Wednesday, September 9, 2009

E stim and Incontinence

E stim for incontinenc e
Here are the abstracts for two articles about estim and leaky
The bottom line is that a rectal probe or a vaginal probe to deliver
electrical stimulation to help strengthen pelvic floor muscles works.
It is like an electrified kegel exercise. It is uncomfortable, but
one controls how much electricity is delivered. I have used it, and
am using it now each day and have found it to be quite helpful.

A second method uses electrical stimulation to skin over the posterior
tibiliais nerve (by the ankle). That has been quite helpful as well,
but I have not personallly tried that version. I've pasted copies of
the abstracts from two articles talking about estim and incontinence.
You could take the abstracts to your physician and discuss possible
treatments with estim for your leaky bladdder if that is an issue for
Although it is not yet approved for strengthening muscles to walk,
electrical stimulation of muscles is approved for strengthening
muscles to control one’s bladder. Treating a leaky bladder with
electrical stimulation works using a vaginal or rectal probe to
increase the strength of pelvic muscle works. Multiple studies have
shown this to be effective. The FDA has approved the use of such
devices. Minnova, manufactured by EMPI is one such device. If you
want to learn more – go to the EMPI web page.
Below is an abstract which one could take their physician or physical
therapist for more information to support the request to try e-stim
for incontence.

Treatment of urinary stress incontinence by intravaginal electrical
stimulation and pelvic floor physiotherapy
.Treatment of urinary stress incontinence (USI) by intravaginal
electrical stimulation (IES) and pelvic floor physiotherapy represents
an alternative to other therapies. The purpose of this work was to
evaluate the effectiveness of this treatment inpatients with urinary
incontinence. From January 1998 to May 2000, 30 women (mean age 54
years) were studied. All patients had USI and 70% urge incontinence;
average follow-up was 7 months. Selection criteria were based on
clinical history, objective evaluation of perineal musculature by
perineometry, and urodynamics. The treatment protocol consisted of
three sessions of IES per week for 14 weeks using INNOVA equipment.
Physiotherapy was initiated in the fifth week of IES. A significant
decrease in the number of micturitions and urgency was observed after
treatment ( P<0.01). The pad test showed a reduction in urinary
leakage from 13.9 to 5.9 g after treatment ( P<0.01). Objective
evaluation of perineal muscle strength showed a significant
improvement in all patients after treatment ( P<0.01). A positive
correlation was observed between maximum flow rate (Qmax) and all
three variables: urethral pressure profile at rest and on straining
(stop test), and abdominal leak-point pressure (ALPP). A positive
correlation was also observed between ALPP and the stop test. Over 100
different surgical and conservative treatments have been tried to
manage USI. The majority of these procedures reveal that despite
progress already made in this area, there is no ideal treatment.
Satisfactory results can be achieved with this method, especially with
patients who are reluctant to undergo surgery because of personal or
clinical problems.

Urodynamic effect of acute transcutaneous posterior tibial nerve
stimulation in overactive bladder

J.Urol. Amarenco,G 2003
PURPOSE: Of the various treatments proposed for urge incontinence,
frequency and urgency electrostimulation has been widely tested.
Different techniques have been used with the necessity of surgical
implantation (S3 neuromodulation or sacral root stimulation) or
without requiring surgery (perineal transcutaneous
electrostimulation). Recently peripheral electrical stimulation of the
posterior tibial nerve was proposed for irritative symptoms in first
intention or for intractable incontinence. Clinical studies have
demonstrated good results and urodynamic parameters were improved
after chronic treatment. However, to our knowledge no data concerning
acute stimulation and immediate cystometry modifications have been
reported. We verified urodynamic changes during acute posterior tibial
nerve stimulation. MATERIALS AND METHODS: A total of 44 consecutive
patients with urge incontinence, frequency and urgency secondary to
overactive bladder were studied. There were 29 women and 15 men with a
mean age +/-SD of 53.3 +/- 18.2 years. Of the patients 37 had detrusor
hyperreflexia due to multiple sclerosis (13), spinal cord injury (15)
or Parkinson's disease (9), and 7 had idiopathic detrusor instability.
Routine cystometry at 50 ml. per minute was done to select the
patients with involuntary detrusor contractions appearing before 400
ml. maximum filling volume. Repeat cystometry was performed
immediately after the first study during left posterior tibial nerve
stimulation using a surface self-adhesive electrode on the ankle skin
behind the internal malleolus with shocks in continuous mode at 10 Hz.
frequency and 200 milliseconds wide. Volume comparison was done at the
first involuntary detrusor contraction and at maximum cystometric
capacity. The test was considered positive if volume at the first
involuntary detrusor contraction and/or at maximum cystometric
capacity increased 100 ml. or 50% during stimulation in compared with
standard cystometry volumes. RESULTS: Mean first involuntary detrusor
contraction volume on standard cystometry was 162.9 +/- 96.4 ml. and
it was 232.1 +/- 115.3 ml. during posterior tibial nerve stimulation.
Mean maximum cystometric capacity on standard cystometry was 221 +/-
129.5 ml. and it was 277.4 +/- 117.9 ml. during stimulation. Posterior
tibial nerve stimulation was associated with significant improvement
in first involuntary detrusor contraction volume (p <0.0001) and
significant improvement in maximum cystometric capacity (p
<0.0001). The test was considered positive in 22 of the 44
patients. CONCLUSIONS: These results suggest an objective acute effect
of posterior tibial nerve stimulation on urodynamic parameters.
Improved bladder overactivity is an encouraging argument to propose
posterior tibial nerve stimulation as a noninvasive treatment modality
in clinical practice

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