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Samanburður á grindarbotnsþjálfun með og án raförvunar sem meðferð við áreynsluþvagleka

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Authors
Halldóra Eyjólfsdóttir
María Ragnarsdóttir
Guðmundur Geirsson
Issue Date
2009-09-01

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Other Titles
Pelvic floor muscle training with and without functional electrical stimulation as treatment for stress urinary incontinence
Citation
Læknablaðið 2009, 95(9):575-81
Abstract
BACKGROUND: Twelve to 55% of women experience stress urinary incontinence at some time during their lifetime. OBJECTIVE: To compare the effectiveness of pelvic floor muscle training with and without electrical stimulation in treatment of stress urinary incontinence. MATERIAL AND METHODS: Participants were 24 women, 27-73 years of age, diagnosed with stress urinary incontinence. Exclusion criteria were pregnancy and urge urinary incontinence. These participants were randomly divided into group 1 and 2. Both groups trained 15 min. twice a day for 9 weeks. Group 2 used simultaneously intermittent electrical stimulation. The pelvic floor muscles were evaluated using the Oxford scale, vaginal palpation, and by electromyogram, (Myomed 930, Enraf Nonius). The quantity and frequency of urinary incontinence episodes was evaluated using a questionnaire and a VAS scale before and after the treatment. RESULTS: The groups were demographically similar, except group 2 was significantly younger. Both groups had significantly increased pelvic floor muscle strength (p=0.007; p=0.005 respectively) after the treatment and 70% of all the women had reduced or no stress urinary incontinence. Group 2 had significantly (p=0.013) better relaxation post treatment. CONCLUSION: Pelvic floor muscle training is an effective treatment for stress urinary incontinence, but electrical stimulation gave no additional effect for this patient group. The significantly lower relaxation threshold in group 2 indicates that electrical stimulation could be a possible treatment for symptoms caused by hypertensive pelvic floor muscles.
Inngangur: Tólf til 55% kvenna finna fyrir þvagleka einhvern tímann á ævinni og því mikilvægt að sýna fram á árangursríka meðferð við honum. Markmið: Að bera saman árangur grindarbotnsþjálfunar með og án raförvunar sem meðferð við áreynsluþvagleka. Efniviður og aðferðir: Þátttakendur voru 24 konur, 27-73 ára, sem greindar voru með áreynsluþvagleka. Útilokaðar voru barnshafandi og konur með bráðaþvagleka. Þátttakendum var skipt með slembivali í hóp 1 sem stundaði grindarbotnsþjálfun og hóp 2 sem notaði raförvun að auki. Styrkur og úthald grindarbotnsvöðva var metinn á Oxford-kvarða með þreifingu og vöðvarafriti (Myomed 930 Enraf Nonius). Konurnar svöruðu sannreyndum spurningalista fyrir og eftir meðferð um magn þvaglekans. Þær mátu einnig þvaglekann samkvæmt kvarða fyrir og eftir meðferð. Meðferð: Konur í báðum hópum æfðu tvisvar á dag, 15 mínútur í senn í 9 vikur. Konur í hópi 2 notuðu auk þess samtímis rofna raförvun á grindarbotnsvöðva um leggöng. Niðurstöður: Hóparnir voru sambærilegir í upphafi nema konur í hópi 2 voru marktækt yngri. Styrkur grindarbotnsvöðva jókst marktækt (Hópur 1: p=0,007; Hópur 2: p=0,005) og þvagleki varð marktækt minni en fyrir þjálfun (p=0,008) eða horfinn hjá 70% kvennanna. Hópur 2 hafði auk þess marktækt meiri slökun (p=0,013). Munur á árangri milli hópanna var hvergi marktækur. Ályktanir: Grindarbotnsþjálfun er árangursrík bæði með og án raförvunar en raförvun til viðbótar grindarbotnsþjálfun bætir ekki árangur meðferðar við áreynsluþvagleka hjá þessum sjúklingahópi. Þar sem slökun var meiri hjá hópi 2 gæti raförvun verið valkostur í meðferð þar sem yfirspenna í grindarbotni veldur einkennum.
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