Reabilitação das Disfunções do Assoalho Pélvico

folder-assoalho-pelvicoA presença de incontinências urinária (IU) e/ou fecal (IF) representa um problema de saúde pública. Estima-se que na população mundial, entre 4% e 35% de pessoas sofram com a IU e que entre 2% e 33% apresentam IF. Ambas as incontinências geram impacto sobre a qualidade de vida, pois situações comuns tais como, rir, tossir, abaixar, carregar objetos pesados, caminhar, saltar e correr, são seguidas de perda urinária e/ou fecal.

O assoalho pélvico representa a estrutura principal para a abordagem deste problema. É composto por um conjunto de músculos, ligamentos e tecido de sustentação que reveste a abertura inferior da bacia e que promove a sustentação dos órgãos pélvicos e a continência. Seu enfraquecido devido às aberturas laterais da uretra, vagina e ânus figura como a principal causa das incontinências. Além deste, a idade avançada, a obesidade, a menopausa e as cirurgias pélvicas, o estado hormonal e os traumas físicos também são fatores importantes que favorecem o seu desenvolvimento.

O tratamento visa aperfeiçoar o controle neuromotor, recuperar vias nervosas inibidas ou dessensibilizadas, aumentar o ganho de massa muscular e a ação coerente dos músculos do assoalho pélvico e a coordenação no controle dos esfíncteres.

Por considerar o controle neurológico, a ação muscular e o comportamento miccional e evacuatório a fisioterapia também é capaz de atuar sobre os prolapsos, a obstipação e a impactação fecal, as disfunções sexuais do tipo vaginismo e a dispareunia, além de estimular mudanças no comportamento miccional e intestinal, na ingestão de líquidos e na dieta.


The presence of urinary incontinence (UI) and / or fecal (FI) represents a problem in public health. It is estimated that in the world population, between 4% and 35% of people suffer from UI and between 2% and 33% have IF. Both incontinence generate impact on the quality of life, as in common situations such as laughing, coughing, lowering, carrying heavy objects, walking, jumping and running, they are followed by urinary and/or fecal loss.

The pelvic floor is the main structure to address this problem. It consists of a set of muscles, ligaments and supporting tissue that covers the lower opening of the bowl and which promotes the support of the pelvic organs and continence. Its weakened state due to the side openings of the urethra, vagina and anus, are seen as the main cause of incontinence. In addition to this, old age, obesity, menopause and pelvic surgery, hormonal status and physical trauma are also important factors that favor its development.

Treatment aims to improve the neuromotor control, recover inhibited or desensitized nerve pathways, increase muscle mass and coherent action of the pelvic floor muscles, and coordination in controlling sphincters.

As it considers the neurological control, muscle action and micturition and defecation behavior, physiotherapy is also capable to act on the prolapse, constipation and fecal impaction, sexual dysfunction that are vaginismus type and dyspareunia, and it stimulates changes in intestinal and urinal behavior, in fluid intake and on the diet.


Artigos Internacionais que respaldam nosso trabalho:


Management of obstructed defecation.

Podzemny V, Pescatori LC, Pescatori M.

World J Gastroenterol. 2015.


Incontinência Urinária:

Physiotherapy for women with stress urinary incontinence: a review article.   

Ghaderi F, Oskouei AE.

J Phys Ther Sci. 2014.


Electrical stimulation of the pelvic floor versus vaginal cone therapy for the treatment of stress urinary incontinence.

Santos PF, Oliveira E, Zanetti MR, Arruda RM, Sartori MG, Girão MJ, Castro RA.

Rev Bras Ginecol Obstet. 2009.


The Investigation and Treatment of Female Pelvic Floor Dysfunction.

Jundt K, Peschers U, Kentenich H.

Dtsch Arztebl Int. 2015.


Using the Vibrance Kegel Device With Pelvic Floor Muscle Exercise for Stress Urinary Incontinence: A Randomized Controlled Pilot Study.

Ong TA, Khong SY, Ng KL, Ting JR, Kamal N, Yeoh WS, Yap NY, Razack AH.

