Disfuncion de Suelo Pelvico

La disfunción del suelo pélvico es un grupo de trastornos que cambian la manera en que las personas tienen movimientos intestinales ya veces causan dolor pélvico. Estos trastornos pueden ser avergonzados para discutir, puede ser difícil de diagnosticar y, a menudo tienen un efecto negativo sobre la calidad de vida. Los síntomas varían según el tipo de trastorno. Muchos médicos generales pueden no estar familiarizados con la disfunción del suelo pélvico, y puede ser necesario que un especialista, como un cirujano colorrectal, descubra el diagnóstico correcto.

TIPOS DE DISFUNCIÓN DE SUELO PÉLVICO

Defecación obstruida: La defecación obstruida es dificultad para obtener movimientos intestinales fuera del cuerpo. Aunque las heces alcanzan el recto, o parte inferior del colon, el paciente tiene dificultades para vaciar. Esto a menudo hace que los pacientes sientan que necesitan ir al baño más a menudo, o que no pueden vaciarse por completo, como si las heces permanezcan en su recto. La defecación obstruida puede ser causada por prolapso del suelo pélvico (discutido más adelante), síntomas de dolor o los músculos que no funcionan normalmente.

Rectocele: Un rectocele es un bulto de la pared frontal del recto dentro de la vagina. Normalmente, el recto va directamente hacia el ano (foto). Cuando un paciente con cepas de rectocele, las heces pueden quedar atrapados en un bolsillo anormal del recto que se hincha en la vagina. Esto evita que el paciente vacíe completamente el recto. Generalmente, los rectoceles no producen síntomas. A medida que crecen, los rectoceles pueden causar dificultad para ir al baño, o causar fuga de heces después de tener una evacuación intestinal. Los rectoceles son más comunes en las mujeres que han dado la luz. Rectoceles son causados ​​generalmente por adelgazamiento del tejido entre el recto y la vagina y el debilitamiento de los músculos del suelo pélvico.

Prolapso del suelo pélvico: El suelo pélvico consiste en los músculos y órganos de las pelvis, tales como el recto, la vagina, la vejiga. El estiramiento del suelo pélvico puede ocurrir con el envejecimiento, trastornos del colágeno o después del parto. Cuando el suelo pélvico se estira, el recto, la vagina o la vejiga pueden sobresalir a través del recto o la vagina, causando un bulto, que se puede sentir. Además de un rectocele, los pacientes pueden tener prolapso rectal, un cistocele (prolapso de la vejiga) o protrusión del intestino delgado. Los síntomas generalmente incluyen dificultad en el vaciado durante la micción o defecación, incontinencia o presión en la pelvis.

Puborectal Paradoxical Contracción: El músculo puborectalis es parte de los músculos de control que controlan los movimientos intestinales. El puborectal se envuelve como una honda alrededor del recto inferior. Durante una evacuación, se supone que el puborectalis se relaja para permitir el paso del intestino. Si el músculo no se relaja o se contrae durante la contracción paradójica, puede sentir que está empujando contra una puerta cerrada.

Síndrome de Levator: El síndrome de Levator es espasmos anormales de los músculos del suelo pélvico. Los espasmos pueden ocurrir después de tener movimientos intestinales o sin una causa conocida. Los pacientes a menudo tienen períodos prolongados de presión vaga, aburrida o dolorida en el recto. Estos síntomas pueden empeorar al sentarse o acostarse. El espasmo de los levantadores es más común en las mujeres que en los hombres.

Coccigodinia: El coxis, o coxis, se encuentra en la parte inferior de la columna vertebral. Coccygodynia es el dolor es el coxis. El dolor suele empeorar con el movimiento y puede empeorar después de la defecación. Por lo general, es causada por una caída o un traumatismo que involucra al cóccix, aunque en un tercio de los pacientes no se observa ninguna causa.

Proctalgia Fugax: Proctalgia fugax es un dolor anormal repentino en el recto que a menudo despierta a los pacientes del sueño. Este dolor puede durar hasta varios minutos y desaparece entre los episodios. Proctaliga fugax se cree que es causada por espasmos del recto y / o los músculos del suelo pélvico.

Neuralgia Pudendal: Los nervios pudendales son los principales nervios sensoriales de la pelvis. La neuralgia de Pudendal es dolor crónico en el piso pélvico que implica los nervios pudendal. Este dolor puede ocurrir primero después del parto, pero a menudo viene y desaparece sin razón.

