Effect of Posterior Tibial Nerve Superficial Stimulation with Kegel Exercises on the Frequency of Urination and Score of Quality of Life in Women with Overactivity of Bladder

Document Type : Original article

Authors

1 MSc Student, Department of Physiotherapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

2 Lecturer, Department of Physiotherapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor of Physiotherapy, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Professor of Urology, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background and Aim: Over activity of Bladder (OAB) is a syndrome with symptoms in urinary storage phase and it appears with the increase of the frequency of urination or emergency condition. During the recent years, using Posterior Tibial Nerve Stimulation (PTNS) has been introduced as a simple, noninvasive, without-the-side-effect method for the treatment of OAB. The purpose of the present study was evaluation of the effect of PTNS with kegel exercises on women with over activity of bladder.
Materials and Method: The current study was a randomized, double-blind, placebo controlled trial including 67 female participants with OAB syndrome divided in two groups of test and control. During 12 sessions, kegel exercise was taught to patients and PTNS was performed for the two groups but the flow rate was zero for the control group. The perineometry device was used to evaluate the pelvic floor muscles strength and three questionnaires of 1-assess quality of life 2- ICIQ-OAB, and 3- ICIQ-UI SF, as well as voiding diary form was used to evaluate the symptoms and severity of the disease, before and after the intervention.
Results: Analysis of the results with paired sample t test in the two groups showed that the strength of pelvic floor muscles increased and the quality of life improved (P≤0/05). The use of the independent samples t-test showed increase of the pelvic floor muscles strength and improvement of quality of life and the decrease of scores of urinary symptoms in the test group was significantly greater than those of the control group (P≤ 0/05).
Conclusion: According to the results of the study, the PTNS with kegel exercises caused increase of the pelvic floor muscles strength and the improvement of the quality of life in women with OAB syndrome.

Keywords

Main Subjects


  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. American journal of obstetrics and gynecology. 2002;187(1):116-26##               
  2.  Safarinejad MR. Prevalence of the overactive bladder among Iranian women based on the International Continence Society definition: a population-based study. International urology and nephrology. 2009;41(1):35-45##
  3. Abrams P, Andersson K, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourology and urodynamics. 2010;29(1):213-40##
  4. Burks FN, Bui DT, Peters KM. Neuromodulation and the neurogenic bladder. Urologic Clinics of North America. 2010;37(4):559-65 ##
  5. Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Current urology reports. 2012;13(5):327-34 ##
  6. Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B, et al. Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. The Journal of urology. 2003;169(6):2210-5##
  7. Klingler H, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56(5):766-71##
  8. Geirsson G, Wang Y-H, Lindström S, Fall M. Traditional acupuncture and electrical stimulation of the posterior tibial nerve: a trial in chronic interstitial cystitis. Scandinavian journal of urology and nephrology. 1993;27(1):67-70##
  9.  Mayer RD, Howard FM. Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics. 2008;5(1):107-13##
  10. Olujide LO, O''Sullivan SM. Female voiding dysfunction. Best practice & research clinical obstetrics & gynaecology. 2005;19(6):807-28##
  11. De Gennaro M, Capitanucci ML, Mosiello G, Zaccara A. Current state of nerve stimulation technique for lower urinary tract dysfunction in children. The Journal of urology. 2011;185(5):1571-7##
  12. Fjorback MV, van Rey FS, van der Pal F, Rijkhoff NJ, Petersen T, Heesakkers JP. Acute urodynamic effects of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with MS. European urology. 2007;51(2):464-72##
  13. Messelink E. The overactive bladder and the role of the pelvic floor muscles. BJU international. 1999;83(S2):31-5##
  14. Van balken, Michael R, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM, et al. Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. The journal of urology. 2001;166(3):914-8##
  15. W. Scott McDougal – Alan J. Wein – Louis R. Kavoussi – Alan W. Partin – Craig A. Peters. Campbell-walsh urology 11th edition review 2nd edition. Elseviered2016##
  16. Finazzi-Agrò E, Petta F, Sciobica F, Pasqualetti P, Musco S, Bove P. Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. The Journal of urology. 2010;184(5):2001-6##
  17. Kaya S, Akbayrak T, Gursen C, Beksac S. Short-term effect of adding pelvic floor muscle training to bladder training for female urinary incontinence: a randomized controlled trial. International urogynecology journal. 2014;26(2):285-93##
  18. Ruiz BC, Outeiriño XP, Martı́ PC, Dueñas EL, López AL. Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms. European urology. 2004;45(1):65-9##
  19. Van Balken, Michael R , Vandoninck V, Messelink BJ, Vergunst H, Heesakkers JP, Debruyne FM, et al. Percutaneous tibial nerve stimulation as neuromodulative treatment of chronic pelvic pain. European urology. 2003;43(2):158-63##
  20. Uyar Y, Baytur Y, Inceboz U. Perineometer and digital examination for assessment of pelvic floor strength. International journal of gynecology & obstetrics. 2007;98(1):64-5##
  21. Vodušek DB, Plevnik S, Vrtačnik P, Janež J. Detrusor inhibition on selective pudendal nerve stimulation in the perineum. neurourology and urodynamics. 1987;6(5):389-93##
  22.  Barbosa PB, Franco MM, Souza FdO, Antônio FI, Montezuma T, Ferreira CHJ. Comparison between measurements obtained with three different perineometers. Clinics. 2009;64(6):527-33##
  23.  Sarimotlagh R, Hajebrahimi S, Sadeghi‐bazarghani H, Jooditutunsaz J. Reliability and validation of the international consultation on incontinence questionnaire in over active bladder to persian language. luts: lower urinary tract symptoms. 2015;7(2):99-101 ##

24. Hajebrahimi S, Nourizadeh D, Hamedani R, Pezeshki MZ. validity and reliability of the international consultation on incontinence questionnaire-urinary incontinence short form and its correlation with urodynamic findings. urology journal. 2012;9(4):685-90##

25. Pourmomeny A, Zargham M, Fani M. Reliability and Validaty of the Quality of Life Questionnaire in Iranian patients with lower urinary tract symptoms.Lower Urinary Tract Symptoms(LUTS) journal. 2017;DOI:10.1111/LUTS.12147##

26. Wang C-C, Chen J-J, Peng C-H, Huang C-H, Wang C-L. Use of a voiding dairy in the evaluation of overactive bladder and nocturia. Incont & Pelvic Floor Dysfunct. 2008;2(Suppl 1):9-11##

Volume 7, Issue 1
March and April 2018
Pages 193-200
  • Receive Date: 26 February 2017
  • Revise Date: 16 May 2017
  • Accept Date: 05 July 2017
  • First Publish Date: 21 March 2018