PELVIC-FLOOR REHABILITATION .1. COMPARISON OF 2 SURFACE ELECTRODE PLACEMENTS DURING STIMULATION OF THE PELVIC-FLOOR MUSCULATURE IN WOMEN WHO ARE CONTINENT USING BIPOLAR INTERFERENTIAL CURRENTS

Background and Purpose. Electrical stimulation of the pelvic floor is used as an adjunct in the conservative treatment of urinary incontinen ce. No consensus exists, however, regarding electrode placements for o ptimal stimulation of the pelvic-floor musculature. The purpose of thi s study was to compare two different bipolar electrode placements one suggested by Laycock and Green (L2) the other by Dumoulin (D2), during electrical stimulation with interferential currents of the pelvic-poo r musculature in continent women, using a two-group crossover design. Subjects. Ten continent female volunteers, ranging in age from 20 to 3 9 years ((X) over bar = 27.3, SD = 5.6), were randomly assigned to one of two study groups. Methods. Each study group received neuromuscular electrical stimulation (NMES) of the pelvic-floor musculature using b oth electrode placements, the order of application being reversed for each group. Force of contraction was measured as pressure (in centimet ers of water [cm H2O]) exerted on a vaginal pressure probe attached to a manometer. Data were analyzed using a two-way, mixed-model analysis of variance. Results. No difference in pressure was observed between the two electrode placements. Differences in current amplitude were ob served With the D2 electrode placement requiring less current amplitud e to produce a maximum recorded pressure on the manometer. Subjective assessment by the subjects revealed a preference for the D2 electrode placement (7 of to subjects). Conclusion and Discussion. The lower cur rent amplitudes required with the D2 placement to obtain recordings co mparable to those obtained with the L2 technique suggest a a more comf ortable stimulation of the pelvic-floor muscles. The lower current amp litudes required also suggest that greater increases in pressure might be obtained with the D2 placement by increasing the current amplitude while remaining within the comfort threshold. Measurements will help to define treatment guidelines for a planned clinical study investigat ing the effects of NMES and exercise in the treatment of urinary stres s incontinence in women postpartum.