RU2727587C1 - Method for pelvic floor muscle stimulation by electro-balneotherapy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to gynecology, physiotherapy, and can be used for stimulation of pelvic floor muscles by electro-balneotherapy. Electrostimulation is carried out for women in a bath with fresh water with volume of 200–220 l, having built-in plate electrodes for electric current supply. After the hygienic shower, the patient is immersed in a bath filled with fresh water at temperature of 35–36 °C, so that the exposure area – pelvis area with perineum – is completely covered with water. That is followed by feeding a faradic current of intensity 120 mA at frequency 20 Hz on two electrodes transversely located in the wall of the bath in the region of a projection of the patient's pelvis. Intensity of current is gradually increased until sensation of vibration and muscular contractions in the area of small pelvis, external and internal groups of femoral muscles. Further, within 3–5 min, intensity of current is gradually increased, maintaining sensation of muscular contractions, but no more than 240 mA, being guided by patient's subjective condition – without unpleasant sensations. Total length of procedure is 10–15 min. After completion of the procedure, the patient leaves the bath, is cleaned with a towel and rests in a lying or semi-lying position for 20–25 minutes. Therapeutic course is 10–12 procedures daily or 2 consecutive days with alternation of one day of rest.EFFECT: method provides pelvic floor muscles reinforcement by electrostimulation in aqueous medium.1 cl, 2 ex

Description

The proposed invention relates to medicine, namely to gynecology, physiotherapy, and can be used as a method of active prevention of pelvic floor muscle weakness, as well as a method of choice in the treatment of patients with pelvic organ prolapse in the early stages in the conditions of sanatorium institutions and departments, in medical rehabilitation institutions.

Relevance:

Pelvic organ prolapse is a syndrome of prolapse of the pelvic floor and pelvic organs, in isolation or in combination, resulting from stretching of the fascial structures of the small pelvis. According to various authors, from 2.9 to 53% of women note some manifestation of pelvic floor muscle prolapse, while up to 47% of patients with pelvic organ prolapse are women of working age. In most cases, pelvic floor muscle prolapse is almost asymptomatic, which indicates its high prevalence in the population (MV Gvozdev, NV Tupikina, GR Kasyan, D.Yu. Pushkar. Pelvic organ prolapse. Clinical guidelines . Moscow, 2016).

The most effective method for correcting internal genital prolapse is still the surgical method. However, no surgical intervention for pelvic organ prolapse can guarantee the absence of relapse. According to various authors, approximately one in nine women under 80 years of age are operated on for genital prolapse, 30% of them require repeated interventions. (Radzinsky V. Ye. "Non-surgical design of the perineum" - M .: GEOTAR-Media, 2017. - 256 p.). These circumstances dictate to the modern doctor the idea of the need for active prevention of pelvic floor muscle failure in women at risk for this disease, as well as the detection and conservative treatment of pelvic organ prolapse in the early stages.

Characteristics of analogs of the method recommended for reducing the frequency of surgical interventions.

A known method of treating patients with early stages of pelvic organ prolapse using extracorporeal magnetic stimulation - a non-invasive means of stimulating the pelvic floor muscles by inducing an electric current through a magnetic field. During the procedure, the following anatomical structures are involved in the process: urethra, vagina, buttocks, anal region. An alternating magnetic field generates electromagnetic induction and an alternating electric field. When any conductor is placed in an alternating magnetic field, an electric current is generated in the latter. A nerve is an excellent conductor, and when placed in an alternating magnetic field, an impulse arises in it. Depolarization of the nerve leads to muscle contraction (G.R. Kasyan, M.Yu. Gvozdev, A.G. Konoplyannikov, D.Yu. Pushkar. Urinary incontinence in women. Guidelines No. 4, Moscow, 2017).

