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Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation

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Abstract

The purpose of the study was to compare the effect of voluntary pelvic floor muscle (PFM) contraction and vaginal electrical stimulation on urethral pressure. Twelve women with genuine stress incontinence, mean age 49.4 years (range 33–66) participated in the study. The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter. The patients first performed three voluntary PFM contractions. Then two electrical stimulators, Conmax and Medicon MS 105, 50 Hz, were used in random order. A visual analog scale was used to measure pain and discomfort. Pain was reported to mean 6.8, SEM 0.64 (range 0.7–9.9) and mean 6.1, SEM 0.81 (range 0–9.1) with Conmax and Medicon MS 105, respectively. The mean paired difference in favor of voluntary contraction with Conmax was −8.0, SD 6.7,P=0.0067, and with Medicon MS 105 it was −12.2, SD 5.9,P=0.0022. The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation.

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Authors and Affiliations

  1. Norwegian Center for Physiotherapy Research, Majorstua, PB 7009, 0306, Oslo, Norway

    K. Bø

  2. National Hospital of Norway, Oslo, Norway

    T. Talseth

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  1. K. Bø
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Editorial Comment: Are pelvic floor exercises and electrical stimulation equivalent forms of therapy for genuine stress incontinence? Do they both utilize the same mechanism of action? Bø and Talseth delve deeper into this area of research by comparing the effect of electrical stimulation and voluntary pelvic floor muscle contraction on maximum urethral pressure, finding that voluntary contraction produces a significantly higher rise in maximum pressure than does electrical stimulation. These results suggest that electrical stimulation and voluntary pelvic floor exercises are not one and the same. However, many points should be made. Although the participants in the study carried a clinical diagnosis of genuine stress incontinence and could generate an appropriate pelvic floor contraction, one wonders whether a control group (continent, able to generate pelvic floor contraction) should have been included. Also lacking from the study design is a recording of EMG activity from the pelvic floor, which might assist in identifying patients with poor placement of the vaginal probe. It is interesting that patients reported different perceived sensations in conjunction with a voluntary versus an elicited contraction. It is equally interesting that hip muscle group contraction resulted from electrical stimulation in some patients. Obviously vaginal probe placement for electrical stimulation needs to be standardized to maximize its effects.

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Bø, K., Talseth, T. Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int Urogynecol J 8, 3–7 (1997). https://doi.org/10.1007/BF01920286

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