A comparative study of pelvic floor training and electrical stimulation for the treatment of genuine female stress urinary incontinence

Abstract

Twenty women with pure genuine stress urinary incontinence were randomly allocated to 6 months of pelvic floor training or intravaginal electrical stimulation. The result was evaluated with a pad test and patients' rating of efficacy. Patients not cured by the first treatment given were offered the other one. A long-term follow-up was done 4 years after concluding treatment.The group of patients initially treated with pelvic floor exercises (n = 10) were significantly improved according to the pad test (P < 0.01). This corresponded very well to the subjective result, one patient being cured, five reporting insignificant symptoms, and the remaining four an improvement. The results were similar in patients allocated to intravaginal electrical stimulation (n = 10) (P < 0.05): one patient cured, four having insignificant symptoms, three improved, and two unchanged. We did not find any significant difference of results between thc two groups of treatment (P < 0.10). Follow-up after 4 years in 19 patients revealed that 1 patient was furthcr improved, 8 patients were unchanged and 5 had deteriorated. Five women were operated during the follow-up period. Pelvic floor training is an adequate method for treatment of stress urinary incontinence. Even patients with severe incontinence may show a very good result. However, a sustained effect presupposes continuing exercise and during the follow-up period of 4 years a quarter of the patients had to be operated upon to obtain permanent cure. The study also indicated that patients undergoing both treatments were further improved during the second course of treatment.

Excretion of collagen derived peptides is increased in women with stress urinary incontinence

“…SUI, therefore, may result from a defect or dysfunction in any of these tissues such that there is loss of support to the bladder neck and proximal urethra. A role for muscle weakness in the etiology of SUI is supported by a number of studies demonstrating that various mechanisms of increasing strength and control of pelvic £oor musculature results in improvements in continence [Hahn et al, 1991;Bo et al, 1999;Goode et al, 2003]. The data presented herein support a role for weakened connective tissue in the etiology of SUI.…”

Electrical stimulation for stress incontinence

“…At high-frequency stimulation of slow muscles, the twitch contraction time is shortened and the percentage of fast-twitch fibers is increased [77,81]. A sufficient population of periurethral fast-twitch fibers is necessary to prevent a drop in closure pressure during sudden increases in abdominal pressure, for example coughing, whereas good function of the slow fibers is essential to sustain an adequate resting tone in the urethra [82,83].…”

Le traitement conservateur de l’incontinence urinaire d’effort de la femme

“…Trois études ont évalué l'efficacité comparée à la stimulation électrique [23,25,26]. Seuls Bo et al concluent à une efficacité supérieure du renforcement musculaire, mais les techniques utilisées dans les autres études sont très différen-tes (méthode de Kegel ou exercices de renforcement pendant six mois).…”