NURSES’ PERFORMANCE IN PELVIC FLOOR DISORDERS IN CISGENDER WOMEN: AN INTEGRATIVE REVIEW

EL PAPEL DE LOS ENFERMEROS EN LOS TRASTORNOS DEL SUELO PÉLVICO EN MUJERES CISGÉNERO: UNA REVISIÓN INTEGRADORA

ABSTRACT

Objective:  to analyze evidence available in the literature on nursing care for pelvic floor disorders in cisgender women.

Method:  an integrative review was conducted based on searches of nine information sources. The final sample consisted of 13 studies, with data extracted from a form developed for this study. The level of evidence and methodological quality of included studies were classified according to the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. The analysis and synthesis of results were performed descriptively and presented in synthesis charts and figures.

Results:  the role of nurses is central in the approach to pelvic floor disorders, especially in the conservative management of urinary incontinence and pelvic organ prolapse. The effectiveness of interventions, such as pelvic floor muscle training and the use of pessaries, reinforces the importance of training healthcare professionals to offer continuing support to cisgender women, providing not only symptom relief but also significant improvements in quality of life.

Conclusion:  it is essential that nurses promote health education actions, through educational campaigns and training, with the aim of raising awareness among women about the importance of prevention and seeking early treatment for pelvic floor disorders.

DESCRIPTORS:
Nursing Care; Pelvic Floor Disorders; Female Urogenital Diseases; Nursing; Evidence-Based Nursing; Women’s Health

RESUMO

Objetivo:  analisar as evidências disponíveis na literatura sobre a assistência do enfermeiro nos distúrbios do assoalho pélvico em mulheres cisgêneras.

Método:  revisão integrativa conduzida a partir de buscas em nove fontes de informação. A amostra final foi composta por 13 estudos com os dados extraídos a partir de um formulário desenvolvido para este estudo. O nível de evidência e a qualidade metodológica dos estudos incluídos foram classificados conforme o Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. A análise e a síntese dos resultados foram realizadas de forma descritiva e apresentadas em quadro-síntese e em figuras.

Resultados:  destaca-se a atuação do enfermeiro como figura central na abordagem dos Distúrbios do Assoalho Pélvico, especialmente no manejo conservador da Incontinência Urinária e dos Prolapsos de Órgãos Pélvicos. A eficácia das intervenções, como o Treinamentos Musculares do Assoalho Pélvico e o uso de pessários, reforça a importância de capacitar os profissionais de saúde para oferecer suporte contínuo às mulheres cisgêneras, a fim de proporcionar não apenas alívio dos sintomas, mas também melhoria significativa na qualidade de vida.

Conclusão:  é essencial que os enfermeiros promovam ações de educação em saúde, por meio de campanhas educativas e de treinamentos, com o objetivo de sensibilizar as mulheres sobre a importância da prevenção e da busca por tratamento precoce dos distúrbios do assoalho pélvico.

DESCRITORES:
Cuidados de enfermagem; Distúrbios do assoalho pélvico; Doenças urogenitais femininas; Enfermagem; Enfermagem baseada em evidências; Saúde da mulher

RESUMEN

Objetivo:  analizar la evidencia disponible en la literatura sobre la atención de enfermería para los trastornos del suelo pélvico en mujeres cisgénero.

Método:  revisión integrativa basada en la búsqueda de nueve fuentes de información. La muestra final consistió en 13 estudios, cuyos datos se extrajeron de un formulario desarrollado para este estudio. El nivel de evidencia y la calidad metodológica de los estudios incluidos se clasificaron según el Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. El análisis y la síntesis de los resultados se realizaron de forma descriptiva y se presentaron en tablas y figuras resumen.

Resultados:  el papel del personal de enfermería es fundamental en el abordaje de los trastornos del suelo pélvico, especialmente en el tratamiento conservador de la incontinencia urinaria y el prolapso de órganos pélvicos. La eficacia de intervenciones como el entrenamiento muscular del suelo pélvico y el uso de pesarios refuerza la importancia de capacitar a los profesionales sanitarios para brindar apoyo continuo a las mujeres cisgénero, lo que proporciona no solo alivio de los síntomas, sino también mejoras significativas en su calidad de vida.

Conclusión:  es fundamental que el personal de enfermería promueva la educación para la salud mediante campañas educativas y formación, con el objetivo de concienciar a las mujeres sobre la importancia de la prevención y el tratamiento temprano de los trastornos del suelo pélvico.

DESCRIPTORES:
Atención de Enfermería; Trastornos del Suelo Pélvico; Enfermedades Urogenitales Femeninas; Enfermería; Enfermería Basada en la Evidencia; Salud de la Mujer

INTRODUCTION

During the aging process, cisgender women face several changes that can negatively impact their health, especially in the pelvic region. Factors accumulated over a lifetime, such as childbirth and weight gain, contribute to changes in the pelvic floor muscles (PFMs) structure and function, which favor the development of pelvic floor disorders (PFDs)¹.

The pelvic floor (PF) is composed of muscles and ligaments that support the pelvic and abdominal organs, and is essential for the proper functioning of the vagina, urethra, bladder, and other organs in the female pelvis. The pelvis is formed by bony structures, such as the sacrum and coccyx, which protect the internal organs. The perineum, formed by several muscles, prevents the pelvic opening by enclosing the vagina and anus².

Studies indicate that aging, physical exertion, number of pregnancies, sports activities, menopause, hypoestrogenism, and gynecological surgeries affect PF strength. Understanding these factors can help prevent PFD^3-6.

PFDs include pelvic organ prolapses (POPs), sexual and anorectal dysfunctions, and urinary incontinence (UI)^4,7-9. POPs are defined as pelvic organ displacement, known as hysterocele, cystocele, enterocele or rectocele^10-11. Sexual dysfunctions, in turn, lead to a decrease in sexual interest and limitations in its practice, due to personal, social, physiological and/or psychological factors¹².

Anorectal dysfunctions include pain, constipation, and fecal incontinence, and can be active or passive. In the active form, patients feel the need to defecate but do not reach the bathroom in time. In the passive form, patients do not realize the need until after defecation^4,13.

UI is an underdiagnosed and frequently reported disorder in healthcare services¹⁴. Defined as the involuntary loss of urine, it is associated with social impacts and is often incorrectly considered a natural part of aging. This condition can lead to depression and social isolation, and is classified into three types: stress urinary incontinence (UIS), characterized by urine loss during physical exertion such as coughing or sneezing; urge urinary incontinence (UUI), which occurs when there is a sudden and uncontrollable need to urinate; and mixed urinary incontinence (MUI), which presents symptoms of both types².

In the context of care for patients with PFDs, nursing practice plays a fundamental role through the Nursing Process, which systematizes care and ensures its continuity and personalization. The nursing consultation is an essential step in this process, grounded in theories, care models, standardized languages, risk assessment instruments, and evidence-based protocols. Through this consultation, specialized nurses can indicate, insert, and remove materials for treating UI, POPs, and anal incontinence, in addition to implementing preventive programs for PFDs, promoting evidence-based practice focused on patient well-being¹⁵.

Despite this, there is a gap in knowledge regarding the care provided by nurses in the management of these disorders. Although few studies in Brazil address the role of nurses in the conservative treatment of PFDs, this topic has been discussed internationally, with emphasis on the low cost of conservative therapies as a first-line alternative^16-18.

Given the feminization of old age, which refers to the phenomenon in which there is a greater proportion of older women than older men in a population, and the higher prevalence of PFDs, which significantly impact quality of life, the relevance of this topic for women’s health is evident. Nurses, as an essential part of the interdisciplinary and multidisciplinary team, play a fundamental role in PFD prevention and treatment. Therefore, this study aimed to analyze available evidence in the literature on nursing care for PFDs in cisgender women.

METHOD

This is an integrative review (IR), conducted in six stages: research question formulation; literature search for primary studies; data collection from included studies; study assessment; analysis and synthesis of knowledge; and presentation of results. ¹⁹ The report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines²⁰. The protocol for this review was registered with the Open Science Framework²¹.

