2
Indications of !
perineal !
electrostimulation
2.1 - Stress incontinence,
It is frequently due to sphincter deficiency.
Symptoms include leaking of urine, caused by a
strain (such as coughing, rising from a chair, etc), in
absence of detrusor activity. Stress incontinence is
usually treated with relatively high frequency
electrical pulses, from 35 to 100 pulses per second
(p.p.s.) depending on patients and therapist
preference, this exercises the phasic components of
the muscle fibres which provide strong but short
contractions. The treatment should be performed for
about 20 minutes daily starting with relatively short
work periods and gradually building up endurance
by increasing the contraction time as the muscles
strengthen. Pulse widths may be selected between
100 to 400 µs., depending on the patient's subjective
sensation.
2.2 - Urge incontinence
It is caused by detrusor instability. Here the most
appropriate frequency is between 5 and 10 Hz, with
a pulse-width of between 250 and 400
microseconds. The treatment is best performed on
a daily basis for the first week, then 2 to 3 sessions
per week for the next 3 or 4 weeks. The therapy may
be conducted at home.
2.3 - Mixed incontinence
It accounts for about 40% of all cases of
incontinence and is characterised by episodes of
incontinence when straining, along with or
alternating with episodes of incontinence due to
detrusor instability causing urgency. Depending on
the predominance of the first or the second kind of
incontinence, one can decide to use a relatively high
frequency for greater effect on the muscle tone or
lower frequencies to give greatest effect on detrusor
inhibition. Urge incontinence usually responds more
quickly than stress so this is usually treated first.
Alternatively two treatments per day, one for urge
and the other for stress may be carried out.
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