Diana Moreu y Estela Peñaranda, especialistas en fisioterapia perineal integral de Berkana Fisioterapia, con las que colaboramos, nos responden a 15 preguntas importantes sobre el suelo pélvico. Un tema casi tabú y poco conocido hasta hace unos años, pero básico para lograr una mejor calidad de vida. Lee con atención, porque si eres mujer, esto te interesa, estés en la etapa que estés. ¡Y si eres hombre, también! 🙂
· CRISTINA TORRECILLA: Aunque muchas veces no se le da importancia hasta que surgen los problemas, el cuidado del suelo pélvico es básico en la mujer en cualquier etapa de su vida. ¿Por qué antes no se hablaba tanto de ello?
BERKANA: La visibilización de las patologías que afectan a las mujeres es muy reciente. Hasta hace unos años, e incluso hoy en día para muchas personas, tener pérdidas de orina o dolor menstrual es una situación normal y solo le ponemos parches, una compresa o un analgésico en estos casos.
· CT: ¿Qué síntomas manifiestan que hay un suelo pélvico debilitado?
B: Antes de responder, queremos señalar que los problemas de suelo pélvico muchas veces son derivados de un exceso de tono. Lo importante es que la musculatura pueda responder a la actividad para la que se la solicita contrayéndose y relajándose en función de la necesidad. A partir de esto, la dificultad para retener la orina o un gas, el dolor en relaciones, los descensos de órganos pélvicos, ciertos estreñimientos… pueden ser situaciones de alteraciones en el suelo pélvico.
· CT: La incontinencia urinaria, la pérdida de control de la vejiga, es un de las principales preocupaciones relacionadas con el suelo pélvico en mujeres. Muchas veces causada por el embarazo, el parto, la menopausia, la obesidad o el envejecimiento. Según el Observatorio nacional de incontinencia (ONI), el 25% de las mujeres, a partir de 35 años, sufre incontinencia y el porcentaje se eleva hasta el 50% a partir de los 65 años. ¿Pero va siempre asociado a estas fases o también se da en gente más joven?
B: Podemos encontrar incontinencia urinaria en mujeres más jóvenes sin partos previos, generalmente deportistas. Y diríamos que la causa principal no es el estado de la musculatura perineal, sino el desconocimiento y la desconexión con esta parte de nuestro cuerpo. Falta integrar el suelo pélvico en las rutinas de entrenamiento. Esperamos que poco a poco las y los profesionales del deporte se vayan formando en conceptos básicos de suelo pélvico para poder hacer un trabajo más multidisciplinar.
· CT: Otro de los problemas comunes es el prolapso de órganos de la zona por el debilitamiento de los músculos del suelo pélvico, que produce presión vaginal, incomodidad, dolor y dificultad para orinar por ejemplo. Además, casi el 30% de las mujeres sufren estreñimiento, causa frecuente de los prolapsos. ¿Qué soluciones existen en la actualidad para resolver estos problemas en el ámbito de la fisioterapia?
B: El prolapso es una patología silenciosa. El principal problema es que no somos conscientes del descenso hasta que no nos da sintomatología. En un prolapso generalmente ha habido una distensión de los ligamentos que sostienen las vísceras, y lo que hacemos desde la fisioterapia es intentar que el problema no avance y mejorar las molestias que pueda generar. También podemos colocar pesarios, que son unos dispositivos de silicona que introducimos vía vaginal para dar sostén a los órganos pélvicos. El ejercicio hipopresivo suele ser una herramienta terapéutica muy útil en prolapsos, pero lo fundamental es que la paciente entienda qué gestos le están generando presión en la pelvis.
· CT: Para muchas mujeres las disfunciones sexuales por problemas del suelo pélvico son aún un tabú que no comparten con nadie y que no expresan porque lo asumen como normal: dolor durante las relaciones sexuales, disminución del deseo sexual y dificultades para alcanzar el orgasmo, por ejemplo. ¿Notáis que hay más gente que acude a un especialista como vosotras o aún es complicado?
B: Aún son pocas las ocasiones en las que el principal motivo de consulta está asociado a una disfunción sexual. Las mujeres aún tenemos un gran trabajo por delante de autocuidado e inconformismo, tenemos que querernos más y darnos más protagonismo para abordar este tipo de disfunciones con las que muchas veces aceptamos convivir. Aún así, sí que realizamos muchos tratamientos relacionados con la esfera de la sexología principalmente en mujeres postparto y en relación a la sequedad vaginal por diferentes causas.
· CT: ¿Creéis que las mujeres reciben suficiente información sobre el cuidado del suelo pélvico en el embarazo y postparto?
B: Creemos y queremos pensar que cada vez las mujeres durante el embarazo toman más conciencia sobre su suelo pélvico y su abdomen, y buscan ayuda para poder encontrar esa información. Es una de las etapas de la mujer donde más se interesan por este tema, aunque es verdad que todavía falta camino por recorrer desde el punto de vista de la fisioterapia.
· CT: ¿Qué papel juega un suelo pélvico fortalecido en el parto?
