En la Incontinencia Urinaria tratada en Rehabilitación hay mejoría clínica y descenso de valores electromiográficos con la edad

Soraya Hijazi Vega; Julio Carbayo Herencia; Carmen Alonso Ruiz; Jose Mª Sanchez Peña; Jesús Martínez Ruiz; Pedro J. Tarraga Lopez

doi:10.19230/jonnpr.2623

Authors

Soraya Hijazi Vega Unidad Suelo Pélvico Servicio Rehabilitación Gerencia Atención Integrada de Albacete
Julio Carbayo Herencia Facultad de Medicina. Universidad Miguel Hernández de Alicante
Carmen Alonso Ruiz Unidad Suelo Pélvico Servicio Rehabilitación Gerencia Atención Integrada de Albacete
Jose Mª Sanchez Peña Servicio Ginecología Gerencia Atención Integrada de Albacete
Jesús Martínez Ruiz Servicio Urología. Gerencia Atención Integrada de Albacete
Pedro J. Tarraga Lopez Centro de Salud Zona 5 de Albacete

DOI:

https://doi.org/10.19230/jonnpr.2623

Keywords:

Urinary incontinence, Rehabilitation treatment, Electromyographic parameters

Abstract

Introduction. The pelvic floor (SP) is formed by a set of muscular structures, which together with the fascias and ligaments make up the pelvic diaphragm. The function of the SP is the support of the pelvic organs and maintain a correct position of these, influencing urination, intercourse, childbirth and defecation. A weakness or injury of these structures predisposes to the appearance of a symptomatology that can occur in isolation or in combination, one of the main problems being UI urinary incontinence and pelvic organ prolapse POP(1). It is estimated a prevalence of UI in adults between 15 and 30%, presenting in all ages, detecting a progressive increase as age advances and POP in 50% of women who have had at least one vaginal delivery.(2-4)

Objectives. Evaluate both clinically and electromyographically a group of women diagnosed with UI and / or POP, after performing a rehabilitative treatment and one year of follow-up.

Material and methods. This is a longitudinal, analytical observational study of a prospective cohort type, where women aged between 18 and 85 years were evaluated in a period of time between January 2008 and January 2012. The variables used In the present study, they differed in clinical and electromyographic variables. For the evaluation of the MSP an intravaginal surface EMG was performed, which consisted in a quantitative muscular diagnostic evaluation and in which some known muscle parameters were obtained. A rehabilitation treatment protocol was designed, following the guidelines established according to scientific evidence.

Results. In the present study a total of 241 women were included, whose average age was 50.4 years (SD = 12.3), the mean BMI was 27.7 kg / m2, the average duration of symptoms was 6.9 years (SD = 8.9). 88% of women consulted by IU and 29% by POP. The most frequent diagnosis was that of IUM in 118 women (49.0%), followed by SUI in 65 women (27.0%). 49.4% were menopausal, 85.1% had vaginal delivery, only 2.9% were nulliparous. The mean number of deliveries was 2.4 (SD = 1.1) and in 89% of the cases they suffered episiotomy. 92.1% of the women in the sample had urine leaks, 96.4% of them related to the effort. Of the total sample, 189 patients (78.4%) performed treatment in the SP Unit. The average number of sessions was 14.2 (SD = 7.8). At the end of the rehabilitation treatment, 92.3% of the patients reported finding themselves better, 42% of the women presented voiding urgencies, and 47.6% suffered from UUI. The analysis of repeated measures of the electromyographic variables before and after the rehabilitation treatment and during the year of follow-up, statistically significant increases were observed in the maximum values of the phasic contractions, the average values of the tonic contractions, the duration of the tonic contraction selected and the total power of the ttonic contraction. When the means of the maximum values of the phasic contractions were compared, the maximum values of the tonic contractions and the average values of the tonic contractions with the degrees of the modified Oxford scale obtained statistically significant results.

Conclusions. The rehabilitation treatment has achieved an improvement perceived by the patients in 92% of them after finishing the treatment and an improvement in 75% at one year of follow-up. There is a decrease in the maximum values recorded in the EMG by age, decade by decade, experiencing a significant drop in the group of women ?70 years.

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