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- The muscle cells in pelvic floor dysfunctions: systematic reviewPublication . Vieira, Ana Margarida Duarte da Silva; Faleiro, Maria Leonor; Mascarenhas-Saraiva, Miguel; Pais, Sandraackground/Aims: The pelvic floor muscles are important structures involved in pelvic floor tone, pelvic organ support, and continence. The aim of this study was to perform an update on the pelvic floor muscle structure and function alterations of women with pelvic floor dysfunctions. Methods: A systematic search was undertaken in two electronic databases, PubMed/Medline and Ovid Discovery to find manuscripts (in English), published between 1 January 2002 and 31 July 2022, including all clinical studies using the following search terms: “muscle” or “extracellular matrix *” and “pelvic floor dysfunction *”. All clinical trials, observational, or animal studies examining the muscle and reporting pelvic floor dysfunction as a primary outcome were included. Case reports, literature reviews, conference papers and theses, and unpublished data were excluded. To ensure that no eligible articles were overlooked, the reference lists of all included papers underwent manual scrutiny. The bias level was estimated using Newcastle–Ottawa Scale (NOS) for cohort and case-control studies. A qualitative synthesis was performed. Results: The significant qualitative and quantitative heterogeneity between the studies did not allow for a quantitative analysis. Of the 30 articles selected with a total of 5592 women, 15 referred to the analysis of structural muscle defects, which included 3365 participants with urinary incontinence, pelvic organ prolapse, fecal incontinence, cistocele, rectocele, and sexual dysfunction; 10 manuscripts referred to the study of pelvic floor muscle function with a population of 2042 women, such as urinary incontinence, pelvic organ prolapse, fecal incontinence, and sexual dysfunction; and 5 papers evaluated cellular and/or molecular changes affecting the pelvic floor muscles, like urinary incontinence, pelvic organ prolapse, and rectocele, which included a total of 185 participants. Women with pelvic floor muscle defects are at greater risk of pelvic floor dysfunctions, and inversely, women with pelvic floor dysfunctions have more pelvic floor muscle defects than women without pelvic floor dysfunctions. These patients demonstrate a reduction in muscle tone, contraction strength, and resistance, a compromised neuromuscular activity, and an alteration of the normal composition and organization of the muscle cells. Conclusions: Women with pelvic floor dysfunction have anatomical muscle defects, disturbance of muscle function and cellular changes involving muscle cells and nerve fibers.
- Sarcopenia in women with anorectal dysfunctions—a female sarcopelvic studyPublication . Vieira, Ana Margarida Duarte da Silva; Pais, Sandra; Martins, Viviana; Castelo, Barbara; Saraiva, Miguel MascarenhasAnorectal dysfunctions (ARDs) include fecal incontinence (FI) and functional defecation disorders (FDDs). The pelvic floor muscles play a central role in the physiology of continence and defecation. We aimed to investigate the prevalence of sarcopenia in a female group with anorectal dysfunctions and compare them with a healthy female age-matched group. As secondary objectives, the relationship between anorectal dysfunction outcomes and sarcopenia was analyzed. Methods: We conducted a single-center cross-sectional, interventional, controlled, and double-blind study involving female adults admitted to an ARD outpatient clinic assessed for FI and/or FDD. A control group was also included of age-matched women without ARD. Sarcopenia was evaluated in the entire cohort, according to the latest criteria. Statistical analysis was performed using SPSS software v.29, considering a confidence interval of 95%. Results: A total of 130 participants were included, equally divided by the two groups. The median age was 64 years. Both groups were also similar regarding body mass index (BMI), physical activity index values, and dietary patterns. Among the 130 investigated women, there were no cases of confirmed sarcopenia or severe sarcopenia, but 15 women (11.5%) had probable sarcopenia or dynapenia. The case group had significantly more probable sarcopenia than women in the control group (14 (21.5%) vs. 1 (1.5%), p < 0.001). The presence of relevant comorbidities, such as irritable bowel syndrome (IBS), urinary incontinence (UI), and meat dietary pattern (MDP), was a risk factor for probable sarcopenia. The binomial logistic regression analysis showed that probable sarcopenia (OR 3.9; CI 1.1–14.1, p = 0.039) was associated with a worse treatment response. Conclusions: Probable sarcopenia or dynapenia was significantly more prevalent in women with ARD and was a predictive factor of a worse treatment response, regardless of the ARD severity. Concomitant UI, MDP, IBS, and psychiatric conditions were significantly associated with dynapenia. The inclusion of the evaluation of sarcopenia in these patients should be considered.