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Pelvic Floor in Rehabilitation

Paula method of circular muscle exercises for urinary stress incontinence--a clinical trial.
Liebergall-Wischnitzer M, Hochner-Celnikier D, Lavy Y, Manor O, Arbel R, Paltiel O
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Sep-Oct;16(5):345-51. Epub 2005 Jan 20.

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences.

Effect of intravaginal electrical stimulation on pelvic floor muscle strength.
Amaro JL, Gameiro MO, Padovani CR
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Sep-Oct;16(5):355-8. Epub 2005 Jan 13.

The aim of this study was to evaluate the effect of intravaginal electrical stimulation (IES) on pelvic floor muscle (PFM) strength in patients with mixed urinary incontinence (MUI). Between January 2001 and February 2002, 40 MUI women (mean age: 48 years) were studied. Urge incontinence was the predominant symptom; 92.5% also presented mild stress urinary incontinence (SUI). Selection criteria were clinical history and urodynamics. Pre-treatment urodynamic study showed no statistical differences between the groups. Ten percent of the women in each group had involuntary detrusor contractions. Patients were randomly distributed, in a double-blind study, into two groups. Group G1 (n=20), effective IES, and group G2 (n=20), sham IES, with follow-up at 1 month. The following parameters were studied: (1) clinical questionnaire, (2) examiner's evaluation of perineal muscle strength, (3) objective evaluation of perineal muscle by perineometry, (4) vaginal weight test, and (5) urodynamic study. The IES protocol consisted of three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence, present in all patients before treatment, was reduced to 15% in G1 and 31.5% in G2 post-treatment. The subjective evaluation of PFM strength demonstrated a significant improvement in G1. Objective evaluation of PFM force by perineometer showed a significant improvement in maximum peak contraction post-treatment in both groups. In the vaginal weight test, there was a significant increase in average number of cone retentions post-treatment in both groups. With regard to satisfaction level, after treatment, 80% of the patients in G1 and 65% of the patients in G2 were satisfied. There was no statistically significant difference between the groups. There was a significant improvement in PFM strength from both effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy in treating MUI.

Functional and histological effects of intravaginal electrical stimulation on the pelvic muscles: a study in the rat.
Wyndaele JJ, Poortmans A
Int Urogynecol J Pelvic Floor Dysfunct 2005 Sep 28;:1-5.

We studied functional and histological effects of electrical stimulation (ES) on pelvic muscles of the rat. With intravaginal electrodes, the musculus pubococcygeus and musculus iliococcygeus in the awake animal were stimulated three times 6 min per day with 5 min of rest in between, 5 days per week, 7 consecutive weeks with a biphasic rectangular symmetrical current of 25 Hz, 400-mus pulse duration, on/off time of 5/10 and with an amplitude of 2-4 mA. A "sham group" received the same handling but no stimulation. Contraction measured with intra-rectal pressure during stimulation increased more in the stimulated than in the sham group, but did not reach statistical significance probably due to low power. The 2A fast fibres increased with 14% in the musculus iliococcygeus and with 6% in the musculus pubococcygeus. Type 1 slow fibres did not change. Increased capillary density was found after stimulation. Repeated intravaginal ES has mainly an influence on the fast fibres in the pelvic muscles. To influence slow fibres, another stimulation program or current parameters would seem necessary.

Information from your family doctor. Pelvic floor muscle exercises.
Am Fam Physician 2005 Jan 15;71(2):329.