Our department now applies transdermal sacral nerve electrical stimulation, electronic acupressure combined with pelvic floor muscle biofeedback treatment for urinary frequency and urinary incontinence, the effect is very good, the advantage of this treatment method is that no surgery is required, all treatment is non-invasive, safe, without any side effects, and the traditional subcutaneous buried “stimulator” has the same treatment It has the same effect as the traditional subcutaneous “stimulator”, but without the need for surgery, and is significantly more effective when combined with biofeedback treatment. Because the operation is non-invasive and non-traumatic, it does not have any adverse effects on the body and does not affect the patient’s ability to adopt more advanced treatments in the future.
The following is the conventional recommended way of treating urinary frequency and urinary incontinence, which can be used as a common study for everyone in science:
1.Preferred treatment.
(1) bladder training (Bladder Drill)
1, Method 1: Delay urination and gradually make each urination volume greater than 300ml.
①Treatment principle: relearn and master the skill of controlling urination; interrupt the vicious circle of mental factors; reduce the sensitivity of the bladder.
②Indications: OAB symptoms such as urinary urgency and frequency.
③ Contraindications: low compliant bladder, bladder pressure greater than 40cmH2O at the end of the storage period.
④Requirement: practical implementation of treatment according to the plan
⑤Cooperative measures: adequate ideological work; urinary diary; others.
2, Method 2: Timed Voiding (Timed Voiding)
①Objective: To reduce the number of incontinence and improve the quality of life.
②Indications: serious incontinence and difficult to control.
③ Contraindication: with severe urinary frequency.
3.Biofeedback method
The correct mastery of the contraction of the pelvic floor muscles is the success factor of the pelvic floor muscle movement. Swartz et al. defined biofeedback as the use of electronic or mechanical tools to correctly assess the normal or abnormal activity of the patient’s nerves, muscles and autonomic nerves, and to inform the patient with audio or visual feedback, while the International Continent Society defined biofeedback as Biofeedback is defined by the International Continent Society as a form of behavioral treatment for incontinence that teaches the patient to correctly contract the pelvic floor muscles and autonomously inhibit abnormal contractions of the bladder forcing muscles.
The concept of biofeedback was already used by Dr. Kegel in the 1950s to treat urinary incontinence. The design was simple: a hollow tubular probe was inserted into the vagina and a manometer was attached to the other end so that the user could see the change in pressure as the pelvic floor muscles contracted. According to Kegel’s literature, 90% of patients with stress incontinence experienced improvement in their symptoms. This simple biofeedback device is still available today, and the convenience, ease of use and affordability are the advantages.
Biofeedback devices are currently available in both direct pressure measurement and electromyography (electromyography). At present, there are also] papers pointing out which of the two measuring devices is more effective, depending on the needs of the patient.
1.Vaginal or anal device: It is simple and convenient to know directly the force of vaginal or anal muscle contraction, but the disadvantage is that the patient must buy a personal probe and it must be inserted into the vagina or anus, and some patients may feel rejected.
2.Electromyographic system: There are 2 channel and multi-channel machines. 2 channel is used for general pelvic floor muscle training, one side is connected to the perineum to monitor pelvic floor muscle contraction, and the other side is connected to the abdomen to determine whether there is relaxation. The multi-channel system can measure bladder, sphincter, and abdominal muscle activity simultaneously and can be used for the treatment of urge incontinence.
The correct and consistent use of biofeedback has been shown to have good results. It is effective in 76% of patients with stress incontinence, 80% of patients with mixed incontinence, and 82% of patients with urge incontinence.
In addition to stress incontinence, biofeedback is also effective in the treatment of urge incontinence and mixed incontinence. It is now widely accepted in the academic community that when the external urethral sphincter (pelvic floor muscle) contracts, it can produce a reflex in the sacral spinal nerve, which inhibits the contraction of the bladder forcing muscles. If patients with urge incontinence can first actively, or even subconsciously, contract the pelvic floor muscles when there is intense urination, the frequency of voiding can be reduced and urge incontinence can be avoided. However, the pelvic floor muscles are very abstract and cannot be seen or touched, so biofeedback devices can be used as an auxiliary tool to strengthen the patient’s training effect and improve the motivation of pelvic floor muscle training.
4.Sacral nerve electrical stimulation
Pelvic floor muscle rehabilitation (rehabilitation) includes active exercises (Kegel exercises) and passive exercises. Electrical stimulation (electrical stimulation) is the latter. Although active exercises are effective, electrical stimulation is an option for patients who are unable to properly and effectively perform pelvic floor muscle contractions.
Electrical stimulation can also treat stress incontinence and urge incontinence, using different frequencies to achieve different results. When set at a low frequency (12.5 Hz), the pudendal nerve can be stimulated, causing the pelvic nerve (pelvic nerve) reflex to decrease, thereby decreasing bladder forcing muscle sensitivity and increasing bladder capacity. According to a paper by Rodney A. Appell, MD, of Cleveland Clinic, the application of low frequency (5-10 Hz) and moderate current (<20 mA) can achieve 45% to 91% of the results, and a further follow-up survey showed that about 1/3 of patients achieved good results. of patients who received electrical stimulation were completely dry and no longer had urge incontinence, and another 37% had significant improvement.
When the frequency is set at 50 Hz, it causes the pelvic floor muscles to contract and increase in strength, achieving an effect similar to that of active exercise (Kegel exercises). If the patient has mixed incontinence, different frequencies can be set in the morning and in the evening. According to Smith et al, electrical stimulation for stress urinary incontinence had significant improvement in 66% of patients.
5, other behavioral therapy: hypnotherapy.
(2)Drug therapy
(3) Indications for changing the preferred treatment.
① Ineffective ;
②Patients can not adhere to the treatment or request to change the treatment;
(3) Intolerable side effects;
④Irreversible side effects may occur;
⑤ Significant decrease in urinary flow rate or significant increase in residual urine volume during treatment.
2.Optional treatment
(1) Bladder perfusion with capsaicin, RTX, hyaluronidase.
The above substances can be involved in bladder sensory afferents and reduce bladder sensory afferents after instillation, which can be tried for those with severe bladder sensory allergy.
(2) Botulinum toxin type A multi-point injection into the bladder forced urinary muscle: It is effective for severe forced urinary muscle instability.
(3) Neuromodulation: Sacral nerve electrical modulation therapy is effective in patients with intractable urinary frequency and urgency and urge incontinence. Commonly known as a bladder pacemaker, this treatment is minimally invasive, reversible, adjustable and other advantages, and is the treatment of choice for poor results of drug therapy.
(4) Surgery.
(5) Acupuncture treatment: Some data show that acupuncture at the foot San Li, San Yin Jiao, Qi Hai, and Guan Yuan points helps to relieve symptoms.