ABSTRACT
La fisioterapia del suelo pélvico en las enfermedades desmielinizantes ha sido poco estudiada. El objetivo del presente estudio es describir los resultados obtenidos con la aplicación de un programa de fisioterapia basado en electroestimulación, biofeedback, gimnasia abdominal hipopresiva y conos vaginales con el fin de mejorar la calidad de vida y reducir los síntomas de la incontinencia urinaria y fecal de una paciente con denervación parcial del suelo pélvico. Se presenta a una mujer de 63 años que presentó 3 episodios de mielopatía dorsal y que fue diagnosticada de neuromielitis óptica, debido a la presencia de anticuerpos IgG anti-NMO, trastornos visuales tras el primer brote y ausencia de lesiones cerebrales en la resonancia magnética. Presentaba incontinencia urinaria y fecal de origen neurógeno. La fisioterapia del suelo pélvico mejoró la calidad de vida de esta paciente con enfermedad desmielinizante y también la severidad de la incontinencia urinaria y fecal
Pelvic floor physiotherapy in myelitis disorders has been little studied. The current study has aimed to describe the results obtained through the application of a physiotherapy program based on electrostimulation, biofeedback, abdominal hypopressive technique and vaginal cones to improve quality of life and to reduce urinary and fecal incontinence symptoms in a patient with partial denervation of the pelvic floor. We present the case of a 63-year-old woman who suffered three episodes of dorsal myelopathy. She was diagnosed with neuromyelitis optica due to the presence of anti-NMO IgG antibodies, visual disorders after the first outbreak and absence of brain lesions in magnetic resonance. She presented urinary and fecal incontinence of neurogenic etiology. Pelvic floor physiotherapy improved the quality of life of this patient with a myelitis disorder and also improved the severity of her urinary and fecal incontinence
Subject(s)
Humans , Neuromyelitis Optica/rehabilitation , Pelvic Floor Disorders/rehabilitation , Physical Therapy ModalitiesABSTRACT
Contexto: La electroestimulación (EE) es una de las técnicas empleadas en el tratamiento conservador de la incontinencia urinaria (IU) y/o síndrome de vejiga hiperactiva (SVH). Sin embargo, existe controversia en la literatura científica acerca de su eficacia como monoterapia. Objetivo: Evaluar la evidencia científica sobre la EE del suelo pélvico en mujeres con IU y/o SVH. Adquisición de evidencia: Se realizó una revisión sistemática de ensayos clínicos en las bases de datos PubMed, Cochrane, PEDro, Elsevier (Doyma) y EnFisPo (1980-2011). Se evaluó la calidad de los estudios y se extrajo la información de los que reunieron los criterios de inclusión establecidos. Síntesis de evidencia: Un total de 27 ensayos clínicos han sido incluidos en la revisión: 13 ensayos controlados aleatorizados, 11 ensayos aleatorizados no controlados y 3 ensayos no aleatorizados. Conclusión: La mayor parte de los ensayos clínicos concluyen que la EE es eficaz en el tratamiento de la IU y el SVH en mujeres. Sin embargo, son necesarios más estudios de buena calidad metodológica para obtener un mayor nivel de evidencia científica y conocer cuál es la modalidad, tipo y parámetros de corriente óptimas para cada tipo de IU y el SVH (AU)
Context: Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. Objective: To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. Evidence acquisition: A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. Evidence synthesis: The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. Conclusion: Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB (AU)
Subject(s)
Humans , Female , Urinary Incontinence/diagnosis , Urinary Incontinence/radiotherapy , Urinary Bladder, Overactive/diagnosis , Urinary Bladder, Overactive/therapy , Electric Stimulation/instrumentation , Evidence-Based Medicine/standards , Randomized Controlled Trials as Topic/methods , Clinical Trials as Topic/methods , Pelvic Floor/physiopathology , Pelvic Floor/radiation effects , Pelvic Floor , Evidence-Based Medicine/methodsABSTRACT
CONTEXT: Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. OBJECTIVE: To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. EVIDENCE ACQUISITION: A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. EVIDENCE SYNTHESIS: The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. CONCLUSION: Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB.