Investigação e manejo de condições miccionais durante o ciclo gravídico puerperal em uma mulher com epilepsia acompanhada no serviço de pré-natal de alto risco: um estudo de caso

Abstract

During the gravid-puerperal cycle, the female body undergoes various adaptations, both physiological and emotional. When these changes are associated with pre-existing neurological conditions, such as epilepsy, they may require more intensive care. The aim of this study was to present a clinical case report of a puerperal woman with epilepsy, followed in a high-risk prenatal service, focusing on the analysis of evaluative tools and the management of voiding dysfunctions during the gravid-puerperal cycle. The methodology consisted of a case report based on physiotherapy care provided during pregnancy and postpartum, where a Checklist for Case Reports 2017 was used for greater clarity of the clinical findings. Assessments included anamnesis, directed physical examination, voiding diary, associated with the interpretation of complementary exams. During pregnancy, symptoms such as increased urinary frequency and voiding hesitancy were interpreted as physiological changes and did not prompt further investigation. In the puerperium, the absence of bladder sensation, low urinary volumes, and high post-void residual indicated an undiagnosed atonic neurogenic bladder. Complementary exams revealed reduced cystometric capacity, abnormally high bladder compliance, and a voiding pattern consistent with chronic retention. The study participant showed low adherence to intermittent catheterization and antiepileptic medication, although she maintained regularity in physiotherapy and psychology appointments. Despite clinical and psychosocial barriers, she reported subjective improvement and scored the maximum satisfaction level (7) on the PGIC scale regarding prenatal physiotherapy care. The analysis highlights the difficulty of early recognition of pathological urinary tract changes in pregnant women with epilepsy, due to their similarity with physiological symptoms of pregnancy. A gap in the literature and the absence of clinical protocols for this population were also observed, restricting professional practice to empirical adaptations. We conclude that there is an urgent need for specific protocols for the assessment and physiotherapeutic follow-up of pregnant women with epilepsy, especially in the management of bladder and bowel changes. The study reinforces the importance of a multidisciplinary and individualized approach that considers the neurological history and psychosocial factors influencing treatment adherence and quality of life.