The guiding question was: what evidence is available on nursing care for PFDs in cisgender women? The acronym PICo (Population, Intervention or Area of Interest and Context)²² was adopted for its formulation, with the following elements: P: Cisgender women with PFDs, I: Nursing care, Co: In gynecological nursing consultation.

The search was conducted on February 7, 2024, in the following information sources: Medical Literature Analysis and Retrieval System online (MEDLINE/PubMed); Web of Science Core Collection (WOSCC); Scopus; Biomedical Answer (Embase); Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Base de Dados em Enfermagem of Virtual Health Library (BDENF/VHL); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and in gray literature sources ProQuest Dissertations & Theses Global (ProQuest) and Google Scholar. The research was conducted through the Comunidade Acadêmica Federada (CAFe) portal for remote access to the Coordination of Improvement of Higher Education Personnel (In Portuguese, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) Journal Portal content.

Specific terms, such as Health Sciences Descriptors (In Portuguese, Descritores em Ciências da Saúde - DeCS), Medical Subject Headings (MeSH), CINAHL Subject Headings, and Emtree were used to compose the search strategy, with the goal of adjusting the terms according to each information source. In Google Scholar, the first 100 terms were examined for relevance.

Initially, a pilot test was carried out in the MEDLINE/PubMed and LILACS databases, with the aim of identifying the main descriptors, alternative terms and keywords in the sentinel studies²². These terms were then combined using the Boolean operators AND and OR, consistently between the P and I components of the PICo acronym. From this combination, a unique search strategy was developed, tailored to each of the information sources. To ensure search specificity and comprehensiveness, two specialized librarians were consulted²³. The search strategies used to select the primary studies included in this review are available in the protocol²¹.

Primary studies addressing the care provided by nurses, midwives, and/or obstetricians in PFDs for cisgender women, published in Portuguese, English, and Spanish, from 2004 onwards, were included. Time frame was chosen due to the implementation of the Brazilian National Policy for Comprehensive Women’s Healthcare (In Portuguese, Política Nacional de Atenção Integral à Saúde da Mulher - PNAISM)²⁴. The PNAISM established guidelines for the promotion and organization of women’s healthcare in the country, enabling a reorganization of healthcare services, including the role of nurses in gynecological health as well as PFDs. This policy aimed to integrate care actions, focusing on improving the quality of care. Reflective studies, reviews, editorials, response letters, experience reports, case studies, studies focusing on PFDs in men, children, and transgender individuals, and research conducted in a hospital setting were excluded.

After the search, studies were exported to the reference manager²⁵ for organization and deletion of duplicates²⁰. The records were then transferred to ASReview LAB, a machine learning software for automated screening used to accelerate and improve the study screening process, which allowed for more efficient study selection and prioritized the most relevant studies for review, based on criteria defined by the researcher^26-27. The studies were divided into two batches, each one blindly assessed by pairs of reviewers. A preliminary training process (“warming up”) was conducted in ASReview LAB²⁶, and study selection followed previously established eligibility criteria. Screening was conducted in two stages: in the first, titles and abstracts were assessed; in the second, selected studies were analyzed in full. Conflicts that arose during these stages were resolved by a third reviewer. Furthermore, a manual search of reference lists of selected primary studies was performed to identify additional evidence relevant to the topic²⁸.

Evidence was extracted using a form developed by the authors of this IR²². The form items were organized based on the PICo elements, as described in the review protocol. To ensure uniform and consistent application of the form, prior training was provided to the reviewers²². Data extraction was conducted independently by the pair of reviewers, and subsequently by a third reviewer to resolve any discrepancies.

The Johns Hopkins Evidence-Based Practice (JHEBP) Model for Nursing and Healthcare Professionals Hierarchy of Evidence Guide was used to classify the level of evidence. Methodological quality was assessed using the JHEBP Model for Nursing and Healthcare Professionals Research-Based Evidence Assessment Tool to provide nursing and healthcare professionals with a solid foundation for evidence-based decision-making²⁹. Prior training was provided to reviewers to establish consistent assessment and calibration parameters. The review was conducted independently by two reviewers, and a third reviewer was called in to resolve conflicts^22,28.

The data were analyzed descriptively and organized into synthesis tables and figures to provide the reader with a comprehensive view of each primary study, in line with the objective of making these data available in a clear and detailed manner.

This IR can strengthen nurses’ role in caring for cisgender women with PFDs, expand their knowledge, and promote evidence-based practice to deliver high-quality, humane care. In addition to training professionals, the study will provide information and theoretical support for the care of these women. Socially, the IR can raise awareness of PFDs by highlighting the importance of prevention and appropriate treatment. Thus, the research seeks to fill gaps in the literature on the topic and promote a better understanding and approach to PFDs.

RESULTS

A total of 9,036 potentially relevant records were identified, with seven automatic losses detected during save and 858 duplicates excluded in the reference manager.³⁰ Thus, 8,171 records were submitted for preliminary analysis using ASReview LAB.²⁶ This tool assessed the relevance of studies based on titles and abstracts, resulting in the exclusion of 7,505 studies, while 666 studies were retained for eligibility assessment. Figure 1 illustrates the process.

Figure 1 -
Adapted PRISMA flowchart. Alfenas, MG, Brazil, 2024

Chart 1 presents the descriptive synthesis of the 13 studies included according to authorship, year and country of study, journal, study objective(s), study design and main outcomes.

The criteria for classifying the level of evidence and methodological quality were based on hierarchical recommendations, with category “A” assigned to studies with the highest methodological rigor. Chart 2 presents the level of evidence and methodological quality of included studies, arranged sequentially after Chart 1.

Chart 1 -
Synthesis of studies included in the integrative review. Alfenas, MG, Brazil, 2024.

