Adhesión de las mujeres embarazadas a los ejercicios para fortalecer el suelo pélvico

Fernanda Santos; Nathalie Leister; Karina Trevisan; Camila Cruz; Míriam Zanetti; Maria Luiza Riesco

Fernanda Santos Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brasil
Nathalie Leister Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brasil
Karina Trevisan Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brasil
Camila Cruz Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brasil
Míriam Zanetti Departamento de Gestão e Cuidados em Saúde, Universidade Federal de São Paulo, Santos, Brasil
Maria Luiza Riesco Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brasil

Palabras clave: Embarazada, Incontinencia Urinaria, Cooperación del Paciente, Embarazo, Perineo, Terapia por Ejercicio

Key-words: Pregnant woman, Urinary Incontinence, Patient Compliance, Pregnancy, Perineum, Exercise Therapy

Resumen

Objetivo: Analizar la adhesión de las mujeres a los ejercicios de fortalecimiento de los músculos del suelo pélvico (EFSP) durante el embarazo. Métodos: Estudio prospectivo con 315 mujeres; la recolección de datos se realizó por teléfono y personalmente; el análisis de los datos fue descriptiva e inferencial con nivel de significación del 5%. Resultados: En la primera mitad del embarazo, la adhesión total fue del 36,5%; cuando se agruparon adhesión total y adhesión parcial, este porcentaje alcanzó el 54%; a lo largo del embarazo, hubo una reducción gradual (desde 46% hasta 39,7%) de mujeres que informaron la falta de adhesión; no hubo asociación significativa entre la adhesión y las características sociodemográficas, clínicas y obstétricas. Conclusión: Hubo adhesión total o parcial de la mayoría de las mujeres en todos los trimestres del embarazo; fue muy positiva la proporción de mujeres que informaron realizar EFSP.

Abstract

Objective: To analyse the adherence of pregnant women to pelvic floor muscle exercises (PFME) during pregnancy. Methods: Prospective study, with 315 pregnant women; data collection was performed by phone and face-to-face; data analysis was descriptive and inferential with 5% significance level. Results: In the first half of pregnancy, the total adherence was 36.5%; when gathered total adherence and partial adherence, the percentage reached was 54%; during pregnancy, there was a gradual decrease (from 46% to 39.7%) of women who reported no adherence; there was no significant association between adherence and the sociodemographic, obstetric and clinics characteristics. Conclusion: The majority of pregnant women in all trimesters of pregnancy reported total or partial adherence to PFME; it was highly positive the proportion of women who reported performing PFME.