During the magnetic stimulation procedure, the patient sits freely in a special chair, in the seat of which magnetic inductors are mounted. The maximum induction of the alternating magnetic field on the surface of the therapy chair is 0.5 ± 0.1 T. Frequency adjustment is carried out in the range from 1 to 50 Hz with a discreteness of 1 Hz, and the adjustment of the duration of a treatment session is in the range from 1 to 60 minutes in 1 minute steps (Kulikov A.G., Voronina D.D. Modern aspects of the use of magnetic stimulation in clinical practice. Physiotherapy, balneology and rehabilitation. 2016; 15 (3): 155-159). Electromagnetic impulses cause alternate contraction and relaxation of the muscles of the pelvic floor, colon, bladder, uterus. As a result of this effect, blood microcirculation improves, congestion disappears, muscles are trained. The treatment session lasts 20 minutes (Borisenko L.Yu., Sivkov A.V., Romikh V.V., Zakharchenko A.V., Panteleev V.V., Kostin A.A., Apolikhin O.I. biofeedback with test electrical stimulation of the pelvic floor muscles as monotherapy and in combination with extracorporeal magnetic stimulation of the pelvic floor muscles for functional bladder outlet obstruction in women. Experimental and Clinical Urology. 2019; 2: 146-151).

A known method of training pelvic floor muscles in biofeedback mode (BFB). The restoration of the function of the pelvic floor muscles is carried out by teaching patients the skill of voluntary (conscious) and reflex (involuntary) control of the contractile function of the pelvic floor muscles in urogynecological diseases. For visual control of the effectiveness of the performed exercises, special devices for biofeedback are used. Methodology: position of the patient - sitting on a chair. The patient inserts a pre-treated antiseptic probe into the vagina to record electrical signals from the muscles. The patient's task is either to periodically tension and relax the muscles of the pelvic floor, or in their prolonged tension. The device sets the time mode of operation and demonstrates the results of muscle activity in the form of graphs. After a phase of muscle tension (from 30 to 60 seconds), a relaxation period (15-45 seconds) follows. During the rest period, the patient can watch a film or slide show. The total duration of the session is 20 minutes. Sessions are held every day, once a day. Course - 10-15 sessions (Apolikhina I.A., Chochueva A.S., Saidova A.S.Pelvic floor muscle training in biofeedback mode on the PELVIC-FIT device. Effective pharmacotherapy. 2018; 23: 18-23) ...

A similar mechanism of action is possessed by the technique using the Urostym pelvic floor muscles rehabilitation system (Basic obstetric and gynecological clinic. Topical issues of urogynecology. Pelvic floor muscles rehabilitation system. Teaching and methodological manual for residents and practitioners. Krasnodar. 2017, 27 p.).

A known method of training the muscles of the pelvic floor - Kegel exercises using special devices . Well-known exercises complement sets of vaginal simulators, which are weights of various weights for long-term retention in the vagina. Vaginal cones and vaginal balls are examples of such therapy simulators. Training with vaginal cones helps to develop the feeling of the pelvic floor muscles and helps to build them. Due to the special shape and weight, the inserted cone slides out of the vagina. The pelvic floor muscles respond to this with a contraction reflex. With regular training, the pelvic floor muscles noticeably strengthen after a few weeks (Apolikhina I.A., Dodova E.G., Borodina E.A., Saidova A.S., Filippenkova E.V. Pelvic floor dysfunction: modern principles of diagnosis and Effective pharmacotherapy. 2016; 22: 16-23).

The known method of conservative therapy of pelvic organ prolapse, which consists in the use of gynecological massage, including massage of the perineum. Under the influence of gynecological massage, there is a pronounced direct and reflex irritation of a large area of exteroreceptors of the skin of the abdomen, perineum and external genital organs, endometrium and myometrium of the uterus, peritoneum of the bladder and rectum, which has a significant effect on the muscles of the pelvic organs and on the entire ligamentous apparatus - strengthening ligamentous-muscular apparatus of the uterus, pelvic floor muscles, connective tissue and fascial plates. General techniques of gynecological massage include massaging (rubbing and stroking the uterus, appendages, other organs of the cavity of the large and small pelvis, in order to increase the tone and activate hyperemia); restoration of the normal position of the uterus by stretching pathological formations (scars, adhesions, adhesions), this eliminates stagnation in the uterus, passive hyperemia, edema and pain; massaging the ligamentous apparatus by displacing the uterus in the horizontal and vertical directions to increase its tone and normalize the position of the internal genital organs, as well as improve lymph and blood circulation; massage of the abdominal muscles, parietal muscles and pelvic floor muscles by stroking, stretching and pushing pressure helps to increase blood circulation in internal organs, increase muscle tone and strengthen the normalized position of the internal genital organs. When massaging the perineum, 4 main techniques are used: stroking, rubbing, stretching and vibration. The massage technique includes 3 techniques: manual rubbing and stroking of the outer parts of the perineum to increase the tone and hyperemia of the tissues; stretching the tissue of the posterior commissure and lateral walls of the vagina and the vaginal opening; vibration massage of the external tissues of the perineum and external sphincter of the anus (V.A.Kulavsky, A.M. Ziganshin, E.V. Kulavsky, N.I. Nikitin, F.A. Shavaleeva. Pelvic floor failure in women (clinic, diagnosis and treatment) Methodical recommendations - Ufa, 2016 - 100 p.).