Authorship, year and country	Journal	Objective(s)	Study design	Main outcomes
Dannecker et al., 2005, Germany31.	Wound Management & Prevention	Assess the effectiveness of an electromyography (EMG) biofeedback-controlled program as therapy for SUI or MUI, in relation to short- and long-term subjective and objective outcomes.	Cohort	Intensive PF training with EMG-controlled biofeedback therapy is effective. Surgery can often be avoided. Therefore, most women with SUI or MUI should be offered conservative therapy before surgery.
Maito et al., 2006, USA32.	Journal of Midwifery & Women’s Health	Identify predictors of successful and unsuccessful pessary fitting, as well as predictors of continued pessary use.	Cohort	Pessaries are an effective, non-invasive treatment for UI and POP, but many women hesitate to discuss their use. Most women adapt well to pessaries and prefer this method to surgery. Obstetric nurses can facilitate adaptation, especially in settings that allow monitoring. Serious complications are rare, and the benefits, such as improved quality of life, outweigh the risks.
Butterfield, Connell and Phillips, 2007, Australia33.	Women and Birth	Examine Victorian midwives’ assessment and management practices of UI in women of childbearing age and to explore their knowledge of risk factors associated with the development of UI.	Non-experimental descriptive	The impact of childbirth on female continence is a global health issue. Many women are not assessed or treated for UI due to variations in provider knowledge and a lack of guidelines. Addressing these gaps can reduce postpartum UI morbidity and improve women’s health. Midwives have a good understanding of the factors that affect UI during childbirth.
Whitford, Alfer and Jones, 2007, Scotland34.	Midwifery	Discover the reported rates of pelvic floor muscle training (PFMT) practice by postpartum women and to report the prevalence of SUI.	Cohort	Over 80 % of women reported using PFMT in the immediate postnatal period. Postnatal SUI was also confirmed to be a common problem. Although many women reported using PFMT during pregnancy, it is possible that using PFMT less frequently than daily may be insufficient to prevent postpartum UI.
Hernández, Aznar and Aranda, 2014, Spain35.	Journal of Nursing Scholarship	Determine the prevalence of UI during pregnancy and the postpartum period, the impact on quality of life and the healthcare offered to women with UI.	Cross-sectional	Counseling, not the severity of UI or its impact on quality of life, determines treatment-seeking behavior. Data suggest that when women have information about UI, they may be more likely to consult and treat mild incontinence symptoms without waiting for them to worsen, confirming that lack of knowledge about available treatments is a barrier to seeking help.
Wang, Li and Deng, 2014, China36.	International Journal of Nursing Sciences	Observe the effect of PFMT as a persistent nursing intervention on birth outcomes and PF myodynamics.	Randomized clinical trial	PFMT, as a persistent nursing intervention for pregnant women, is most effective in shortening the second stage of labor and contributing to postpartum recovery. However, these trainings do not appear to effectively reduce the prevalence of perineal tears or episiotomies.
Caagbay et al., 2018, Nepal37.	International Journal of Health Promotion and Education	Determine whether a one-day educational workshop for nurse-midwives increases their knowledge of PFDs and PFMTs and to determine the level of supervision needed to assist nurse-midwives in teaching women how to properly contract their PFDs.	Description of the educational intervention type	A one-day educational workshop on PFMT for auxiliary nurse-midwives in Nepal resulted in a significant increase in their knowledge of PFMT and POPs. The workshop, along with one-on-one supervision, is an effective way to train auxiliary nurse-midwives to teach women in the community how to correctly perform a PFMT contraction.
Åhlund, 2019, Sweden38.	Karolinska Institute	Contribute to knowledge about risk factors for symptomatic hemorrhoids related to childbirth, UI, anal incontinence, evacuation difficulties and perineal pain at different times during the first 18 months postpartum.	Study 1 - mixed design with experimental, explanatory, and sequential design. Studies 2, 3, and 4 - cohort design	A slow, spontaneous cephalic birth can protect against hemorrhoids in first-time mothers, who feel the need for better care. Perineal pain one year after delivery is related to injury severity, with more than 10 % of women reporting pain and one in four experiencing UI between 9 and 12 months, impacting their daily activities. UI and anal incontinence can occur during pregnancy, and women with minor tears face similar difficulties as those with more severe injuries. Proper midwife care can reduce these symptoms.
Barroso, 2020, Portugal39.	Repositório Instituto Politécnico de Viana do Castelo	Understand the needs for rehabilitation nursing care in women with PF hypotonia.	Qualitative, exploratory and descriptive	PF hypotonia affects women’s quality of life, and there is little emphasis on conservative treatments, prioritizing surgery. Rehabilitation nurses can implement lifelong programs focused on women, in collaboration with multidisciplinary teams, to improve PFD prevention and treatment and emphasize the importance of nursing in rehabilitation.
Terry et al., 2020, United Kingdom40.	Midwifery	Explore the challenges, opportunities, and concerns for women and healthcare professionals related to the implementation of PFMT for women in antenatal care.	Description of ethnographic approach	Midwives should recommend PFMT to facilitate teaching to women. They also emphasize the need to address social challenges and stigmas to ensure that both midwives and women feel prepared to address these issues. Furthermore, they emphasize the need for supportive policies to integrate PFMT into healthcare services.
Jayanthi et al., 2022, India41.	Journal of Pharmaceu-tical Negative Results	Assess the impact of Nurse-Led Bundle Care Therapy on nurse-led care therapy.	Quasi- experimental	Nurse-Led Bundle Care Therapy has benefits in managing symptoms related to POPs including symptom reduction, improved health, and potential reductions in hospitalization rates.
Pizzoferrato et al., 2022, France42.	Journal of Women’s Health	Investigate current knowledge and practices among key healthcare professionals involved in pessary use in France.	Cross-sectional	Most healthcare professionals in France involved in pessary fitting, including nurses, are comfortable with them. The main pessaries used are ring-shaped and cube-shaped. Even though opinions seem to be changing, additional and adapted training is necessary to improve knowledge and practice.
Le Quoy et al., 2023, France43.	Journal of Clinical Medicine	Focus on experts’ experience in the use of pessaries, analyze the factors that influence the choice of the type of vaginal pessary, and propose and test the accuracy of an algorithm that assists in pessary selection.	Qualitative	Healthcare professionals, including nurses, in France are comfortable with pessaries and primarily prescribe the ring and cube forms. Opinions about pessaries appear to be changing, and healthcare professionals are seeking training to improve their knowledge and practices.

Chart 2 -
Level of evidence and methodological quality of included studies. Alfenas, MG, Brazil, 2024.

Included studies /LoE*		Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12	Q13	Q14	Q15	Q16	Q17	Q18	MQ†
Quantitative	31/III	Y	Y	Y	Y	Y	NA	NA	NA	Y	Y	N	Y	Y	Y	Y	Y			B
	32/III	Y	Y	Y	Y	Y	NA	NA	NA	Y	Y	Y	Y	Y	Y	Y	Y			A
	33/III	Y	Y	Y	N	Y	Y	Y	NA	Y	Y	Y	Y	Y	Y	Y	Y			B
	34/III	Y	Y	Y	N	Y	NA	NA	NA	Y	Y	N	Y	Y	Y	Y	Y			B
	35/III	Y	Y	Y	N	N	NA	NA	NA	Y	Y	Y	Y	Y	Y	Y	Y			B
	36/I	Y	Y	Y	N	Y	Y	NA	Y	Y	Y	N	Y	Y	Y	Y	Y			B
	37/III	Y	Y	Y	N	N	NA	NA	NA	Y	Y	Y	Y	Y	Y	Y	Y			B
	41/III	Y	Y	Y	N	Y	NA	NA	NA	Y	Y	N	Y	Y	Y	Y	Y			B
	38‡/III	Y	Y	Y	N	Y	NA	NA	NA	Y	N	Y	Y	Y	Y	Y	Y			B
Qualitative	39/III	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	A/B
	40/III	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	A/B
	42/III	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	A/B
	43/III	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	A/B
	38‡/III	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	A/B

• *LoE=Level of evidence. †MQ=Methodological quality. ‡Mixed study

The distribution of studies across different years and journals reveals a diversity of research areas and topics covered. This variety enriches the field and provides a solid foundation for future interdisciplinary research.

The diversity of countries that have conducted studies on PFDs is notable, including France, Germany, Australia, China, Scotland, Spain, the United States, India, Nepal, Portugal, the United Kingdom, and Sweden, with France standing out with two studies^42,43. However, the lack of research on the topic in Brazil, a country with a significant female population and, therefore, with diverse demands related to women’s health, is noteworthy.

Among the methodological characteristics, cohort^31,32,34, descriptive^33,37,41, randomized clinical trial³⁶, mixed³⁸, qualitative^39,43, quasi-experimental⁴¹ and cross-sectional^35,42 studies stand out.

The analysis revealed that, among the 13 studies included, eight were quantitative^31-37,41, four qualitative^39,40,42,43 and a mixed³⁸. Only one quantitative study was classified as level I evidence, while the others were classified as level III, highlighting the predominance of lower-level observational studies. In terms of methodological quality, only one quantitative study received an “A” rating, while seven were classified as “B”, indicating a reasonable analysis. The qualitative studies also received A/B ratings, reflecting high methodological rigor, and were classified as level III evidence. Most responses in the quality assessment reports were “yes”, indicating good reliability in the synthesis presented.

A study³⁸ was analyzed as mixed, being classified as level of evidence III and quality B.

At the end of the data synthesis, it was found that the prevalent PFDs are UI, POPs, and anal incontinence.

DISCUSSION

PFDs significantly compromise women’s quality of life, as they cause restrictions on physical activity, difficulties in professional performance, impaired sex lives, and embarrassment in social settings. Urinary, bowel, and gynecological symptoms lead to withdrawal from family and social events, contributing to isolation and low self-esteem. Furthermore, PFDs are strongly associated with mental health problems such as depression, anxiety, feelings of vulnerability, and shame, which amplify the psychosocial impact of these conditions^39,44.