DIAGNÓSTICO

Una historia médica completa y un examen físico exhaustivo son fundamentales para evaluar la disfunción del suelo pélvico. El médico debe preguntar sobre otros problemas de dolor en el cuerpo, así como la dificultad para tener movimientos intestinales, orina o dolor durante las relaciones sexuales. Es importante tener un examen físico completo, incluyendo exámenes rectales y vaginales.

La función de los diversos nervios y músculos involucrados en los movimientos intestinales es compleja y el médico puede necesitar pruebas adicionales para determinar la causa del problema. Las pruebas que pueden ser ordenadas por su cirujano de colon y rectal pueden ayudar a hacer un diagnóstico y guiar el tratamiento.

  • Ultrasonido Endoanal / Endorrectal: Proporciona imágenes de las estructuras de la pelvis, incluyendo el ano, la pared rectal y los músculos de control. También puede demostrar rectocele, prolapso rectal o enterocele (prolapso del intestino delgado). Esto se realiza generalmente en la oficina.
  • Manometría anorrectal: evalúa la capacidad de los músculos de control y del recto para funcionar y la fuerza de los músculos. Esto también se realiza generalmente en la oficina o en un centro de endoscopia. Esta prueba requiere que el paciente empuje y tensión, de modo que pueda determinar correctamente la fuerza de los músculos.
  • Electromiografía (EMG) / Prueba de latencia del motor nervioso de Pudendal: Estas son pruebas que verifican para determinar cómo funcionan los nervios del suelo pélvico. Las pruebas de latencia del motor del nervio de Pudendal evalúan sólo el nervio pudendo, mientras que el EMG es una prueba más compleja de varios nervios en el esfínter anal y el suelo pélvico. Estas pruebas pueden requerir agujas y pequeñas dosis de electricidad.
  • Estudio de Tránsito Colónico: Un estudio de tránsito colónico es una serie de rayos X que evalúan el paso de las heces a través del colon para identificar posibles causas y localizaciones de estreñimiento. El paciente toma una píldora pequeña que contiene marcadores metálicos, que se verán en los rayos X durante los próximos días.
  • Videodefecograma: Un defograma es una radiografía especial que se toma mientras usted está teniendo un movimiento intestinal para probar el movimiento del músculo. Esta prueba es muy útil para determinar la causa de la disfunción del suelo pélvico. Esta prueba puede incluir radiografías regulares, fluoroscopio o una máquina de MRI.

TRATAMIENTO

El tratamiento se basa en la causa de la disfunción y la gravedad de los síntomas. El tratamiento quirúrgico es rara vez necesario para la disfunción del suelo pélvico, excepto por grandes rectoceles sintomáticos u otro prolapso pélvico. En el caso de prolapso, la cirugía puede ayudar a restaurar la ubicación normal de los órganos pélvicos. Esto puede realizarse a través del abdomen o a través del fondo, dependiendo del problema específico.

Para los síndromes de dolor pélvico, el objetivo del tratamiento es aliviar o reducir los síntomas. En algunos casos, una combinación de métodos de tratamiento ayuda a reducir el dolor.

  • Cambios en la dieta, como el aumento de fibra y la ingesta de líquidos para hacer los movimientos intestinales más fáciles.
  • Biorretroalimentación, una forma especial de fisioterapia del suelo pélvico dirigida a mejorar la sensación rectal y la contracción del músculo del suelo pélvico. Esto puede incluir estimulación eléctrica de los músculos del suelo pélvico, ultrasonido o terapia de masaje. Además, hay ejercicios que se pueden hacer en casa que pueden ayudar a mejorar los síntomas.
  • Inyección de un anestésico local y / o agentes antiinflamatorios

PROGNOSIS POSQUIRÚRGICA

La tasa de éxito de la cirugía de prolapso depende de los síntomas específicos y de su duración. Los riesgos de corrección quirúrgica incluyen sangrado, infección y dolor durante el coito (dispareunia). También existe la posibilidad de que el prolapso pélvico se repita o empeora.

¿QUÉ ES UN CIRUJANO DE COLON Y RECTO?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y pasan los exámenes intensivos llevados a cabo por la Junta Americana de Cirugía y la Junta Americana de Cirugía de Colon y Recto. Ellos están bien versados en el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano. Ellos son capaces de realizar exámenes de detección rutinas y de tratar quirúrgicamente condiciones, si está indicado para hacerlo.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.

 



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