Função do assoalho pélvico e sintomas uroginecológicos em mulheres com e sem fibromialgia

Abstract

Objective: To investigate the function of Pelvic Floor Muscles (PFM) and the frequency of urogynecologic signs and symptoms in women with and without FM diagnosis, comparing them. Material and methods: A Cross-sectional study composed of women over 18 years old, with and without Fibromyalgia (FM), divided into Group with FM (G_FM) and Control Group (G_C). Translated and validated questionnaires were applied to evaluation of urinary, vaginal, sexual symptoms and quality of life: International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-SF), International Consultation on Incontinence Overactive Bladder Questionnaire (ICIQ-OAB), International Consultation on Incontinence Questionnaire— Vaginal Symptoms (ICIQ-VS), Female Sexual Function Index (FSFI), King’s Health Questionnaire (KHQ) and Fibromyalgia Impact Questionnaire (FIQ). It was performed a physical examination with PFM function evaluation of control, coordination, tonus, presence of Tender points (TP), strength and endurance by vaginal digital palpation and electromyography of the PFM and accessories (abdominal, gluteal, adductors) and algometry for investigation of Widespread Pain Index (WPI), Symptom Severity (SS), as well as the scale of severity of symptoms for women with FM, as recommended by the American College of Rheumatology (ACR), in 2010. Data analysis was performed using the software BioEstat 5.3 and Gpower 3.1. A significance level of 5% and 95% confidence interval were adopted. Data comparison was performed using Student's t test for parametric and Mann-Whitney for non-parametric variables, Spearman's correlation and Logistic Regression tests were used to establish correlations between the variables. Results: 84 women were evaluated, from these 6 were excluded, and 39 were included in G_FM and 39 in G_C. The groups differed in terms of educational level (G_FM: 56,4%, G_C: 30,8%, p<0,01) and hormone replacement therapy (G_FM:10,3%, G_C: 23,1%, p<0,001). When comparing the groups, it was observed that the G_FM presented greater impairment of sexual function (FSFI) (G_FM: 7,2 (2-31,6), G_C: 21,6 (2-36), p<0,001), higher TP frequency (G_FM: 25,6%, G_C: 2,6%, p=0,03) during the vaginal digital palpation and less use of abdominal muscles (G_FM: 59,69 ±63,24, G_C: 127,89 ±228,83, p=0,01) during investigation of the PFM electromyographic activity concomitant to its accessories. The pain scale reported in the TP of the PFM of the G_FM women presented correlation with the total IFSF score (r=-0,327, p=0,041); however, no correlations were found between the WPI, SS with the presence of TP in the PFM, in this group. Although, no difference was found in urinary incontinence frequency (G:_FM; 59%, G_C: 64,1%, p=0,34), the G_FM women presented greater UI impact in the areas of "quality of life"(G_FM: 5 (3-8), G_C: 4 (2-7), p=0,01) and “sleep/ energy” of KHQ (G_FM: 5 (2-8), G_C: 2 (2-8), p<0,01). In G_FM, the ICIQ-VS vaginal symptoms score (ESV) was positively correlated with the total KHQ score (r=0,386, p=0,015). Conclusion: Women with fibromyalgia had a higher frequency of PD in the MAP, less use of the abdominals during the contraction of the MAP, greater impairment of sexual function and greater impact of urinary incontinence on quality of life and sleep / energy, although no difference was found frequency of urinary symptoms