Electrical Stimulation

A treatment program for urgency urinary incontinence

Urgency urinary incontinence, which is the involuntary loss of urine associated with urgency, is a common health problem in the female population. The effects of urgency urinary incontinence results in limitations to daily activity and quality of life.

Current guidelines recommend conservative management, defined as interventions that do not involve treatment with drugs or surgery targeted to the type of incontinence, as a first-line therapy in urinary incontinence.¹

Pelvic floor electrical stimulation (PFES) has been used for the treatment of urinary incontinence since 1952.² The treatment of PFES using a vaginal probe was not reported in the literature until 1967 when interest in this therapy resurfaced.³ Since then the use of electrical stimulation for incontinence has grown, and many insurances reimburse for this treatment.

Electrical stimulation is commonly used as part of a treatment program for women with urge urinary incontinence. There are several methods and parameters that can be used to improve urge incontinence, however the magnitude of the alleged benefits and best parameters is not completely established.

Studies have suggested that the use of electrical stimulation to inhibit an overactive bladder functions to modulate unwanted detrusor contractions by way of sensory afferent stimulation of S2 and S3. This causes parasympathetic inhibition.⁴ In addition to this effect, contraction of the pelvic floor muscles results in inhibition and relaxation of the detrusor muscle which reduce urinary urgency.⁵

Common methods of electrical stimulation include suprapubical, transvaginal, sacral and tibial nerves stimulation.

As with any medical treatment, practitioners seek the most effective methods and parameters to achieve the patient’s goals. A recent systematic review of electrical stimulation in the treatment or urgency urinary incontinence included nine trials to treat urge urinary incontinence were included with total of 534 female patients. Most patients in the trials were close to 55 years of age. Five articles (total of nine) described a frequency of twice-weekly therapy and sessions of 20 minutes. Twelve weeks was the most common duration of therapy. All the studies applied an intensity of stimulation below 100 mA, with four of them (4/9) using 10 hz as the frequency. Intervaginal electrical stimulation showed the greatest subjective improvement and was the most effective.⁶

The most frequent outcome measure was bladder diary, used in all papers; subjective satisfaction was used in 8; and quality-of-life questionnaires in 6, from a total of 9 papers.

The study noted that reports about electrical stimulation generally lack information on its cost-effectiveness. This is an important point, especially because in therapies with similar benefits cost may be one of the factors to indicate the most appropriate treatment. If we consider the relatively few adverse effects, low cost, and similar effectiveness when compared to medication, intravaginal electrical stimulation, according to available data, appears to be a good alternative treatment for urge urinary incontinence.

References

1. Thüroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al.: EAU guidelines on urinary incontinence. Eur Urol. 2011; 59: 387-400.
2. Huffman JW, Osborne SL, Sokol JK. Electrical stimulation in treatment of intractable stress incontinence. Arch Phys Med Rehabil.1952;33:674-676
3. Erikson BC, Mjolnerod OK. Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence. Br J Urol.1987;59:45-49.
4. Kralj B. The treatment of female urinary incontinence by functional electrical stimulation. In:Ostergard DR, Dent AD (eds). Urogenecology and Urodynamics. 3rd ed. Baltimore, MD: Williams and Wilkins; 1991.
5. Eriksen, BC. Electrical Stimulation. In: Benson JT editor. Female pelvic floor disorders: investigation and management. New York:Norton, 1992; 219-231.
6. Lucas Schreiner , Thais Guimarães dos Santos , Alessandra Borba Anton de Souza, et al. Int. braz j urol. vol.39 no.4 Rio de Janeiro July/Aug. 2013.