There is also known a method of extracorporeal electrical stimulation for prolapse of the pelvic organs, which consists in carrying out tibial electrical stimulation (described in RU 2559148 C2, Khitaryan A.G. et al., Publ. 08/10/2015). For tibial electrical stimulation, a needle (active electrode) is used, which is inserted at a point 3 cm cranially in relation to the medial malleolus. The end of the electrode needle should be located in close proximity to the tibial nerve. This type of electrical stimulation consists of repeated sessions lasting 30 minutes 1-2 times a week for 1-2 months. The method of tibial electrical stimulation is based on the fact that the tibial nerve contains autonomic fibers from 2-3 sacral vertebrae of the internal pelvic plexus, which is the main one in the transmission of impulses for the regulation of pelvic functions. Many authors point to the universal nature of such electrical stimulation and its effectiveness in urinary incontinence, dysuric phenomena, obstructive defecation, anal incontinence, pelvic pain (W. Thon et al., 1991, R. Bosch et al., 1995; W. de Groat et al. al., 1997, H. Shaker, M. Hassouna, 1998; R. Schmidt, 1999, E. Wein et al., 2000; M. Chancellor, W. Leng., 2002).

The closest in technical essence the proposed method is a method of intravaginal electrical stimulation of the pelvic floor muscles.

In this case, exponential or rectangular currents in the form of single pulses or a series of pulses with pauses between them are used for electrical stimulation. When a pulsed current passes through the tissues at the moments of its rapid turn-on and interruption, a large number of like-charged ions suddenly accumulate at semipermeable cell membranes. This brings the cell into a state of excitement, which is accompanied by a motor reaction, if the action is carried out on a motor nerve or muscle. Stimulation of the neuromuscular apparatus by a series of impulses with a frequency of 5-15 to 150 Hz leads to tetanic muscle contraction, which is close in shape to voluntary movements. Impulse electric currents, causing motor excitement and muscle contraction, at the same time reflexively increase blood and lymph circulation, as well as the whole complex of metabolic and trophic processes aimed at providing energy to working muscles. (Ulashchik V.S., Lukomsky I.V. General physiotherapy: Textbook. - Minsk: Book House, 2005. - S. 125-126). The mechanism of action of electromyostimulation includes indirect stimulation of the pelvic floor muscles through the branches of the pudendal nerve, and as a result of systematic repeated contraction under the influence of electrical impulses, the mass and strength of muscle tissue increases. They use various stimulation modes - constant, batch, work / rest and modulated, which provides a wide range of applications, increasing the effectiveness of therapy. It has been shown that the positive effect of electromyostimulation can persist for several months, after which the training cycles must be repeated. Moreover, the number of repeated cycles is not limited (Serov V.N., Apolikhina I.A., Kubitskaya Yu.V., Zheleznyakova A.I. Electrostimulation of the pelvic floor muscles in the treatment of urinary incontinence in women. Obstetrics and gynecology. 2011; 7-2 : 51-55).

The disadvantage of this method is intravaginal insertion of the electrode, which in some cases limits the use of this method. In addition, the methods of intravaginal stimulation, when applied, are limited to the area of the vagina, practically shallow muscles and ligamentous structures of the small pelvis.

To eliminate these shortcomings, we propose a new non-invasive method of electrical stimulation of the pelvic floor muscles, which is carried out in a bath with fresh water. Thus, it is known to use hydroplating baths as a therapeutic method based on the combined effect of low-frequency electric current and fresh water on the body. In terms of the area of application, such baths can be general and local (two-chamber and four-chamber for isolated or simultaneous exposure to the upper and lower extremities). Hydroplating baths can be exposed to constant galvanic and pulse (diadynamic, faradic, Trebert current) currents. In this case, the procedures of hydroplating baths can be carried out along the longitudinal (electrodes are fixed in the head and foot ends) or transverse method (electrodes are located on the inner side panels of the bath) (Borodulina I.V. et al. Hydroplating baths as a method of medical rehabilitation: a review of the literature and prospects Clinical application J. Questions of balneology, physiotherapy and exercise therapy. 2018; 95 (1): 46-52). They are used for various diseases and conditions of the cardiovascular, nervous systems, musculoskeletal system.

