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OPINIONES ACTUALES SOBRE LA PREVENCION DE LA INCONTINENCIA ANAL POSPARTO: CESAREA VERSUS PARTO VAGINAL

(especial para SIIC © Derechos reservados)
La incontinencia anal posparto obedece a muchos factores y su alcance, incluidas su frecuencia y gravedad, exige un análisis adecuado para que puedan implementarse estrategias de prevención apropiadas.
lal9.jpg Autor:
Mira Lal
Columnista Experto de SIIC

Institución:
Department of Obstetrics & Gynaecology Russells Hall Hospital

Artículos publicados por Mira Lal
Recepción del artículo
21 de Febrero, 2005 		Aprobación
14 de Febrero, 2005
Primera edición
20 de Enero, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

OPINIONES ACTUALES SOBRE LA PREVENCION DE LA INCONTINENCIA ANAL POSPARTO: CESAREA VERSUS PARTO VAGINAL

Resumen
Los obstetras a veces tienen que considerar si una cesárea electiva puede prevenir la incontinencia anal de las embarazadas sanas. El aumento mundial de las tasas de cesárea afecta la salud reproductiva y la economía de la salud, por lo tanto existe una necesidad de justificar las cesáreas preventivas. La incontinencia anal obedece a muchos factores y su alcance, incluidas su frecuencia y gravedad, exige un análisis adecuado para que puedan implementarse estrategias de prevención. Un estudio llevado a cabo en primíparas (n = 184) sometidas a cesárea y comparadas con mujeres que tuvieron parto normal (n = 100) mostró que los síntomas más graves –que requirieron compresas– ocurrieron en 2 (3%) madres con incontinencia anal luego una cesárea realizada antes del trabajo de parto (n = 80). Este trabajo discute, mediante un enfoque biopsicosocial, los estudios que evalúan la gravedad de los síntomas de la incontinencia anal. Se aplicaron herramientas de evaluación psicosocial que incorporaron la percepción de gravedad por parte de las madres. El impacto físico serio asociado a esta condición acarreó trastornos psicosociales importantes pero otras causas, como las experiencias de parto insatisfactorias, se hicieron relevantes cuando los síntomas se percibieron como menos graves. Las herramientas de evaluación psicosocial posparto orientadas a las pacientes podrían mejorar nuestra comprensión de sus necesidades reales. Otras publicaciones actuales comunican que la incidencia de la incontinencia anal tras la cesárea quizá sea similar o menor a la del parto vaginal. Los síntomas pueden no relacionarse con los resultados anormales de los estudios y pueden resolverse espontáneamente. Las investigaciones de la cesárea preventiva para la incontinencia anal deberían tener en cuenta aquellos factores no relacionados con el trabajo de parto y los aspectos psicosociales.

Palabras clave
Incontinencia anal, incidencia posparto, impacto psicosocial, prevención


Artículo completo
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CURRENT THOUGHTS ON THE PREVENTION OF POSTPARTUM ONSET OF ANAL INCONTINENCE: CAESAREAN VS. VAGINAL DELIVERY

Abstract
Obstetricians occasionally have to consider whether an elective caesarean will prevent anal incontinence in a healthy gravida. The global rise in the caesarean rate impinges on reproductive health and health economy, hence, there is a need to justify prophylactic caesarean. Anal incontinence is multifactorial. Its scope including its frequency and severity need adequate assessment for developing preventative strategies. A study investigating primiparae in which caesarean (n = 184) mothers were compared with vaginally delivered (n = 100) reported that severe physical symptoms necessitating pad use occurred in 2 (3%) mothers with anal incontinence following pre-labour caesarean (n = 80). This paper discusses the study’s progress in assessing the severity of these symptoms of anal incontinence using a biopsychosocial approach. Postpartum psychosocial assessment tools which incorporated the mother’s perception of severity were applied. Severe physical burden led to severe psychosocial impairment but other causes, e.g. an unsatisfactory childbirth experience, gained prominence when physical symptoms were perceived as less severe. Assessment using these consumer-orientated postpartum psychosocial evaluation tools would improve our understanding of consumer needs. Other current publications report that frequencies of anal incontinence following caesarean may be similar or lower than that following vaginal delivery. Symptoms may not relate to abnormal investigation results and can resolve spontaneously. Research investigating prophylactic caesarean for preventing anal incontinence should evaluate non-labour factors and the psychosocial aspect.

Key words
Anal incontinence, postpartum incidence, psychosocial impact, prevention


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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
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Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Medicina Familiar, Medicina Interna, Salud Mental



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Patrocinio y reconocimiento:
Agradecimientos: Mi sincero reconocimiento a Roger Callender, Teresa Allen y Helen Pattison por su apoyo general y a Bailas Sarhadi y Jane Taylor por su respaldo técnico.
Las figuras 1 a 4 sobre los cambios en el piso y los órganos pelvianos a partir del sexto mes de embarazo son ilustraciones de William Smellie (1852) (cortesía de la Biblioteca William Smellie, Lanarkshire, Reino Unido).
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