and a third of fecal incontinence (FI). These conditions lead, in addition to a reduced quality of life, also to a high risk of manifesting symptoms after childbirth, determining not only a further worsening of the mother's well-being, but also a greater psychological, social and economic impact. Since both types of incontinence are preventable and treatable, this thesis aims to explore the various physiotherapeutic approaches present in the literature to reduce the risk of onset and possibly the symptomatology of UI and IF in pregnant women. Methods: The search was conducted by consulting two databases, Pubmed and PEDro, including only systematic reviews regarding physiotherapy interventions for the prevention or treatment of urinary or fecal incontinence during pregnancy. The included studies are more recent than 2010 and in English, Italian and Spanish. Furthermore, they present outcomes related to self-reporting of urinary or fecal incontinence during pregnancy or after delivery, the degree of postpartum perineal laceration, the use of episiotomy and the duration of labor. Results: Thirteen systematic reviews were selected and most of them have a low methodological quality. The studies included for the prevention and treatment of UI concern PFMT and aerobic/resistance exercise interventions, performed both individually and in combination and both in groups and alone. To reduce the risk of UI and FI, PFMT and perineal massage are analyzed, while for the prevention and treatment of UI and FI, aerobic/resistance exercise is also evaluated. No review deals exclusively with FI. Conclusion: PFMT is the most studied and effective intervention for the prevention of UI, but when combined with aerobic and/or resistance exercise it achieves better results. The effectiveness of interventions for the treatment of UI during pregnancy is still uncertain. Except for perineal massage and PFMT, which directly or indirectly reduce the risk of onset and symptoms of FI, all other interventions have not been proven valid or have not been investigated in relation to FI. Further studies are needed to confirm the results and investigate further possible interventions for the prevention and treatment of FI and the treatment of UI.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/75768