The technical result of the proposed  "The method of stimulating the muscles of the pelvic floor by the method of electro-balneotherapy"Is: strengthening the pelvic floor muscles, reducing symptoms and severity of prolapse, improving the quality of life of patients. The training effect of the proposed course of procedures is manifested in more pronounced contractions of the pelvic floor muscles and the appearance of sensations of increased tone of the pelvic organs.

Specified technical result is achieved by the fact that the warm water of the bath, in which the human body is located, provides a pronounced anti-gravity and muscle relaxant effect, in which the contraction and relaxation of muscles (passive electro-gymnastics) occurs painlessly and more effectively than outside the water environment.

For this, the proposed method of stimulating the muscles of the pelvic floor by the method of electrobalneotherapy is carried out. It includes an electrostimulating effect.

The exposure procedure is carried out for women in a hydrogalvanic bath with fresh water with a volume of 200-220 liters, which has built-in plate electrodes for supplying electric current.

After a hygienic shower, the patient is immersed in a bath filled with fresh water at a temperature of 35-36 ° C, so that the affected area - the pelvic region with the perineum - is completely covered with water

then a faradic current with an intensity of 120 mA and a frequency of 20 Hz is applied to two electrodes located transversely in the bath wall in the projection area of the patient's pelvis.

The intensity of the current is gradually increased until a sensation of vibration and muscle contractions appears in the pelvic region, external and internal groups of the femoral muscles.

Then, within 3-5 minutes, they continue to gradually increase the intensity of the current, maintaining the sensation of muscle contractions, but not more than 240 mA, focusing on the subjective state of the patient - avoiding unpleasant sensations.

The total duration of the procedure is 10-15 minutes.

After its completion, the patient leaves the bath, wipes herself with a towel and rests in the supine or reclining position for 20-25 minutes.

The course is carried out 10-12 procedures daily or 2 days in a row with alternating one day of rest.

For electrical stimulation, faradic currents with a frequency of 20 Hz were selected. The current is supplied through two transverse electrodes located in the bath body. The area of action of the current is defined as the area of the small pelvis, including the perineum. The faradic current causes a pronounced contraction of the pelvic floor muscles, while simultaneously involving the thigh muscles, gluteal muscles and abdominal muscles in contraction. We have determined the most effective frequency of faradic current pulses (20 Hz) and its strength (from 120 to 240 mA). These parameters affect not only the striated muscles of the small pelvis, but also the smooth muscle elements, providing an improvement in microcirculation and activation of the metabolism of the pelvic organs. Perceptible and painless contractions of the pelvic floor muscles are well tolerated and do not cause discomfort or pain. The stimulation time is set at 10-15 minutes. Expressed subjective sensations of increased tone persist for 1.5-2 hours after taking the procedure.

The method is non-invasive, easily reproducible in the presence of special electrotherapeutic baths, equipped with transversely located electrodes, providing the supply of faradic currents. This technique can also be effectively combined with special exercises in the bath, and the woman is taught to do these exercises on her own in a warm bath at home.

As a clinical example, we present data on the results of treatment of 2 patients.

An example of the implemented method No. 1:

Patient D, 35 years old ...

Diagnosis: Pelvic floor muscle failure. Genital prolapse I-II degree. Cystocele.

History of 2 births, one of them with a large fetus. The patient complained of discomfort during intercourse (air ingress into the vagina), urine dripping during physical exertion.

Before starting treatment, the patient underwent a clinical examination, a manual gynecological examination, and an ultrasound examination of the pelvic organs with a transvaginal transducer.

When examining the external genital organs: the genital gap gapes, when straining within the genital gap, a hernial protrusion is determined, the wall of which is the anterior wall of the vagina, the contents are, in part, the bladder.

