Pelvic floor rehabilitation with biofeedback and electrical stimulation with Urostym® for treatment of urinary incontinence

Abstract

Objective: To show that supervised pelvic floor rehabilitation with biofeedback and electrostimulation using the Urostym® system is an effective treatment for urinary incontinence. Methods: A retrospective case series of women who underwent pelvic floor rehabilitation program using the Urostym® system at our institution. The Urostym® program includes supervised biofeedback and electrostimulation for pelvic floor muscle weakness. Charts were reviewed for demographics, prior treatment, completion of program, number of leaks preand post-treatment, patient satisfaction, and need for treatment at six months’ post-treatment. Results: There was a significant decrease in the number of leaks after undergoing the pelvic floor rehabilitation program. The mean (SD) number of leaks decreased from 2.4 ± 2.1 to 1.1 ± 2.2 (p<0.0005) after treatment. There was a trend towards an association between patient satisfaction and treatment success. 71.4% of those with complete or partial satisfaction required no further treatment, whereas only 20% of those who were unsatisfied required no further treatment, (p=0.55). Conclusions: Pelvic floor rehabilitation with biofeedback and electrostimulation using the Urostym® system is an effective therapy for urinary incontinence and significantly decreases the number of urinary accidents. *Correspondence to: Monica Chiu, Department of Obstetrics and Gynecology, St. John Hospital and Medical Center, 22101 Moross Rd, Detroit, MI 48236, USA, E-mail: monicachiu82@gmail.com Received: August 01, 2018; Accepted: September 03, 2018; Published: September 06, 2018 Introduction Urinary incontinence is a prevalent and significant problem worldwide. In the United States, a large study has shown up to 37% prevalence with at least one diagnosis of pelvic floor disorders [1]. Urinary incontinence has been shown to be present in 51.4% of women in the United States [2]. Successful management and treatment of incontinence could significantly affect a large population who has been left untreated or undertreated in the past. Non-surgical treatment options offer less risk and morbidity to the patient population by avoiding surgical interventions. There is currently a wide array of treatment modalities ranging from conservative management and medical therapy to surgical methods. Conservative management with pelvic floor muscle therapy has been shown to be effective as a first line treatment for urinary incontinence when comparing to placebo or other treatment modalities such as advice, general education, and exercises aimed at weight loss [3]. Supervised pelvic floor therapy by health professionals showed increased satisfaction and reports of overall improvement by patients when compared with individual non-supervised therapy [4]. Biofeedback is an adjunct therapy modality, in addition to pelvic floor muscle therapy. Biofeedback provides patients with either audible or visual cues on proper use and strength of contractions of the pelvic floor during therapy. In a randomized control study of postmenopausal women with stress urinary incontinence, biofeedback versus therapy without biofeedback shows increased patient satisfaction and rate of cure and improvement of stress incontinence [5]. However, another randomized control study showed that adjunct outpatient biofeedback showed no difference in subjective or objective cure [6]. In our institution, the Urostym® system is utilized for our pelvic floor rehabilitation program. Urostym® by Laborie uses not only biofeedback but also electrical muscle stimulation via a vaginal probe as well as an intensive supervised program by healthcare professionals. Patients undergo weekly sessions in the office with assigned home therapy throughout the week, for a total of 4-6 sessions. There are studies using electrostimulation but within specific populations (i.e. multiple sclerosis) [7]. These studies show supervision by health professionals as well as biofeedback can significantly improve outcomes for patients undergoing pelvic floor muscle therapy. A study by Erekson et al. also showed the cumulative factors of pelvic floor muscle therapy with supervision, biofeedback, and electrical stimulation to demonstrate a significant improvement in symptoms for mixed urinary incontinence [8]. Urostym® was not used in that study. Our study investigated patients who underwent our institution’s pelvic floor muscle therapy program via Urostym® with weekly supervised sessions using biofeedback and with the primary endpoint as a decrease in the number of accidents post-treatment. While there have been studies on pelvic floor physical therapy and urinary incontinence, to Chiu M (2018) Pelvic floor rehabilitation with biofeedback and electrical stimulation with Urostym® for treatment of urinary incontinence Front Womens Healt, 2018 doi: 10.15761/FWH.1000152 Volume 3(4): 2-4 our knowledge, this is the first study using Urostym® for pelvic floor rehabilitation in adult women with urinary incontinence. Materials and methods This is a retrospective case series. We conducted a retrospective chart review using electronic charts from St. John Hospital and Medical Center in Detroit, MI from June 2015 to April 2017 of all patients diagnosed with urinary and/or fecal incontinence and treated who underwent pelvic floor physical therapy with the Urostym® program. Patients were females of any age with urinary stress, urge, or mixed incontinence with or without fecal incontinence. Patients underwent at least one full session of the pelvic floor rehabilitation program which includes supervised biofeedback therapy by a medical health professional followed by electrostimulation with the Urostym® system. We conducted a chart review for age, race, ethnicity, type of incontinence, parity, mode of delivery, comorbidities, BMI, smoking status, pelvic organ prolapse, concurrent medical therapy, prior treatment (including medications and Kegel exercises), number of leaks (preand post-treatment program), completion of program to be defined as at least four sessions, total number of sessions, and overall patient satisfaction. Our primary outcome was to evaluate the number of leaks preand post-treatment. Number of leaks were measured on a voiding diary. Secondary outcomes included success of treatment (defined as lack of need for further treatment) and correlation of satisfaction with success. Complete satisfaction was defined as at least 80% or more satisfied by a subjective standard at the termination of the program, whereas partial satisfaction was defined as anything less than 80% but had some subjective satisfaction with the program. Success was indicated if there was no need for any further treatment at six months or failure if there was need for treatment at six months or less. Descriptive statistics for all variables were calculated. Associations between categorical variables were made with Fisher’s exact tests. Differences between groups on continuous variables were measured using the Wilcoxon signed rank test. P values <0.05 were considered significant. Analyses were performed with SPSS version 22.