Resumen
La disfunción del suelo pélvico es una afección multifactorial prevalente que deteriora la calidad de vida de quienes la padecen. Tradicionalmente abordada desde una visión compartimentalizada, la evidencia reciente destaca la conexión entre el suelo pélvico y el eje cerebro-intestino. Esta revisión analiza la asociación fisiopatológica entre ambos y propone un enfoque diagnóstico y terapéutico integrado que involucra a la ginecología, la gastroenterología y la cirugía general. Se realizó una revisión narrativa de la literatura. La comunicación bidireccional entre el sistema nervioso central, el sistema nervioso entérico y el microbiota intestinal influye en el tono pélvico, la sensibilidad visceral y la percepción sintomática. El estreñimiento crónico, la disbiosis intestinal y el estrés psicológico pueden exacerbar o desencadenar la disfunción pélvica, y esta, a su vez, altera el hábito intestinal y contribuye a la ansiedad y la depresión. Un modelo interdisciplinario permite un manejo integral con intervenciones dietéticas, fisioterapia pélvica, apoyo psicológico y cirugía coordinada, mejorando la precisión diagnóstica y ampliando las opciones terapéuticas.
Citas
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[2] R. Cobo, M. Rodríguez, and J. Ortiz, "Prevalencia y factores de riesgo asociados a incontinencia urinaria en mujeres ecuatorianas," Revista Ecuatoriana de Ginecología y Obstetricia, vol. 25, no. 2, pp. 45–52, 2019.
[3] G. W. Cundiff, A. C. Weidner, A. G. Visco, R. C. Bump, and W. A. Addison, "An anatomic and functional assessment of the discrete defect rectocele repair," American Journal of Obstetrics and Gynecology, vol. 179, no. 6 Pt 1, pp. 1451–1457, 1998. doi: 10.1016/s0002-9378(98)70017-1.
[4] J. F. Cryan, K. J. O'Riordan, C. S. M. Cowan, K. V. Sandhu, T. F. S. Bastiaanssen, M. Boehme, M. G. Codagnone, S. Cussotto, C. Fulling, A. V. Golubeva, K. E. Guzzetta, M. Jaggar, C. M. Long-Smith, J. M. Lyte, J. A. Martin, A. Molinero-Perez, G. Moloney, E. Morelli, E. Morillas, and T. G. Dinan, "The microbiota-gut-brain axis," Physiological Reviews, vol. 99, no. 4, pp. 1877–2013, 2019. doi: 10.1152/physrev.00018.2018.
[5] S. S. C. Rao and T. Patcharatrakul, “Diagnosis and treatment of dyssynergic defecation,” Journal of Neurogastroenterology and Motility, vol. 22, no. 3, pp. 423–435, Jul. 2016, doi: 10.5056/jnm16060.
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[9] C. Leue, J. Kruimel, D. Vrijens, A. Masclee, J. van Os, and G. van Koeveringe, "Functional urological disorders: A sensitized defence response in the bladder-gut-brain axis," Nat. Rev. Urol., vol. 14, no. 3, pp. 153–163, Mar. 2017. doi: 10.1038/nrurol.2016.227.
[10] Z. A. Khan, C. Whittal, S. Mansol, L. Osborne, P. Reed, and S. Emery, "Effect of depression and anxiety on the success of pelvic floor muscle training," J. Obstet. Gynaecol., vol. 33, no. 7, pp. 710–714, Oct. 2013. doi: 10.3109/01443615.2013.810198. [
11] A. E. Bharucha, P. F. Pemberton, and G. E. Locke III, "American Gastroenterological Association technical review on constipation," Gastroenterology, vol. 144, no. 1, pp. 218–238, Jan. 2013. doi: 10.1053/j.gastro.2012.10.028.
[12] C. Li, Y. Gong, and B. Wang, "The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis," Int. Urogynecol. J., vol. 27, no. 7, pp. 981–992, Jul. 2016. doi: 10.1007/s00192-015-2846-y.
[13] B. J. Shea, B. C. Reeves, G. Wells, M. Thuku, C. Hamel, J. Moran, D. Moher, P. Tugwell, V. Welch, E. Kristjansson, and D. A. Henry, "AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both," BMJ, vol. 358, p. j4008, Sep. 2017. doi: 10.1136/bmj.j4008.
[14] F. F. Fitz, M. A. T. Bortolini, G. M. V. Pereira, G. R. F. Salerno, and R. A. Castro, "Lifestyle and comorbidities as risk factors for pelvic organ prolapse—A systematic review and meta-analysis," Int. Urogynecol. J., vol. 34, no. 9, pp. 2007–2032, Sep. 2023. doi: 10.1007/s00192-023-05569-3.
[15] AGREE Next Steps Consortium, "The AGREE II instrument," 2017. [Online]. Available: https://www.agreetrust.org.
[16] M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, R. Chou, J. Glanville, J. M. Grimshaw, A. Hróbjartsson, M. M. Lalu, T. Li, E. W. Loder, E. Mayo-Wilson, S. McDonald, and D. Moher, "The PRISMA 2020 statement: An updated guideline for reporting systematic reviews," BMJ, vol. 372, p. n71, Mar. 2021. doi: 10.1136/bmj.n71.
[17] M. V. Nishtala, U. J. Patel, J. Sous, C. Heisler, and R. King, "Development of a Pelvic Floor Disorders Multidisciplinary Curriculum for Urogynecology and Reconstructive Pelvic Surgery and Colon and Rectal Surgery Fellows," J. Surg. Educ., vol. 82, no. 9, p. 103597, Sep. 2025. doi: 10.1016/j.jsurg.2025.103597.
[18] D. Kapoor, A. Sultan, R. Thakar, M. Abulafi, R. Swift, and W. Ness, "Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic," Colorectal Dis., vol. 10, no. 2, pp. 118–123, Feb. 2008. doi: 10.1111/j.1463-1318.2007.01264.x.
[19] C. M. Panman, M. Wiegersma, B. J. Kollen, M. Y. Berger, Y. Lisman-Van Leeuwen, K. Vermeulen, and J. H. Dekker, "Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care," BJOG, vol. 124, no. 3, pp. 511–520, Feb. 2017. doi: 10.1111/1471-0528.13992.
[20] B. N. Green, C. D. Johnson, and A. Adams, "Writing narrative literature reviews for peer-reviewed journals: Secrets of the trade," J. Chiropr. Med., vol. 5, no. 3, pp. 101–117, Sep. 2006. doi: 10.1016/S0899-3467(07)60142-6.
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