Urology. 2015.


Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study.

Halski T, Słupska L, Dymarek R, Bartnicki J, Halska U, Król A, Paprocka-Borowicz M, Dembowski J, Zdrojowy R, Ptaszkowski K.

Biomed Res Int. 2014.


Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study.

McClurg D, Hilton P, Dolan L, Monga A, Hagen S, Frawley H, Dickinson L.

Int Urogynecol J. 2014.


Optimizing therapy and management of neurogenic bladder.

Ginsberg D.

Am J Manag Care. 2013.


Effects of surface and intravaginal electrical stimulation in the treatment of women with stress urinary incontinence: randomized controlled trial.

Correia GN, Pereira VS, Hirakawa HS, Driusso P.

Eur J Obstet Gynecol Reprod Biol. 2014.


Incontinência em Pós-Parto:

Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women–a cohort study.

Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ.

Phys Ther. 1995.


 Incontinência em Doenças Neurológicas:

Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?: An Evidence-Based Review.

Block V, Rivera M, Melnick M, Allen DD.

Int J MS Care. 2015.


Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence.

Guo ZF, Liu Y, Hu GH, Liu H, Xu YF.

Clin Interv Aging. 2014.


Incontinência no Envelhecimento:

The effect of pelvic muscle exercises on urinary incontinency and self-esteem of elderly females with stress urinary incontinency, 2013.

Kargar Jahromi M, Talebizadeh M, Mirzaei M.

Glob J Health Sci. 2014.


Incontinência em Mulheres Atléticas:

Prevalence of stress urinary incontinence in elite female endurance athletes.

Poświata A, Socha T, Opara J.

J Hum Kinet. 2014.


Incontinência Após Prostatectomia:

Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis.

Wang W, Huang QM, Liu FP, Mao QQ.

BMC Urol. 2014.


Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial.

Santa Mina D, Matthew AG, Hilton WJ, Au D, Awasthi R, Alibhai SM, Clarke H, Ritvo P, Trachtenberg J, Fleshner NE, Finelli A, Wijeysundera D, Aprikian A, Tanguay S, Carli F.

BMC Surg. 2014.


The relevance of the procedures related to the physiotherapy in the interventions in patients with prostate cancer: short review with practice approach.

Bernardo-Filho M, Barbosa Júnior ML, da Cunha Sá-Caputo D, de Aguiar Ede O, de Lima RP, Santos-Filho SD, de Paoli S, Presta GA, de Oliveira Bravo Monteiro M, Tavares A.

Int J Biomed Sci. 2014.


Early functional results of biofeedback and its impact on quality of life of patients with anal incontinence.

Leite FR, Lima MJ, Lacerda-Filho A.

Arq Gastroenterol. 2013.


Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. 

Bernards AT, Berghmans BC, Slieker-Ten Hove MC, Staal JB, de Bie RA, Hendriks EJ.

Int Urogynecol J. 2014.


Electrical stimulation for urinary incontinence in women: a systematic review.

Schreiner L, Santos TG, Souza AB, Nygaard CC, Silva Filho IG.

Int Braz J Urol. 2013.


Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review.

Vonthein R, Heimerl T, Schwandner T, Ziegler A.

Int J Colorectal Dis. 2013 Nov.


Effects of Sacral Neuromodulation on Urinary and Fecal Incontinence.

Rosen A, Taragano L, Condrea A, Sidi A, Ron Y, Ginath S.

Isr Med Assoc J. 2015.


Posterior tibial nerve stimulation for fecal incontinence: where are we?

George AT, Maitra RK, Maxwell-Armstrong C.

World J Gastroenterol. 2013.


Disfunção Erétil:

Percutaneous perineal electrostimulation induces erection: clinical significance in patients with spinal cord injury and erectile dysfunction.

Shafik A, Shafik AA, Shafik IA, El Sibai O.

J Spinal Cord Med. 2008.


Próstata:

Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome.

Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE.

Evid Based Complement Alternat Med. 2005.


 

 

 

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