Ultrasound examination: the value of the anterior urethrovesical angle (deviation of the longitudinal axis of the urethra from the vertical axis of the body, angle b) at rest was 22 °, with straining 47 °, the deviation of angle b was 25 °; the value of the posterior urethrovesical angle (angle I) was 110 °, the shape of the posterior wall of the bladder was rounded. Thickness m. bulbocavernosus was 13 mm, thickness m. puborectalis 6 mm.

The patient was assigned a course of procedures according to the proposed method. During the treatment, the woman felt well, had no complaints, in dynamics she subjectively noted an increase in muscle tone in the perineum.

At the end of the course of procedures, the patient underwent repeated clinical examination, manual gynecological examination, tonoperineometry at rest and with tension, as well as ultrasound examination of the pelvic organs with a transvaginal sensor.

During clinical examination at rest and against the background of the Valsalva test, no pathological changes characteristic of pelvic organ prolapse were noted. According to the results of ultrasound examination: the value of the anterior urethrovesical angle (deviation of the longitudinal axis of the urethra from the vertical axis of the body, angle b) at rest was 20 °, with straining 37 °, the deviation of angle b was 17 °; the value of the posterior urethrovesical angle (angle I) was 110 °, the posterior wall of the bladder was not deformed. Thickness m. bulbocavernosus was 14 mm, thickness m. puborectalis 7.5 mm.

A month later, at the reception at the gynecologist, the patient had no complaints.

Example No. 2.

Patient V., 31 years old.

Diagnosis: Pelvic floor muscle failure. Prolapse of the genitals I-II degree. Rectocele.

History of 1 childbirth. The hereditary history is aggravated: close female relatives have pelvic organ prolapse. A preventive examination by a gynecologist diagnosed prolapse of the posterior wall of the vagina.

Prior to treatment, the patient underwent a clinical examination, a manual gynecological examination, tonoperineometry at rest and under tension, as well as ultrasound examination of the pelvic organs with a transvaginal transducer.

When examining the external genital organs: the genital gap gapes, when straining within the genital gap, a hernial protrusion is determined, the wall of which is the posterior wall of the vagina, the contents are partially the rectum. Ultrasound examination: there is a deformation of the anterior rectal wall, the size of the protrusion is 1.5 cm. Thickness m. bulbocavernosus was 11 mm, thickness m. puborectalis 5 mm.

The patient was assigned a course of procedures according to the proposed method. During the treatment, the woman felt well, had no complaints, in dynamics she subjectively noted an increase in muscle tone in the perineum.

At the end of the course of procedures, the patient underwent repeated clinical examination, manual gynecological examination, tonoperineometry at rest and with tension, as well as ultrasound examination of the pelvic organs with a transvaginal sensor.

During clinical examination at rest and against the background of the Valsalva test, no pathological changes characteristic of pelvic organ prolapse were noted. Ultrasound examination revealed no defects in the walls of the rectum. Thickness m. bulbocavernosus was 14 mm, thickness m. puborectalis 6.5 mm.

Positive fashion effect.

On the basis of the Federal State Budgetary Institution "National Medical Research Center of the RK" of the Ministry of Health of Russia, 34 patients with pelvic organ prolapse were examined and treated. At the same time, a clinical study was carried out comparing the effectiveness of the known technique and the proposed method for stimulating the pelvic floor muscles by the method of electrobalneotherapy.

The criteria for inclusion in the study were: age 35-45 years, the presence of a prolapse of the pelvic organs of the I-II degree of severity, including accompanied by stress urinary incontinence, the period after childbirth more than 1 year, the absence of contraindications to the use of physiotherapy methods, the patient's consent to participate in a clinical trial. Absence of pathological changes according to bacterioscopic examination of smears from the vagina, cervical canal and urethra, cytological examination of scrapings from the surface of the cervix and cervical canal.

The exclusion criteria were : mental illness preventing understanding of the requirements of the clinical trial, the presence of symptomatic prolapse (sensation of a foreign body in the vagina, pain.

All women were divided into 2 groups by the method of simple randomization. Patients of both groups were comparable in age, history, heredity, characteristics of menstrual and reproductive functions, and the presence of concomitant pathology.

Group 1 - 18 patients aged 39 ± 3.02 g with pelvic organ prolapse I-II degree (according to the POP-Q classification), who received treatment according to the proposed method.

