Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Electrical stimulation is a more sophisticated form of biofeedback used for pelvic floor muscle rehabilitation. This treatment involves stimulation of levator ani muscles using painless electric currents. When the pelvic floor muscles are stimulated with these small electrical currents, the levator ani muscles and urinary sphincter contract and bladder contraction is inhibited. Similar to biofeedback, electrical stimulation can be performed at the office or at home. Electrical stimulation can be used with biofeedback or pelvic floor muscle exercises.
Electrical stimulation therapy requires similar types of tampon-like probes and equipment as those used for biofeedback. This form of muscle rehabilitation is similar to the biofeedback therapy, except small electric currents are used to directly stimulate the pelvic floor muscles.
As in biofeedback, pelvic floor muscle electrical stimulation has been shown to be effective in treating female stress incontinence, as well as urge and mixed incontinence. Electrical stimulation may be the most beneficial in women with stress incontinence and very weak or damaged pelvic floor muscles. A program of electrical stimulation helps these weakened pelvic muscles contract so they can become stronger. For women with urge incontinence, electrical stimulation may help the bladder relax and prevent it from contracting involuntarily.
Research indicates that pelvic floor electrical stimulation can reduce urinary incontinence significantly in women with stress incontinence and may be effective in men and women with urge and mixed incontinence. Urge incontinence that is caused by neurologic
diseases may be decreased with this therapy. Electrical stimulation appears to be the most effective when combined with pelvic floor exercises. The rate of cure or improvement with electrical stimulation ranges from 54% to 77%; however, significant benefit occurs after a minimum of four weeks, and the individual must continue pelvic floor exercises after the treatment.
Bladder training involves relearning how to urinate. This method of rehabilitation is usually used for active women with urge incontinence and sensory urge symptoms known as urgency. Many people who have urge incontinence sense that they have to urinate, but their bladder is not full and they do not urinate much when they return to the bathroom frequently. This means that, although their bladder is not full, it is signaling for them to void.
Bladder training generally consists of self-education, using the bathroom according to a schedule, consciously delaying going to the bathroom, and positive reinforcement. Although bladder training is used primarily for symptoms of urgency and findings of urge incontinence, this program may be used for simple stress incontinence and mixed incontinence. For bladder training to work, a person must resist or inhibit the feeling of urgency and wait to go to the bathroom. An individual must urinate according to a scheduled timetable rather than every time he or she has the feeling that they need to urinate.
This plan incorporates dietary changes such as adjusting how much one drinks and avoiding dietary stimulants. In addition, there are distraction and relaxation techniques to delay voiding to help expand the urinary bladder. By using these strategies, an individual can train the bladder to accommodate more stored urine.
The initial goal is set according to a person's current voiding habits and is not followed at night. Whatever a person's voiding pattern is, the first goal for time between trips to the bathroom (voiding interval) may be increased by 15 to 30 minutes. As the bladder becomes accustomed to this delay in voiding, the interval between voids is increased. The ultimate goal is usually two to three hours between voids, and it may be set further apart, if desired.
Another method of bladder training is to maintain the prearranged schedule and ignore the unscheduled voids. In this method, regardless of whether an individual makes an unscheduled trip to the bathroom, he or she still has to maintain the prearranged voiding times and go to the bathroom as scheduled. This program must be continued for several months.
Another method of bladder training uses ultrasound to prove to that the bladder is not full even though one feels the need to urinate. A bladder scanner is a portable ultrasound machine that measures the amount of urine present in the bladder. With this method, a person can void when their bladder fills to a certain volume visible on ultrasound rather than when he or she feels the need to go to the bathroom. Each time the person feels the need to void, he or she checks their bladder using the scanner to see how much urine is being stored. If the bladder is shown to be empty, then the person should ignore that sensation.
Bladder training has been used primarily to manage symptoms of urgency and the findings of urge incontinence; however, it also may be used for stress and mixed incontinence. With bladder training, the cure rate for mixed incontinence is reported to be 12%, while the improvement rate was 75% after six months.