These disorders also negatively impact postpartum women, being associated with sexual and psychological dysfunctions^42,45. In Brazil, PF physiotherapy is the main approach for PFDs, but access is hampered by barriers such as misinformation, inadequate referrals, costs and lack of professionals, especially in remote regions⁴⁶. In this regard, rehabilitation support stands out as essential for recovery³¹.

In included studies, UI was the most discussed disorder, influenced by several intrinsic, obstetric and gynecological factors, in addition to others that aggravate the condition and intensify its impact on women’s quality of life.

Factors that increase the risk of UI include advanced age, comorbidities such as obesity, conditions that increase intra-abdominal pressure, constipation, physical and recreational activities, lung diseases, smoking, urinary tract infections, menopause, childbirth, surgeries, cognitive impairment, and medication use³⁹.

There is embarrassment and taboo associated with UI, and the belief that it is a normal condition at certain stages of a woman’s life contributes to the lack of discussion on the topic. Many women who experience UI do not feel confident reporting the problem, fearing being considered irrelevant by healthcare professionals⁴⁰.

The treatment of PFDs, including UI, is approached at three levels: primary intervention, which uses conservative methods such as PFMT, pessaries, and lifestyle changes; secondary intervention, which involves invasive techniques; and tertiary intervention, which focuses on surgical rehabilitation and management of persistent symptoms³⁹.

Supporting women in the PF rehabilitation processes is a nursing function, with the aim of facilitating recovery and promoting well-being³⁹. PFMT provides lasting therapeutic benefits. A PFMT program demonstrated a significant reduction in UI severity, as well as improved PFM contraction strength and electromyography biofeedback electrical potentials. After three years, 71 % of women assessed reported persistent symptom improvement, although the response rate was lower among those who discontinued therapy early³¹.

PFMT is effective in treating PFDs, such as UI, as it provides long-term benefits, such as reduced urinary loss and improved quality of life. Combined PFM and hip strengthening is most effective in treating SUI. Individualized PFMT programs, which include hypopressive exercises, improve muscle strength and reduce symptoms of dysfunction. Prenatally, PFMT is more preventive than therapeutic, which limits its use in women already affected. Long-term adherence is challenging, as it compromises results and requires continuity and customization^47-48.

Nursing interventions are fundamental in PF rehabilitation, contributing to physical recovery and psychological support^39,49. In the postpartum period, nurses promote rehabilitation through health education and muscle function testing⁵⁰. They are also essential in the management of chronic pelvic pain syndromes in multidisciplinary teams. Furthermore, nursing programs focused on preventing postpartum dysfunction increase patient satisfaction and clinical effectiveness^34,39,45.

Another form of nursing intervention involves creating health education programs and training workshops to train professionals in PFD assessment, diagnosis, and treatment. The discrepancy in knowledge between nurses and midwives is a concern in obstetric practice³³.

These interventions are needed, especially in healthcare facilities, to train nurses to counsel women about existing treatment options⁵¹. There are a significant number of women with UI, however they are not aware of available treatment options and do not seek appropriate professional assistance³⁵.

In Brazil, the Pelvic Floor Rehabilitation Program was created in Campinas, São Paulo, to meet the growing demand of women with UI complaints. The center stands out for training nurses in advanced rehabilitation practices and for promoting more accessible and effective care for patients⁵¹.

Although PFMT is recognized by healthcare professionals, it is not given the same priority in gynecological and prenatal appointments. Information given to pregnant women fails to emphasize the importance of these exercises, and the lack of references to PFMT in prenatal appointment settings, such as bulletin boards and brochures, exacerbates this situation⁴⁰.

A comparison between conservative and invasive treatments for PFDs shows that conservative techniques, such as PFMT, pessaries, and estrogen therapy, alleviate symptoms of incontinence and prolapse, as well as improve sexual function and quality of life. Surgical approaches carry a higher risk of complications and recurrence. Treatment choice varies depending on the severity of symptoms and patient preference, with patients often opting for conservative methods due to the lower risk and faster recovery^32,42,43,52.

Vaginal pessaries are an effective, non-invasive alternative for treating UI, but many women are hesitant to discuss the issue with healthcare professionals. Most women who adapt to the pessary continue to use it, while a few who fail to adapt opt ​​for surgery³².

Vaginal pessaries are effective in treating SUI and POPs, with good acceptance, significant improvement in quality of life and few adverse effects, such as vaginal discharge^32,42,43,53. They are considered a cost-effective intervention, with the ring and cube models being the most commonly used. However, factors such as a short vagina and severe incontinence may limit their use^33,42,43.

In Brazil, vaginal pessaries are effective in treating POPs, with high levels of patient satisfaction and improved quality of life. However, their acceptance is still limited by cultural barriers, stigma, lack of information, and a shortage of trained professionals. There are also few national studies comparing pessaries to other conservative approaches, which makes it difficult to create protocols tailored to the country’s reality⁵⁴.

Pregnancy and childbirth can cause several changes in PFM, both short- and long-term. During childbirth, PFM can be damaged due to stretching, compression, or lack of blood supply. Excessive stretching can result in spontaneous lacerations and less obvious neurological injuries³⁸; this can lead to the development of various PFMs, including UI.

In one of the selected studies, the authors conclude that the impact of childbirth on women’s urinary continence is an issue of national and international relevance³³. Many women may not receive appropriate assessment, diagnosis, or treatment for UI due to varying knowledge among midwives, nurses, and physicians, as well as a lack of documented guidelines for assessment and management of the condition. These factors represent a significant concern in obstetric nursing practice that needs to be addressed.

Regarding PFMT, British guidelines recommend that midwives provide information about it during antenatal care appointments. However, the high demand from pregnant women, the shortage of professionals, and the need to conduct tests and provide public health information in busy clinics mean that this type of care does not receive the necessary attention from healthcare professionals⁴⁰.

Implementing PFMT exercises during labor reduces the duration of the second stage and aids in postpartum PFMT recovery³⁶. It is essential that nurses share information about PFD prevention with women and integrate these exercises into prenatal education programs. It is also recommended that healthcare professionals promote training and health education in the community to encourage the practice of PFMT from early in pregnancy.

However, even with these prevention strategies, PFDs continue to affect a significant number of postpartum women. In a study of nearly 400 primiparous women, approximately a quarter experienced UI between nine and twelve months postpartum³⁸. In this scenario, it is essential to recognize that many women face difficulties accessing healthcare services in the postpartum period, which compromises early diagnosis and the adoption of appropriate interventions.

Researchers highlight the importance of PFMT during pregnancy to prevent postnatal UI³⁴. Another study corroborates that intensive regimens of these exercises can effectively decrease the risk of UI after childbirth, especially between six weeks and three months after birth³⁶.

Therefore, the need to train nurses to provide support and education about PFMT is highlighted, in order to combat misinformation and improve care. Many women facing PAM are hesitant to discuss the problem, for fear of being considered irrelevant or due to a lack of confidence in their complaints. This situation is exacerbated by stigma, taboo, and the perception that PAM is a normal part of the pregnancy and postpartum experience, which creates barriers that hinder more open discussions on the topic⁴⁰.

Barriers to PFD treatment include women’s reluctance to seek help, with only 37 % seeking care, influenced by a lack of social and educational support. This low level of demand is compounded by a lack of understanding of symptoms and misinformation. Racial and ethnic disparities further hinder access to care, especially for immigrant women, who have less knowledge about the disorders compared to those born in countries with greater access to information^55,56.

Therefore, it is increasingly necessary to gather scientific evidence on UI-related health interventions to make treatment and access to postpartum care accessible. Proper counseling from healthcare professionals and effective patient guidance during pregnancy increase the likelihood of seeking treatment. Nurses and midwives should provide guidance to all women, monitor pelvic-perineal rehabilitation postpartum, ensure continence recovery, and identify difficulties in accessing professional care, with a view to improving the quality of care provided^35,39.

