INDIVIDUALLY PLANNED FUNCTIONAL ETS AND EMG BIOFEEDBACK AND SUPRASPINAL FES STIMULATION OF PELVIC FLOOR MUSCLES IN WOMEN AFTER GYNAECOLOGICAL OPERATIONS WITH SYMPTOMS OF URINARY INCONTINENCY

*Krystyna Garstka-Namysł¹, Juliusz Huber ², Alicja Witkowska², Magdalena Pisarska³, Kamila Witczak³, Łukasz Sroka³, Stefan Sajdak³, Grzegorz H. Bręborowicz⁴

Summary
Background: Women with symptoms of urinary incontinence and after gynaecological operations experience pelvic floor muscle and nerve action disorders which significantly affect their functional state. On the basis of the results of global electromyography, parameters for supraspinal stimulation (FES) and transvaginal electrical muscle stimulation (EMS) can be individually specified and the effects of therapy objectively assessed.
Material and methods: In 25 randomly selected (out of 236) women after gynaecological operations (on average 9 months after operations) with symptoms of micturition disorders the following examinations were carried out: gynaecological, urodynamic, ultrasonographic and psychological. In patients without contraindications for electrotherapy, global electromyography using an intravaginal electrode was carried out as well as examination of motor evoked potentials (MEP) induced by a magnetic field. Parameters for EMS and FES were selected individually, on the basis of the diagnostics results of nervous and muscular disorders. Comparative EMG and MEP were carried out after patients had undergone the therapy for two months at home.
Results: on the basis of diagnostic tests in 85% of patients a neurogenic cause of the complaints was found in the form of axonopathy of motor fibres rather than weakening of impulsation at the level of neurons of the motor centre. Muscle resting tone was on average 2.52 ?V before the therapy and 1.87 ?V after therapy. Action potential in the phase of contraction was 11.41 ?V before and 16.92 ?V after therapy.
Conclusions: EMG tests have shown a beneficial, statistically significant increase in the amplitude of muscle tone measured in exercise conditions. A two-monthly therapeutic cycle of electrostimulation resulted in an improvement of the functional state of motor units (stability) in the conditions of maximum contraction and post-exercise relaxation. Our study demonstrates that therapy of muscle activity disorders using the EMS and FES methods preceded by global electromyography and visualisation of contraction using EMG biofeedback has expected therapeutic effects.

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