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1、電刺激在尿失禁治療中之技巧及運用,陳怡靜 中山醫學大學 物理治療學系 講師 中山醫學大學附設醫院 物理治療師,Types of Incontinence,Stress incontinence Urge incontinence Mixed incontinence Reflex incontinence Overflow incontinence,Treatment for Urinary Incontinence,Federal Agency for Health Care Policy and Research (AHCPR), 1996Behavioral treatmentPharm
2、acologic treatmentSurgical treatment,Behavioral Therapy,Bladder retraining Pelvic muscle rehabilitation PMEs, PMEs and bladder inhibition augmented by biofeedback therapy, PMEs augmented with vaginal weight training, and pelvic floor electrical stimulation,Different frequencies of stimulation are ad
3、vocated for the activation of these different nerve fibresthe pudendal efferents (alpha-motor axons) produces a contraction of the levator anithe pudendal afferent (medium-size myelinated) will active the inhibit premature, unwanted bladder contractions,Physiological Effects,Improvement of reinnerva
4、tion of partly denervated PFMs by encouraging axonal sprouting.Muscle strength is increased in a similar manner to voluntary exercise.Electrically elicited contractions can target and train type 2 (fast-twitch) fibers effectively.,Mechanism of Action:Electrical stimulation activates a reflex with th
5、e pudendal nerve afferent limb and with the following central actions:Activation of sympathetic inhibitory fibers ( hypogastric inhibitory fibers) to pelvic ganglia and the detrusorCentral inhibition of the pelvic motor outflow to the bladder,Electrical Stimulation,Increase awareness of the PFM Teac
6、h effective PFM exercise Increase peri-urethral pressure Inhibit detrusor contraction,Electrical Parameters,Frequency:-10 Hz or less in the treatment of bladder instability.-10-50 Hz in treatment of weakened pelvic floor muscle.,Electrical Parameters,Intensity: maximal tolerated level,Pulse width (p
7、ulse duration): 0.2- 0.5ms,Electrical Parameters,Electrical Parameters,On/off ratio (duty cycle): 1:1 or 1:2,Electrical stimulation delivery systemNonimplanted delivery system:vaginal, anal, surface electrode,Electrical stimulation delivery system,Transcutaneous Electrical Stimulation,Percutaneous T
8、ibial Nerve Stimulation,Transvaginal electrical stimulation for female urinary incontinence,A prospective, double-blind, randomized clinical trial49% of women with detrusor instability who used an active electrical device were cured ( stable on provocative cyctometry). no statistically significant c
9、hange in the percentage with detrusor instability in the sham device group (control group).Brubaker L et al: Am J Obstet Gynecol 1997; 177(3): 536-540,Intravaginal stimulation randomized trial,Electrical stimulation is safe and at least as effective as anticholinergic therapy in the treatment of urg
10、e urinary incontinence.Smith JJ: J Urol 1996; 155:127-130 no significant differences between daily and every-other-day users.Siegel SW et al: Urology 1997; 50:934-940.,Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence on women,The greatest improvement in th
11、e first 6 weeksTwenty weeks of pelvic floor electrical stimulation therapy is effective,Adverse Effects,Transrectal stimulationAbdominal cramps Diarrhoea Anal pain Anal bleeding,Intravaginal stimulationVaginal irritation Pain bleeding,Contraindications,Implanted pacemaker Pregnancy Malignant tumour
12、Atrophic vaginitis, vaginal infection Recent or recurrent haemorrhage/ haematoma,Patients-Oriented Approach,Payne C.K. Urology, 2000; 55 (Suppl 5): 3-6,Physiotherapy,Pelvic Floor Re-education,Pelvic Floor Assessment,0 1 2,3 4 5,Biofeedback Electrical stimulation,Grade 3,Biofeedback Pelvic floor exer
13、cise,The following considerations should be made before using electrical stimulation with the individual patient,Dose the patient need electrical stimulation?Which kind of electrical stimulation is preferable?Is electrical stimulation alone sufficient for effective pelvic floor re-education?,Thank You for Your Attention!,