After UI, POPs were the most frequently discussed dysfunctional condition. This disorder encompasses urogenital and rectal prolapse. It occurs due to weakened PF structures. This results in the protrusion of pelvic organs into the vagina or beyond the hymenal ring. In POPs, the vagina and adjacent organs, such as the bladder, bowel, and uterus, shift from their physiological positions due to hypotonia of the supporting tissues³⁹.

Although POPs are considered benign, they can cause significant distress and disability. Symptoms, such as vaginal protrusion, a feeling of heaviness in the pelvis, discomfort when urinating, changes in bowel movements, and sexual dysfunction, negatively impact women’s quality of life. Predisposing factors include genetics, number of births, high fetal weight, perineal tears, use of forceps, advanced age, white race, menopause, systemic diseases, obesity, smoking, and chronic constipation⁴¹.

As with UI, there are common misconceptions among women about POPs, including the mistaken belief that these disorders are inevitable consequences of childbirth and aging. It is essential that healthcare professionals address this issue through health education strategies to demystify this perception, which can discourage help-seeking and limit access to appropriate treatments. Several effective approaches to raising awareness include educational workshops, health promotion programs, group classes, and social media campaigns^37,39.

Still addressing these misconceptions, researchers confirm that many women with POP experience a sensation of vaginal bulge, often accompanied by problems related to urinary, bowel, or sexual function. However, seeking professional help is limited because they feel embarrassed by the presence of the bulge or fear it may be a more serious condition, as this condition is surrounded by stigma⁴¹.

The delay in seeking treatment for POPs is linked to the association many women make between their condition and surgical interventions, which generates fear of procedures even before diagnosis. This issue is often overlooked by women and healthcare professionals due to a lack of knowledge or sensitivity, resulting in an underestimation of the seriousness of the situation and its impact on quality of life³⁹.

An alternative treatment that can be performed by trained nurses and midwives is the prescription and insertion of pessaries. When performed with the proper technique, this approach can positively impact women’s quality of life, being an effective treatment for POPs and UI⁴³.

Regarding treatment, vaginal pessaries are an option, so it is important to identify indications and contraindications, manage complications, and assess associated risk factors. According to researchers^42,43, most healthcare professionals in France feel comfortable fitting and monitoring pessaries and view them as a viable option for the initial treatment of POPs, with the most commonly used pessaries being ring-shaped and cube-shaped. Although there is evidence of a shift in professionals’ perceptions of pessaries, additional, specific training is still needed to improve knowledge and practice.

Most women who opt for pessary treatment achieve satisfactory results and continue to use them, even if only for a short time. Researchers emphasize the need to invest in continuing education programs for nurses to improve techniques and ensure quality care, as well as the importance of continuing monitoring of these women with POPs³².

PFMs offer benefits in POP treatment by strengthening PFMs, but their implementation can be difficult in regions with limited resources. In these settings, the shortage of trained professionals and time pressure due to high demand combine with geographic barriers, resulting in low levels of health literacy and social stigma related to women’s health³⁷.

Compared to PFMTs, pessaries demonstrate greater efficacy in treating prolapse, without increasing the risk of complications⁵⁷.

A study addresses the treatment of women with POPs in a clinic run by nurses, who manage cases and perform educational roles, in addition to providing emotional support and monitoring patients. The recommendations highlight the importance of nurse-led healthcare services, which promote independent practice and the implementation of interventions for women with POPs. The proposed care included exercises, guidance sessions, and easy-to-use counseling, which resulted in a reduction in symptoms that affect patients’ quality of life. Furthermore, nursing guidance improved women’s health and may reduce hospital admission rates⁴¹.

Healthcare professionals should take steps such as disseminating knowledge about POP prevention, including PFMT in education programs, and conducting community training. This way, women can take actions that improve their quality of life during and after pregnancy, which also helps prevent POPs³⁶.

Anal incontinence is a complex process that requires adequate muscle coordination and neuromuscular function. It manifests as involuntary stool elimination, gas incontinence, and fecal urgency. Factors such as prolonged labor, high birth weight, childbirth, constipation, and genetic predisposition can contribute to its development. Anal incontinence and hemorrhoids are interrelated and require attention from healthcare professionals, as both involve the function of the anus and colon, which requires efficient muscle coordination³⁸.

PF hypotonia is a condition that requires attention, making it essential to implement nursing rehabilitation strategies and targeted patient care. It is important to adopt an interdisciplinary and multidisciplinary approach to ensure effective prevention and treatment. This collaboration enhances outcomes and provides comprehensive and humanized care, meeting affected women’s needs ³⁹.

Nursing interventions for anal incontinence include guidance aimed at retraining bowel habits, as well as actions such as PFMT and biofeedback programs. Furthermore, other commercially available equipment that can contribute to effective continence should be considered, such as electrostimulation therapy to strengthen these muscles⁵⁸.

Therefore, it is necessary to develop nursing intervention projects in primary healthcare with a focus on strengthening PFMs and to conduct new studies that assess the benefits of nursing interventions in PFDs³⁹.

Regarding the limitations of this IR, the quality and diversity of included studies may affect the interpretation of the results. It is noteworthy that there is a scarcity of studies that specifically and in-depth address the role of nurses in PFD prevention, diagnosis, management, and rehabilitation. Although nurses play a central role in the comprehensive healthcare of women with PFDs, this role remains underexplored in the evidence. The identification of few studies on this topic highlights a gap and highlights the need for more robust studies on interventions performed by nurses in PFDs, which could guide recommendations for clinical practice and the strengthening of public policies aimed at improving care in this field.

Analysis of references used in this review indicates that a significant portion of the studies are from before the last five years, which may reflect that the topic investigated was not a researchers’ concern.

Regarding the implications for advancing scientific knowledge in the health and nursing fields regarding nurses’ care for PFDs, the results of this study highlight nurses as a central figure in the conservative treatment of these disorders, such as PFMT and the use of pessaries. This reinforces the need to train nurses to provide continuing support and improve women’s quality of life. Gaps in practice, such as varying knowledge and lack of standardized interventions, require a structured approach to ensure results.

The discussion about PFDs must overcome stigmas and barriers that prevent women from seeking treatment. Public policies should promote continuing education for professionals, focusing on early and personalized interventions. The integration of educational technologies and cultural adaptation of these interventions are essential to ensuring equitable access to care. These actions can transform the landscape, expand treatment options, and promote more humane and efficient care.

Future research should fill these gaps through robust, interdisciplinary approaches that involve nurses and assess the effectiveness and implementation of interventions. It is necessary to examine the acceptance and usability of educational technologies by patients and professionals, in addition to implementing personalized interventions. This aims to improve nursing care for women with PFD and positively impact their quality of life.

CONCLUSION

The most prevalent PFDs are UI, POPs, and anal incontinence. These disorders significantly affect women’s quality of life, both physically and psychologically. The belief that these conditions are inevitable consequences of pregnancy, aging, or other comorbidities contributes to the lack of open discussion about PFDs, which hinders understanding of available treatment options.

To address these issues, nurses must promote health education through educational campaigns and training, raising awareness among women about the importance of prevention and seeking early treatment for PFDs. It is also important to enhance the training of nursing professionals in performing conservative interventions, such as PFMT, the use and management of pessaries, and guidance on lifestyle changes. Furthermore, it is essential to facilitate the provision of these services within the public health system to ensure that the knowledge generated is translated into accessible and effective practices.

Future research should explore the impact of nursing interventions for specific subgroups, taking into account cultural and social aspects. The lack of national studies was noted as a gap. Research focused on the Brazilian context and on middle-income countries is essential to better understand local needs and adapt interventions in a culturally appropriate manner.