Bibliografía

1. Miller NH, Hill M, Kottke T, Ockene IS. The multilevel compliance challenge: recommendations for a call to action: a statement for health care professionals. Circulation 1997;95:1085-90.
2. Leite SN, Vasconcellos MPC. Adesão à terapêutica medicamentosa: elementos para a discussão de conceitos e pressupostos adotados na literatura. Cien Saude Colet 2003;8(3):775-82.
3. Rocha CH, Oliveira AP, Ferreira C, Faggiani FT, Schroeter G, Souza AC, et al. Adesão à prescrição médica em idosos de Porto Alegre, RS. Cienc Saude Colet 2008;13(Supl): 703-10.
4. Gusmão JL, Mion Jr D. Adesão ao tratamento: conceitos. Rev Bras Hipertens 2006;13(1):23- 5.
5. Cunha MF, Gandini RC. Adesão e Não-Adesão ao tratamento farmacológico para depressão. Psicol Teor Pesqui 2009; 25(3): 409-18.
6. Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. 4th International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence. Neurourol Urodyn 2010; 29(1): 213-40.
7. Franco EM, Parés D, Lorente Colomé L, Mendéz Paredes JR, Amat Tardiu L. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Report Biol. 2014; 182: 86-90.
8. Sangsawang B. Risk factors for the development of stress urinary incontinence during oregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2014; 178: 27-34.
9. Oliveira Cd, Seleme M, Cansi PF, Consentino RF, Kumakura FY, Moreira GA, et al. Urinary incontinence in pregnant women and its relation with socio-demographic variables and quality of life. Rev Assoc Med Bras. 2013; 59(5): 460-6.
10. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J. 2013; 24(6): 901-12.
11. Bø K, Pauck Øglund G, Sletner L, Mørkrid K, Jenum AK. The prevalence of urinary incontinence in pregnancy among a multi-ethnic population resident in Norway. BJOG. 2012; 119(11): 1354-60.
12. Hansen BB, Svare J, Viktrup L, Jørgensen T, Lose G. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women. Neurourol Urodyn. 2012; 31(4): 475-80.
13. Flisser AJ, Blaivas JG. Evaluating incontinence in women. Urol Clin North Am 2002; 29(3): 515-26.
14. Abrams P, Cardoso L, Fall M, Griffiths D, Rosier P, Ulmesten U, et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the international continence society. Urology 2003; 61(1): 37-49.
15. Silveira SR. Estudo observacional de aspectos relacionados à adesão ao tratamento da incontinência urinária em mulheres que realizaram exercícios da musculatura do assoalho pélvico [disertación]. São Paulo: Universidade de São Paulo, Faculdade de Medicina; 2006. Disponible en: <http://www.teses.usp.br/teses/disponiveis/5/5139/tde-20092006-155730/> Consultado en 17 de Diciembre de 2012.
16. Oliveira JM. Avaliação do tipo de parto sobre a força muscular do assoalho pélvico de primípara [disertación]. Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo; 2007. Disponible en: <http://www.teses.usp.br/.../publico/JANAINAMAYERDEOLIVEIRA.pdf> Consultado en 15 de noviembre de 2015.
17. Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J 2004; 15: 76-84.
18. Nielsen CA, Sigsgaard I, Olsen M, Tolstrup M, Danneskiold-Samsoee B, Bock JE. Trainability of the pelvic floor: a prospective study during pregnancy and after delivery. Acta Obstet Gynecol Scand 1988; 67(5): 437-40.
19. Mørkved S, Salvesen KA, Bø K, Eik-Nes S. Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Int Urogynecol J 2004; 15: 384-90.
20. Oliveira C, Lopes MAB, Pereira LCL, Zugaib M. Effects of pelvic floor muscle training during pregnancy. Clinics (São Paulo) 2007; 62(4): 439-46.
21. Assis LC. Efetividade de exercícios do assoalho pélvico durante a gestação como medida preventiva da incontinência urinária e da disfunção muscular do assoalho pélvico [disertación]. Botucatu: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista; 2010. Disponible en: <http://hdl.handle.net/11449/99200> Consultado en 15 de Noviembre de 2015.
22. Bø K, Haakstad LAH. Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. Physiotherapy 2011; 97: 190-5.
23. Salvesen KÅ, Mørkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 2004; 329(7462): 378-80.
24. Gameiro MO, Moreira ECH, Amaro JL. Exercícios perineais. In: Amaro JL, Haddad JM, Trindade JCS, Ribeiro RM. Reabilitação do assoalho pélvico nas disfunções urinária e anorretais. São Paulo: Segmento; 2005.
25. Abrams P, Artibani W, Cardozo L, Dmochowski R, van Kerrebroeck P, Sand P, et al. Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn 2009; 28(4): 287.
26. Ismail SIM. An audit of NICE guidelines on antenatal pelvic floor exercises. Int Urogynecol J 2009; 20(12): 1417-22.
27. Boyle R, Hay-Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Syst Rev. 2012; 10: CD007471.
28. Zanetti MRD, Castro RA, Rotta AL, Santos PD, Sartori M, Girão MJBC. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. São Paulo Med J 2007; 125(5): 265-9.
29. Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014; 48(4): 299-310.
30. Pelaez M, Gonzalez-Cerron S, Montejo R, Barakat R. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2014; 33(1): 67-71.
31. Stafne SN, Salvesen KÅ, Romundstad PR, Torjusen IH, Mørkved S. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG. 2012; 119(10): 1270-80.
32. Ko PC, Liang CC, Chang SD, Lee JT, Chao AS e Cheng PJ. A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence. Int Urogynecol J. 2011; 22(1): 17-22.
33. Rosediani M, Nik Rosmawati NH, Juliawati M, Norwati D. Knowledge, attitude and practice towards pelvic floor muscle exercise among pregnant women attending antenatal clinic in Universiti Sains Malaysia Hospital, Malaysia. IMJ 2012; 19(1): 42-43.
34. Whitford HM, Jones M. An exploration of the motivation of pregnant women to perform pelvic floor exercises using the revised theory of planned behavior. Br J Health Psycol 2011; 16(4): 761-78.
35. Atalah ES, Castillo LC, Castro SR, Aldea PA. Propuesta de un nuevo estandar de evaluación nutricional en embarazadas. Rev Med Chil 1997; 125(12): 1429-36.
36. Merino Garrido L, Mínguez Arias J, Calvo Hornillos M, Herreros Gorría A. Autocuidado en personas con hipertensión arterial en cumplimiento terapéutico en Atención Primaria. Evidentia 2015; 12(49). Disponible en: <http://www.index-f.com/evidentia/n49/ev9731.php> Consultado el 15 de Noviembre de 2015.
37. Kurita GP, Pimenta CAM. Adesão ao tratamento da dor crônica e o locus de controle da saúde. Rev Esc Enferm USP 2004; 38(3): 254-61.

Adhesión de las mujeres embarazadas a los ejercicios para fortalecer el suelo pélvico

Pregnant women adherence to pelvic floor muscle exercises

Resumen

Abstract

Bibliografía