Relação entre história reprodutiva e prolapso de órgãos pélvicos sintomático com força muscular respiratória em mulheres de meia-idade e idosas residentes na comunidade

Abstract

Background: Female reproductive history and pelvic floor dysfunction have contributed to the physical changes that appear in aging, such as early changes in the functional capacity of women. Thus, investigating the female reproductive history and symptomatic pelvic organ prolapse (POP), and its relationship with respiratory muscle strength, becomes a great necessity for the institution of treatment and adequate monitoring of this musculature. Objective: To assess the relationship of respiratory muscle strength with variables of reproductive history and pelvic floor prolapse in middle-aged and elderly women living in the community. Methods: A total of 208 women aged 41-80 years were studied in the cities of Santa Cruz - RN. The subjects were recruited for convenience and after consentment, the evaluation was performed. Socio-demographic data, anthropometric measures, life habits, reproductive history, pelvic floor changes (all variables by structured questionnaire for this research), physical performance evaluation (through IPAQ - short version) and respiratory muscle strength (manovacuometry), through maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Results: More than ninety percent (90.4%) of the women with seven or more children had less than basic education, while 80.8% of this group received less than three minimum wages. Approximately 44.1% of the sample had three pregnancies or less, 30.4% had 4-6 pregnancies and 25.5% had more than seven pregnancies. Women with seven or more pregnancies are older than women in the group with three children or fewer pregnancies. As for MIP, those who had seven or more pregnancies had more than 12 cmH2O less when compared to those who had seven or more pregnancies (β = -12.29; p = 0.233). Considering MEP, those who had seven or more pregnancies had more than 21 cmH2O less when compared to those who had seven or more pregnancies (β = -21.69, p <0.001). Regarding POP, 14.7% of the women presented symptomatic POP, which was not associated with MIP. The variables age, schooling, BMI, smoking and parity were associated with MIP in the univariate analysis, but only age, BMI and smoking are determinants of MIP in the multivariate model. In the univariate model, symptomatic POP, age, schooling, BMI and parity were associated with MEP. Women with symptomatic POP presented lower MEP when compared to women without this condition (β = -14.78; p = 0.014). Women with greater age and greater number of children (≥ 5 children) had worse values of MEP, and those with higher BMI and more years of studies (> 7 years), higher values, in the univariate analysis. In the multivariate model, only age, BMI and symptomatic POP are determinants for MEP. Conclusion: This study provides evidence that multiple pregnancies and symptomatic POP influence the respiratory muscle strength, since women with more gestations and with symptomatic POP have lower values of maximum respiratory pressures. Still, other variables such as BMI and smoking are related to the capacity to generate respiratory pressures.