REFERENCES

• 1. Blomquist JL, Carper B, Muñoz A, Bernard L, Roy S, Templeton S, et al. Pelvic floor muscle strength and the incidence of pelvic floor disorders after vaginal and cesarean delivery. Am J Obstet Gynecol [Internet]. 2020 [cited 2023 May 18];222(1):62-8. Available from: https://doi.org/10.1016/j.ajog.2019.08.003
  » https://doi.org/10.1016/j.ajog.2019.08.003
• 2. Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R, et al. Urinary incontinence in women. Nat Rev Dis Primers [Internet]. 2017 [cited 2023 Apr 18];3(17042):1-44. Available from: https://doi.org/10.1038/nrdp.2017.42
  » https://doi.org/10.1038/nrdp.2017.42
• 3. Katarina PI, Jankovic N, Vlajkovic M, Dragisic A, Vasiljevic N, Filipovic N, et al. The influence of various risk factors on the strength of pelvic floor muscle in women. Vojnosanit Pregl [Internet]. 2017 [cited 2023 Jun 4];74(5):557-63. Available from: https://doi.org/10.2298/VSP150420083P
  » https://doi.org/10.2298/VSP150420083P
• 4. Vasconcelos CTM, Costa LC, Oliveira WM, Pinheiro AKB, Lopes MHBM, Martins A, et al. Disfunções do assoalho pélvico: perfil sociodemográfico e clínico das usuárias de um ambulatório de uroginecologia. Rev Eletrôn Gestão Saúde [Internet]. 2013 [cited 2023 May 18];4(1):1484-98. Available from: https://repositorio.ufc.br/bitstream/riufc/6758/1/2013_art_ctmvasconcelos.pdf
  » https://repositorio.ufc.br/bitstream/riufc/6758/1/2013_art_ctmvasconcelos.pdf
• 5. Almousa S, Vanloon AB. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review. Maturitas [Internet]. 2018 [cited 2023 May 18];107:78-83. Available from: https://doi.org/10.1016/j.maturitas.2017.10.003
  » https://doi.org/10.1016/j.maturitas.2017.10.003
• 6. Vrijens D, Berghmans B, Nieman F, Nelen W, Van Gestel S, Van der Laar E, et al. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions: a cross sectional cohort study at a pelvic care centre. Neurourol Urodyn [Internet]. 2017 [cited 2023 Maio 22];36(7):1816-23. Available from: https://doi.org/10.1002/nau.23186
  » https://doi.org/10.1002/nau.23186
• 7. Borba AMC, Lelis MAS, Bretas ACP. Significado de ter incontinência urinária e ser incontinente na visão das mulheres. Texto Contexto Enferm [Internet]. 2008 [cited 2023 May 13];17(3):537-42. Available from: https://doi.org/10.1590/S0104-07072008000300014
  » https://doi.org/10.1590/S0104-07072008000300014
• 8. Cunha RM, Costa KNFM, Bezerra SRR, Ferreira RE, Vasconcelos CTM. Perfil epidemiológico e sintomas urinários de mulheres com disfunções do assoalho pélvico atendidas em ambulatório. Rev Fisioter Saúde Funcional [Internet]. 2016 [cited 2023 Apr 21];5(1):42-9. Available from: https://repositorio.ufc.br/bitstream/riufc/19344/1/2016_art_ %20rmcunha.pdf
  » https://repositorio.ufc.br/bitstream/riufc/19344/1/2016_art_ %20rmcunha.pdf
• 9. Fante JF, Martins G, Freitas R, Silva M, Teixeira M, Couto R, et al. Do women have adequate knowledge about pelvic floor dysfunctions? A systematic review. Rev Bras Ginecol Obstet [Internet]. 2019 [cited 2024 May 18];41(8):508-19. Available from: https://doi.org/10.1055/s-0039-1695002
  » https://doi.org/10.1055/s-0039-1695002
• 10. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology [Internet]. 2003 [cited 2024 May 18];61(1):37-49. Available from: https://doi.org/10.1016/s0090-4295(02)02243-4
  » https://doi.org/10.1016/s0090-4295(02)02243-4
• 11. Berghmans DDP, Nieuwenhuys A, Vrieling T, Konings S, Banerjee N, Gielen N, et al. The patient-specific functional scale: Its reliability and responsiveness in patients undergoing a total knee arthroplasty. J Orthop Sports Phys Ther [Internet]. 2015 [cited 2024 May 13];45(5):550-6. Available from: https://doi.org/10.2519/jospt.2015.5825
  » https://doi.org/10.2519/jospt.2015.5825
• 12. Piassarolli VP, Vieira APG, Lopes MHBM. Treinamento dos músculos do assoalho pélvico nas disfunções sexuais femininas. Rev Bras Ginecol Obstet [Internet]. 2010 [cited 2024 Jul 5];32(5):234-40. Available from: https://doi.org/10.1590/S0100-72032010000500006
  » https://doi.org/10.1590/S0100-72032010000500006
• 13. Maciel CBT, Lima MP, Alves EC, Campos MJ. Associação entre disfunções anorretais e prática de sexo anal em homossexuais do sexo masculino que utilizam o ânus como via única de sexo: revisão de literatura. Rev Bras Sexualidade Humana [Internet]. 2020 [cited 2024 May 18];31(2):46-53. Available from: https://doi.org/10.35919/rbsh.v31i2.473
  » https://doi.org/10.35919/rbsh.v31i2.473
• 14. Carvalho KB, Ibiapina FTO, Machado DCD. Força muscular do assoalho pélvico em mulheres com queixas de disfunção pélvica. Fisioter Bras [Internet]. 2021 [cited 2024 Jun 18];22(3):425-41. Available from: https://doi.org/10.33233/fb.v22i3.4257
  » https://doi.org/10.33233/fb.v22i3.4257
• 15. Conselho Federal de Enfermagem (COFEN). Resolução COFEN nº 736 de 17 de janeiro de 2024. A implementação do processo de enfermagem em todo contexto socioambiental onde ocorre o cuidado de enfermagem [Internet]. 2024 [cited 2024 Sep 18]. Available from: https://www.cofen.gov.br/resolucao-cofen-no-736-de-17-de-janeiro-de-2024/
  » https://www.cofen.gov.br/resolucao-cofen-no-736-de-17-de-janeiro-de-2024/
• 16. Conselho Federal de Enfermagem (COFEN). Parecer n° 41/2022: Prescrição e inserção de pessários uroginecológicos utilizados para o tratamento conservador do prolapso de órgãos pélvicos e incontinência urinária [Internet]. 2022 [cited em 2024 Aug 12]. Available from: http://www.cofen.gov.br/parecer-de-camara-tecnica-n-41-2022-ctas-cofen_102198.html#
  » http://www.cofen.gov.br/parecer-de-camara-tecnica-n-41-2022-ctas-cofen_102198.html#
• 17. Coelho SCA. Conhecimentos, práticas e desfechos do uso do pessário no tratamento conservador do prolapso de órgão pélvico [tese]. Campinas, SP(BR): Universidade Estadual de Campinas; 2020 [cited 2024 Sep 10]. Available from: http://bdtd.ibict.br/vufind/Record/UNICAMP30_fc12f6351ea56505f10ed832c5ed5f25
  » http://bdtd.ibict.br/vufind/Record/UNICAMP30_fc12f6351ea56505f10ed832c5ed5f25
• 18. Ferreira HLOC, Brito LGO, Oliveira Filho GRS, Gonçalves LB, Freitas MF. Protocolo para tratamento de prolapso de órgãos pélvicos com pessário vaginal. Acta Paul Enferm [Internet]. 2018 [cited 2024 Feb 13];31(6):585-92. Available from: https://doi.org/10.1590/1982-0194201800081
  » https://doi.org/10.1590/1982-0194201800081
• 19. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm [Internet]. 2008 [cited 2024 Apr 22];17(4):758-64. Available from: https://doi.org/10.1590/S0104-07072008000400018
  » https://doi.org/10.1590/S0104-07072008000400018
• 20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ [Internet]. 2021 [cited 2024 Sep 13];372(71):1-9. Available from: https://osf.io/preprints/metaarxiv/v7gm2/
