Osteopathic musculoskeletal manipulative treatment combined with pelvic floor physiotherapy in women with urge urinary incontinence and mixed urinary incontinence
DOI:
https://doi.org/10.62827/fb.v26i6.1112Keywords:
Osteopathic; Urinary Incontinence; Women's Health.Abstract
Introduction: Urinary incontinence is defined by the International Continence Society as any involuntary loss of urine, a condition prevalent in women and associated with significant physical, psychological, and social impacts. Objective: The effectiveness of combining Osteopathic Manipulative Treatment and pelvic floor physiotherapy in improving symptoms of urge urinary incontinence and mixed urinary incontinence in adult women was evaluated. Methods: This is a prospective, controlled, and randomized clinical trial conducted with 19 participants treated at the Voiding Dysfunction Center of the Piquet Carneiro Polyclinic (NDM/PPC/UERJ). Participants were randomly divided into two groups: the PHYSIO group, undergoing only pelvic floor physiotherapy, and the TMO group, undergoing pelvic floor physiotherapy combined with osteopathic musculoskeletal manipulative treatment. The study lasted 12 weeks, with assessments at baseline, and after six and twelve weeks. The instruments used were a Voiding Diary, the ICIQ-SF, ICIQ-OAB, WHOQOL-bref questionnaires, and the NEW PERFECT functional scale for pelvic floor assessment. Results: The results showed that the TMO group presented a significant reduction in urinary leakage as early as the sixth week, in addition to an improvement in urinary urgency symptoms. Both groups demonstrated increased strength and endurance of the pelvic floor muscles, with more pronounced endurance in the FISIO group. The TMO group showed a significant improvement in quality of life on the WHOQOL-bref questionnaire, demonstrating a more comprehensive positive impact of the combined treatment. Conclusion: The association between bone marrow transplantation (BMT) and pelvic floor physiotherapy is effective, promoting functional improvement and quality of life, suggesting potential for integrated therapeutic protocols.
References
Abrams P, Artibani W, Cardozo L, Dmochowski R, van Kerrebroeck P, Sand P. International Continence Society. Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn. 2009; 28(4):287. doi:10.1002/nau.20737
Mannella P, Palla G, Bellini M, Simoncini T. The female pelvic floor through midlife and aging. Maturitas. 2013; 76(3):230-234. doi:10.1016/j.maturitas.2013.08.008
Chaitow L. Chronic pelvic pain: pelvic floor problems, sacro-iliac dysfunction and the trigger point connection. J Bodyw Mov Ther. 2007;11(4):327-339. doi:10.1016/j.jbmt.2007.05.002
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):125-132. doi:10.1007/s001920200027
Arab AM, Chehrehrazi M. Ultrasound measurement of abdominal muscles activity during abdominal hollowing and bracing in women with and without stress urinary incontinence. Man Ther. 2011;16(6):596-601. doi:10.1016/j.math.2011.03.009
Capson AC, Nashed J, McLean L. The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kinesiol. 2011;21(1):166-177. doi:10.1016/j.jelekin.2010.07.017
Hodges PW, Sapsford RR, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26(3):362-371. doi:10.1002/nau.20232
Junginger B, Baessler K, Sapsford R, Hodges PW. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J. 2010;21(1):69-77. doi:10.1007/s00192-009-0981-z
Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008;13(3):206-212. doi:10.1016/j.math.2006.12.006
Richardson CA. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. Churchill Livingstone; 1999. [Book (no DOI)]
Gavira Pavón A, Walker Chao C, Rodríguez Rodríguez N, Gavira Iglesias FJ. Prevalence and risk factors of urinary incontinence in women who visit the doctor with low back pain: multicentre study. Aten Primaria. 2014;46(2):100-108. doi:10.1016/j.aprim.2013.07.004
Ponzoni LC, Valentin EK, Carrerette FB, Damião R. Tratamento manipulativo osteopático musculoesquelético em mulheres com incontinência urinária não complicada. Fisioterapia Brasil. 2019;20(2):230-238. Doi:10.33233/fb.v20i2.2397
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322-330. doi:10.1002/nau.20041
Pereira SB, Thiel Rdo R, Riccetto C, Bandeira C, Herrmann V, Palma PCR. Validation of the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for Portuguese. Rev Bras Ginecol Obstet. 2010;32(6):273-278. doi:10.1590/S0100-72032010000600004
Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida WHOQOL-bref. Rev Saude Publica. 2000;34(2):178-183. doi:10.1590/S0034-89102000000200012
Haslam J, Laycock J. Therapeutic management of incontinence and pelvic pain. 2nd ed. London: Springer; 2008. [Book (no DOI)]
Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631-642. doi:10.1016/S0031-9406(05)61108-X
Póvoa LC, Vanuzzi FK, Ferreira APA, Ferreira AS. Intervenção osteopática em idosos e o impacto na qualidade de vida. Fisioter Mov. 2011;24(3):429-436. [DOI not found]
Figueiredo VF, Figueiredo EM, Freitas Junior IF, Ribeiro LH, Pereira LC, dos Santos CR. Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly. Braz J Phys Ther. 2015;19(1):70-76. doi:10.1590/bjpt-rbf.2014.0073
Giordani G, Lazzari M, Mazzoni G, Pironi C, Gori R, Catalfamo L, et al. Manual physiotherapy combined with pelvic floor training in women suffering from stress urinary incontinence and chronic nonspecific low back pain: a preliminary study. Healthcare (Basel). 2022;10(10):2031. doi:10.3390/healthcare10102031
Origo D, Dal Farra F, Tramontano M. The presence of abnormal palpatory findings in the sacrococcygeal area is correlated with chronic pelvic pain: a cross-sectional study. Int Urol Nephrol. 2025;57(11):3521-3531. doi:10.1007/s11255-025-04521-2
Dal Farra F, Risio R, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: a systematic review and meta-analysis. Complement Ther Med. 2024;56:103245. doi:10.1016/j.ctim.2024.103245
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Copyright (c) 2025 Lilian de Castro Ponzoni , Ronaldo Damião, Fabricio Borges Carrerette , Ericka Kirsthine Valentin , Ricardo José de Souza (Autor)
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