B: Durante el parto necesitamos que nuestra musculatura perineal sea elástica, pero también debe tener un buen tono. Igual que todos los músculos de nuestro cuerpo para que trabajen bien y se lesionen lo menos posible frente a una puesta en tensión tan potente como es el paso del bebé a través del él. Cuanto mejor llegue nuestro periné al parto, mejor será la recuperación postparto.
· CT: ¿Qué es la diástasis abdominal y cómo se puede solucionar?
B: La diástasis abdominal es la separación de los músculos rectos del abdomen (la tableta de chocolate). Es importante remarcar que no hace falta haber tenido un embarazo para tener esta separación, los hombres también pueden tenerla. Es importante la coordinación de los otros músculos del abdomen (los oblicuos y el transverso) para corregir esta diástasis. Cada caso es individual, por eso en consulta siempre hacemos una ecografía funcional para saber qué está pasando en el abdomen en diferentes ejercicios.
· CT: Trabajáis también con deportistas de todos los niveles. ¿Es cierto que ciertos deportes perjudican el estado del suelo pélvico como correr?
B: Vienen muchas mujeres que practican diferentes deportes (running, crossfit, trail, acrobacias…). No nos gusta prohibir. Sabemos que la actividad física va más allá de la salud física, es también salud mental. Por lo que intentamos buscar la reeducación de suelo pélvico aplicado en la práctica deportiva. Pero la verdad es que nos gustaría recibir aún más este sector de mujeres deportistas.
· CT: ¿Los famosos ejercicios de Kegel o los hipopresivos deberían ser un ejercicio habitual para cualquier mujer?
B: Como todo en esta vida, no se puede generalizar. No todas las mujeres deben hacer ejercicios de Kegel ni todas deben hacer hipopresivos. Lo ideal es ver cada caso en particular para poder pautar los ejercicios que mejor nos vienen a cada una.
· CT: ¿Cómo influye también la dieta y los masajes en el suelo pélvico, además de la fisioterapia?
B: Tener una buena salud intestinal es fundamental para nuestro suelo pélvico. Si tenemos malas digestiones, inflamación abdominal, estreñimiento… Todo esto influye negativamente sobre nuestro periné. Por lo que, muchas veces, necesitamos la colaboración con nutricionistas para que nuestro tratamiento sea más efectivo.
· CT: ¿Cómo habéis notado la evolución de las soluciones para problemas de suelo pélvico desde que empezasteis a trabajar?
B: La fisioterapia uroginecológica es joven, pero es verdad que los últimos años ha habido un gran cambio y muchos más estudios sobre nuevas técnicas para seguir avanzando en el tratamiento de estos pacientes. También existe mucha más posibilidad de formación en este campo. Vamos a llevar unos 10 años trabajando en este área y la verdad que sí que creemos que esta especialización ha ido creciendo, aunque sabemos que tenemos que seguir luchando para que la gente y sobre todo otros profesionales sanitarios conozcan nuestro trabajo.
· CT: Aquello de “cortar el pipí” se ha demostrado que no es un buen hábito. ¿Qué otros errores se cometen, relacionados con el suelo pélvico?
B: El “stop pipí“ es una práctica totalmente contraindicada, no debemos cortar nunca la orina una vez que hemos mandado la orden de hacer pipí. Podemos dejar orina residual en nuestra vejiga y tener más probabilidad de infecciones de orina. Además, alterar al músculo de nuestra vejiga por mandar ordenes contrarias. Otra de las cosas que puede dañar nuestros genitales es el uso de jabones y productos químicos para lavarnos, pueden destrozar nuestra flora vaginal y dejarla más vulnerable frente a bacterias y hongos. También debemos tomar conciencia sobre los tejidos que utilizamos en nuestra ropa interior.
· CT: ¿Qué servicios de reeducación abdominoperineal ofrecéis para las mujeres? ¿Y para el hombre?
B: Ofrecemos reeducación del abdomen y suelo pélvico en todas las etapas de la mujer, ya que cada etapa requiere unas necesidades (preparto, postparto, dolores menstruales, endometriosis, dolor en las relaciones sexuales, climaterio…).
En el caso de los hombres, también hacemos tratamiento abdómino-pélvico, ya que ellos también tienen suelo pélvico. Sobre todo a consulta llegan hombres intervenidos de próstata, pero también tratamos dolor crónico, disfunciones sexuales, hernias inguinales… También tratamos niños con alteraciones urológicas, como es la enuresis nocturna.
· CT: ¿Qué técnicas se utilizan en la actualidad? ¿Hacia dónde tiende el sector de la fisioterapia en el suelo pélvico? ¿Ejercicios terapéuticos manuales, biofeedback, neuromodulación, terapia de ondas de choque…?
B: Hay una gran batería de herramientas, las que más utilizamos nosotras en consulta son: ecografía funcional, electroterapia, terapia manual, biofeedback, neuromodulación, electrólisis percutánea y diatermia. Nos gusta mucho complementar los tratamientos con ejercicio funcional, lo vemos indispensable para una buena recuperación.
¡Desde Cristina Torrecilla Beauty & Wellness, gracias a las dos!
Si quieres saber más sobre nuestra colaboración con Berkana, entra aquí.
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