  » https://osf.io/preprints/metaarxiv/v7gm2/
• 21. Franco APMML, Nascimento MC, Silva TC, Silva LNC, Morasco SSO, Costa ACB, et al. The nurse in pelvic floor dysfunctions in women: An integrative review. Open Sci Framework [Internet]. 2024 [cited 2024 Jan 4]. Available from: https://doi.org/10.17605/OSF.IO/RFKVT
  » https://doi.org/10.17605/OSF.IO/RFKVT
• 22. Canto GL. Revisões sistemáticas da literatura. 22nd ed. Curitiba, PR(BR): Brazil Publishing; 2020.
• 23. Toronto CE, Remington R. A step-by-step guide to conducting an integrative review. New York, NY(US): Springer Nature; 2020 [cited 2024 Jan 22]. Available from: https://doi.org/10.1007/978-3-030-37504-1_3
  » https://doi.org/10.1007/978-3-030-37504-1_3
• 24. Brasil. Ministério da Saúde. Política Nacional de Atenção Integral à Saúde da Mulher - Princípios e Diretrizes [Internet]. 2004 [cited 2024 Jan 12]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/politica-nacional-de-atencao-integral-a-saude-da-mulher-pnaism/
  » https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/politica-nacional-de-atencao-integral-a-saude-da-mulher-pnaism/
• 25. Clarivate. EndNote Online [Internet]. 2024 [cited 2024 Jan 14]. Available from: https://clarivate.com/about-us/
  » https://clarivate.com/about-us/
• 26. ASReview LAB. ASReview LAB developers [Internet]. 2024 [cited 2024 Jan 14]. Available from: https://asreview.readthedocs.io/en/stable/#
  » https://asreview.readthedocs.io/en/stable/#
• 27. Schoot R, de Bruin J, Schram R, Velden B, van de Schoot M. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell [Internet]. 2021 [cited 2024 Jan 13];3:125-33. Available from: https://doi.org/10.1038/s42256-020-00287-7
  » https://doi.org/10.1038/s42256-020-00287-7
• 28. Dhollande S, Clemens K, Brehaut L, Green H, Polus B, Turner L. Conducting integrative reviews: A guide for novice nursing researchers. J Res Nurs [Internet]. 2021 [cited 2024 Jan 14];26(5):427-38. Available from: https://doi.org/10.1177 %2F1744987121997907
  » https://doi.org/10.1177 %2F1744987121997907
• 29. Dang D, Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines [Internet]. 4th ed. Indianapolis, IN(US): Sigma Theta Tau International; 2022 [cited 2024 Jan 14]. Available from: https://www.hopkinsmedicine.org/evidence-basedpractice/model-tools
  » https://www.hopkinsmedicine.org/evidence-basedpractice/model-tools
• 30. Clarivate. EndNote Online [Internet]. 2024 [cited em 2024 Jan 14]. Available from: https://clarivate.com/about-us/
  » https://clarivate.com/about-us/
• 31. Dannecker C, Anthuber C, Wolf V, Raab R, Anthuber S, Gitsch G, et al. EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: A 7-year experience with 390 patients. Arch Gynecol Obstet [Internet]. 2005 [cited 2024 Apr 13];273(2):93-7. Available from: https://doi.org/10.1007/s00404-005-0011-4
  » https://doi.org/10.1007/s00404-005-0011-4
• 32. Maito J, Westhoff C, Brito E, FitzGerald MP, Asarian AC, Hayes JP, et al. Preditores de ajuste de pessário bem-sucedido e uso contínuo em uma clínica de pessário de enfermeiras obstétricas. J Midwifery Womens Health [Internet]. 2006 [cited 2024 Apr 13];51(2):78-84. Available from: https://doi.org/10.1016/j.jmwh.2005.09.003
  » https://doi.org/10.1016/j.jmwh.2005.09.003
• 33. Butterfield YC, O'Connell B, Phillips D. Incontinência urinária periparto: um estudo do conhecimento e das práticas das parteiras. Women Birth [Internet]. 2007 [cited 2024 Apr 13];20(2):65-9. Available from: https://doi.org/10.1016/j.wombi.2007.04.001
  » https://doi.org/10.1016/j.wombi.2007.04.001
• 34. Whitford HM, Alder B, Jones M. Um acompanhamento longitudinal de mulheres em sua prática de exercícios perinatais do assoalho pélvico e incontinência urinária de esforço no nordeste da Escócia. Midwifery [Internet]. 2007 [cited 2024 Apr 13];23(3):298-308. Available from: https://doi.org//10/j.meio.200
  » https://doi.org//10/j.meio.200
• 35. Hernández RRV, Aznar CT, Aranda ER. Fatores associados ao comportamento de busca de tratamento para incontinência urinária pós-parto. J Nurs Scholarsh [Internet]. 2014 [cited 2024 Apr 13];46(6):391-7. Available from: https://doi.org /10.1111/jnu.12095
  » https://doi.org /10.1111/jnu.12095
• 36. Wang X, Li G, Deng M. Treinamento dos músculos do assoalho pélvico como intervenção de enfermagem persistente: efeito no resultado do parto e na miodinâmica do assoalho pélvico. Int J Nurs Sci [Internet]. 2014 [cited 2024 Apr 13];1(1):48-52. Available from: https://doi.org/10.1016/j.ijnss.2014.02.017
  » https://doi.org/10.1016/j.ijnss.2014.02.017
• 37. Caagbay D, Shrestha R, Miltenberger C, Shrestha S, Luitel N, Devkota B, et al. Ensino de treinamento dos músculos do assoalho pélvico para profissionais de saúde locais na área rural do Nepal. Int J Health Promot Educ [Internet]. 2018 [cited 2024 Apr 12];56(6):289-97. Available from: https://doi.org/10.1080/14635240.2018.1522267
  » https://doi.org/10.1080/14635240.2018.1522267
• 38. Åhlund S. Pelvic floor complications after vaginal birth short- and long-term consequenses for primiparous women in Sweden [tese]. Stockholm, (SE): Instituto Karolinska; 2019 [cited 2024 Apr 11]. Available from: https://www.proquest.com/openview/048ed71fa7ddcdc40a249bb977cbad4d/1?pq-origsite=gscholar&cbl=18750&diss=y
  » https://www.proquest.com/openview/048ed71fa7ddcdc40a249bb977cbad4d/1?pq-origsite=gscholar&cbl=18750&diss=y
• 39. Barroso AR. A mulher com hipotonia do assoalho pélvico: necessidades em cuidados de enfermagem [dissertation]. Viana do Castelo, (PT): Instituto Politécnico de Viana do Castelo; 2020 [cited 2024 May 13]. Available from: http://repositorio.ipvc.pt/bitstream/20.500.11960/2513/1/Aurea_Barroso.pdf
  » http://repositorio.ipvc.pt/bitstream/20.500.11960/2513/1/Aurea_Barroso.pdf
• 40. Terry R, Taylor J, Hitchcock T, Armitage H, Hall S. "Você está fazendo seu assoalho pélvico?" Uma exploração etnográfica da interação entre mulheres e parteiras sobre exercícios dos músculos do assoalho pélvico (PFME) durante a gravidez. Midwifery [Internet]. 2020 [cited 2024 Feb 13];83:102647. Available from: https://doi.org/10.1016/j.midw.2020.102644
  » https://doi.org/10.1016/j.midw.2020.102644
• 41. Jayanthi V, Joseph DM, Soumya MS, Naidu KS, Madhavi Y, Ramachandran P, et al. Impacto da terapia de cuidados em pacote liderada por enfermeiros nos sintomas pop entre mulheres com prolapso uterino. J Pharm Negat Results [Internet]. 2022 [cited 2024 Apr 13];13(2):1-7. Available from: https://doi.org/10.47750/pnr.2022.13.S02.19
  » https://doi.org/10.47750/pnr.2022.13.S02.19
