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Home Suelo pélvico Incontinencia ¿Qué es y para qué sirve la electroestimulación?

¿Qué es y para qué sirve la electroestimulación?

Incontinencia


553 10153

¿De qué se trata exactamente y para qué sirve en patología del suelo pélvico?


Compártelo con tus amigas:

La estimulación neuromuscular se consigue con un dispositivo que emite impulsos eléctricos a través de electrodos colocados próximos a la zona a tratar. En uroginecología se usa una sonda que se coloca en el interior de la vagina. Por lo tanto, antes de plantear un tratamiento de este tipo, es necesario realizar una revisión ginecológica reciente donde se descarte infección vaginal o, por ejemplo, estaría también contraindicado durante la menstruación.

La corriente utilizada varía en frecuencia (número de impulsos eléctricos por segundo), intensidad (velocidad del flujo de corriente) y amplitud del impulso (tiempo de paso de la corriente en cada impulso); según el objetivo que queramos.

Los objetivos que se buscan en uroginecología se resumen en tres:

  • Inhibición vesical.
  • Activación muscular.
  • Analgesia.

Tratamiento de la hiperactividad vesical o incontinencia urinaria de urgencia

Si las medidas de cambio de hábitos o con fármacos no han resultado eficaces, recurrimos a la electroestimulación. Los impulsos eléctricos inhibirían las fibras nerviosas responsables de las contracciones involuntarias del músculo detrusor de la vejiga que causan la urgencia miccional, o el aumento de las veces que necesitamos acudir a orinar. Es decir, la paciente tras las sesiones suele aumentar su capacidad vesical, reducir el número de micciones al día y controlar la intensidad de la urgencia, así como los escapes de orina.

En los últimos años la vía vaginal está siendo reemplazada por la electroestimulación del nervio tibial posterior, menos molesta y más cómoda. Este nervio se origina en raíces lumbosacras donde confluye con el centro parasimpático sacro medular, que controla la micción. Por lo tanto, modulamos este centro de forma indirecta a través del nervio.

Los resultados satisfactorios se obtienen con una sesión semanal de 20-30 minutos durante 12 semanas.

Entrenamiento de la contracción voluntaria. Fortalecimiento de la musculatura del suelo pélvico

Pacientes con incontinencia urinaria de esfuerzo, incontinencia anal por bajo tono del esfínter anal o daño residual postparto y/ o prolapso genital leve-moderado se pueden beneficiar de un programa de estimulación muscular vía vaginal.

En estos casos, lo eficaz parece ser la mezcla de un estímulo eléctrico que activa el músculo, propiocepción (observación o toma de conciencia de la contracción muscular secundaria al estímulo eléctrico) y ejercicio activo, es decir, que la paciente responda superponiendo una contracción voluntaria semejante a la percibida. Se trata de aprender a contraer el área muscular del suelo pélvico con ayuda de la corriente. ¡Importante! La electroestimulación pasiva no es tan eficaz.

De esta forma se acelera bastante la obtención de contracciones activas voluntarias y se facilita el trabajo activo en los programas de fortalecimiento de la musculatura de suelo pélvico.

Neuroestimulación eléctrica transcutánea (TENS) para tratamiento del dolor 

Existen estudios que han demostrado la liberación de endorfinas tras la aplicación de corriente transcutánea. En definitiva, aplicándolo sobre el nervio pudendo podemos activar circuitos neurológicos encargados del control del dolor perineal. La respuesta de cada paciente varía en función del tipo de dolor o lesión a tratar, así como el estado emocional y las esperanzas depositadas en el tratamiento. Entre un 25-30% de las casos de dolor la paciente mejora por el efecto placebo.

En cualquier caso, se suele completar con otras maniobras como masaje miofascial o técnicas instrumentales: diatermia(calor) o punción seca, entre otras.

Fuente: Dra. Gema García Gálvez

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