• 42. Pizzoferrato A, Boizet-Coloumb S, Demassieux N, Descamps P, Ferrière JM, Maylin E, et al. Pessário vaginal para prolapso de órgãos pélvicos: uma pesquisa multidisciplinar francesa. J Saúde da Mulher [Internet]. 2022 [cited 2024 Mar 12];31(6):870-7. Available from: https://doi.org/10.1089/jwh.2021.0229
  » https://doi.org/10.1089/jwh.2021.0229
• 43. Le Quoy M, Gilletta E, Robles García J, Guillygomarc'h A, Agnani G. Identification of key factors influencing the choice of the type of vaginal pessary for women presenting with pelvic organ prolapse: Semi-directive interviews and development of an algorithm. J Clin Med [Internet]. 2023 [cited 2024 Mar 12];12(4):1-9. Available from: https://doi .org /10.3390 /jcm12041548
  » https://doi .org /10.3390 /jcm12041548
• 44. Molina R, Martínez A, Vázquez S, Galiano J. Influence of pelvic floor disorders on quality of life in women. Front Public Health [Internet]. 2023 [cited em 2024 Mar 12];11. Available from: https://doi.org/10.3389/fpubh.2023.1180907
  » https://doi.org/10.3389/fpubh.2023.1180907
• 45. Li J, Zhao X, Li J, Liu Y, Li T. Pelvic organ prolapse after delivery: Effects on sexual function, quality of life, and psychological health. J Sex Med [Internet]. 2023 [cited 2024 May 9];20(12)1384-90. Available from: https://doi.org/10.1093/jsxmed/qdad120
  » https://doi.org/10.1093/jsxmed/qdad120
• 46. Zoorob D, Higgins M, Swan K, Cummings J, Dominguez S, Carey E. Barriers to pelvic floor physical therapy regarding treatment of high-tone pelvic floor dysfunction. Female Pelvic Med Reconstr Surg [Internet]. 2017 [cited 2024 May 9];23(6):444-8. Available from: https://doi.org/10.1097/SPV.0000000000000401
  » https://doi.org/10.1097/SPV.0000000000000401
• 47. Marques S, Silveira S, Pássaro A, Haddad J, Baracat E, Ferreira E. Effect of pelvic floor and hip muscle strengthening on stress urinary incontinence: A randomized clinical trial. J Manipulative Physiol Ther [Internet]. 2020 [cited 2024 May 9];43(3)247-56. Available from: https://doi.org/10.1016/j.jmpt.2019.01.007
  » https://doi.org/10.1016/j.jmpt.2019.01.007
• 48. Mou T, Gonzalez J, Gupta A, O'Shea M, Thibault M, Gray E, et al. Barriers and facilitators to the utilization of healthcare services for pelvic floor disorders in the United States: A systematic review and meta-analysis of qualitative and quantitative studies. Urogynecol [Internet]. 2022 [cited 2024 Jun 19];28:574-81. Available from: https://doi.org/10.1097/SPV.0000000000001215
  » https://doi.org/10.1097/SPV.0000000000001215
• 49. Xie M, Huang X, Zhao S, Chen Y, Zeng X. Effect of psychological intervention on pelvic floor function and psychological outcomes after hysterectomy. Front Med [Internet]. 2022 [cited 2024 Jun 19];9:1-9. Available from: https://doi.org/10.3389/fmed.2022.878815
  » https://doi.org/10.3389/fmed.2022.878815
• 50. Xiao-ling Z. Effect of nursing intervention for postpartum pelvic floor rehabilitation. J Qiqihar Univ Med [Internet]. 2022 [cited 2024 Jun 19];2022(1):1-13. Available from: https://doi.org/10.1155/2022/1786994
  » https://doi.org/10.1155/2022/1786994
• 51. Lopes MHBML, Costa JNC, Lima JLDAL, Oliveira LDR, Caetano AS. Programa de reabilitação do assoalho pélvico: relato de 10 anos de experiência. Rev Bras Enferm [Internet]. 2017 [cited 2024 Apr 15];70(1):231-5. Available from: https://doi.org/10.1590/0034-7167-2016-0257
  » https://doi.org/10.1590/0034-7167-2016-0257
• 52. Tunn R, Baessler K, Knüpfer S, Hampel C. Urinary incontinence and pelvic organ prolapse in women: Prevention and treatment. Dtsch Arztebl Int [Internet]. 2022 [cited 2024 Apr 15];119(30):515-21. Available from: https://doi.org/10.3238/arztebl.m2022.0406
  » https://doi.org/10.3238/arztebl.m2022.0406
• 53. Série de Avaliação de Tecnologia em Saúde de Ontário. Vaginal pessaries for pelvic organ prolapse or stress urinary incontinence: A health technology assessment. Ont Health Technol Assess Ser [Internet]. 2021 [cited 2024 Apr 19];21(3):1-155. Available from: https://pubmed.ncbi.nlm.nih.gov/34055111/
  » https://pubmed.ncbi.nlm.nih.gov/34055111/
• 54. Hagawane K, Sinha I, Zeeshan -. Pelvic floor dysfunction after childbirth: A systematic review of prevalence and associated risk factors. World J Adv Res Rev 091;Internet]. 2025 [cited 2024 Jun 27];26(1):3987-95. Available from: https://doi.org/10.30574/wjarr.2025.26.1.1371
  » https://doi.org/10.30574/wjarr.2025.26.1.1371
• 55. Mou, T, Gonzalez, J, Gupta, A, O'Shea, M, Thibault, M, Gray, E. et al. Barriers and facilitators to the utilization of healthcare services for pelvic floor disorders in the United States: Systematic review and meta-analysis of qualitative and quantitative studies. Urogynecology [Internet]. 2022 [cited 2024 Jun 27];28(9)547-81. Available from: https://doi.org/10.1097/SPV.0000000000001215
  » https://doi.org/10.1097/SPV.0000000000001215
• 56. Roa L, Kent S, Yaskina M, Schulz J, Poirier A. Knowledge of pelvic floor disorders amongst immigrant women in Canada. Int Urogyn J [Internet]. 2021 [cited 2024 Jun 27];32:3077-84. Available from: https://doi.org/10.1007/s00192-020-04662-1
  » https://doi.org/10.1007/s00192-020-04662-1
• 57. Bugge C, Adams E, Gopinath D, Stewart F, Dembinsky M, Sobiesuo P et al. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev [Internet]. 2020 [cited 2024 Jun 23];28(9)1-58. Available from: https://doi.org/10.1002/14651858.cd004010.pub4
  » https://doi.org/10.1002/14651858.cd004010.pub4
• 58. Conselho Federal de Enfermagem (COFEN). Parecer n° 04/2016. Manifestação sobre procedimentos da área de enfermagem [Internet]. 2016 [cited 2024 Jun 28]. Available from: https://www.cofen.gov.br/parecer-no-042016ctascofen/
  » https://www.cofen.gov.br/parecer-no-042016ctascofen/

NOTES

• ORIGIN OF THE ARTICLE
  Excerpt from the dissertation “Atuação do Enfermeiro nos Distúrbios do Assoalho Pélvico em Mulheres: Uma Revisão Integrativa”, presented to the Graduate Program in Nursing, Universidade Federal de Alfenas, in 2024.
• FUNDING INFORMATION
  Coordination of Improvement of Higher Education Personnel (In Portuguese, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES).
• TRANSLATED BY
  Letícia Belasco.
• DATA AVAILABILITY
  All the data supporting the results of this study are published within the article itself.

Edited by

• EDITORS
  Associated Editors: Maria Lígia Bellaguarda.
  Editor-in-chief: Gisele Cristina Manfrini.

Data availability

All the data supporting the results of this study are published within the article itself.

Publication Dates

• Publication in this collection
  27 Apr 2026
• Date of issue
  2026

History

• Received
  05 May 2025
• Accepted
  25 Aug 2025