Group II - 16 patients aged 38 ± 2.7 g with grade I-II prolapse (according to the POP-Q classification), who underwent stimulation of the pelvic floor muscles by the well-known method of electrical stimulation on APC with biofeedback "Urostim".

Patients of both groups filled out the PFDI-20 (Pelvic floor disorders distress inventory) questionnaire to subjectively assess their condition. To quantify the prolapse of the pelvic organs, the standardized POP-Q classification (Pelvic Organ Prolapse Quantification), developed by ICS in 1996, was used.At a gynecological examination, perineal turgor was assessed, the degree of dystopia of the pelvic floor muscles was determined, and a cough test with a full bladder was performed (150-200 ml) in the position on the gynecological chair. An ultrasound examination (ultrasound) of the perineum was carried out in order to determine the state of the pelvic floor, in which the height of the tendon center of the perineum, the absence or presence of levator diastasis, the safety of muscle bundles, the width of m. bulbospongiosus.

Research results. All the patients examined by us had complaints, and there were no fundamental differences in their frequency. In group 1, 5 patients (28%) complained of heaviness in the lower abdomen, 10 (56%) - of discomfort in the vagina, 4 (22%) - of a feeling of a foreign body in the vagina, 10 patients had a combination of symptoms ... Stress urinary incontinence was detected in 9 patients (50%).

In group 2, 7 patients (44%) complained of heaviness in the lower abdomen, 8 (50%) complained of discomfort in the vagina, 3 (19%) complained of a feeling of a foreign body in the vagina, 8 (50%) ) - a combination of symptoms. Stress urinary incontinence was detected in 11 patients (69%).

According to the results of a survey of patients using PFDI-20, the following data were obtained: in patients of the 1st group - an average of 67.4 ± 14.8 points, in patients of the 2nd group - an average of 71.4 ± 15.6 points.

During gynecological examination, patients were diagnosed with genital prolapse of I and II degrees of severity: in the 1st group, 10 (56%) - grade I prolapse, in 8 (44%) - grade II; in group 2, 9 (56%) had grade I prolapse, and 7 (44%) had grade II prolapse.

According to the results of the assessment of perineal turgor in the 1st group in 16 patients (89%) it was reduced, in 2 (11%) it was absent, in the 2nd group in 13 patients (81%) it was reduced, in 3 (19% ) - was absent.

A positive high correlation was found between the severity of complaints and the degree of genital prolapse. Correlation coefficients corresponded with severity in the lower abdomen - 0.65, discomfort in the vagina - 0.68, sensation of a foreign body in the vagina - 0.71.

After the examination, the patients of the 1st group underwent a two-week course of treatment, including muscle stimulation by the method of electrobalneotherapy according to the claimed method using the proposed quantitative exposure parameters from the above ranges (water temperature, current characteristics, duration and frequency of exposure, etc.). In group 2, the patients were prescribed treatment with the well-known method of electromyostimulation, alternating with biofeedback therapy, using the Urostym hardware-software complex.

At the end of the course, the patients' complaints were assessed, a survey using PFDI-20 and a gynecological examination were conducted. In group 1, after 2 weeks of treatment, complaints persisted in 5 patients (27%), severity in the lower abdomen disturbed 3 patients (17%), vaginal discomfort was experienced by 2 patients (11%). There was no combination of symptoms, no complaints about the feeling of a foreign body in the vaginal area were presented. Symptoms of stress urinary incontinence were observed in 4 patients (22%). In patients of the same group, after 1 month. using the method, only 4 (22%) had complaints of discomfort in the vagina, and only 1 patient (6%) had complaints of symptoms of stress urinary incontinence.

In group 2, after 2 weeks of follow-up after childbirth, complaints persisted in 7 patients (44%), of whom 5 patients (31%) complained of severity in the lower abdomen, vaginal discomfort disturbed 5 (31%), a combination of symptoms was observed in 4 (25%). Symptoms of stress urinary incontinence were identified in 7 patients (44%). After 1 month. in patients of group 2, 6 (37%) had complaints, of whom 5 (31%) had a feeling of heaviness in the lower abdomen, and 3 (19%) had discomfort in the vagina. Four patients (25%) had symptoms of stress urinary incontinence.

When analyzing the results, attention is drawn to a significant decrease in the number of complaints in patients of the 1st group who were prescribed the proposed method of electrobalneostimulation. Already after 1 month. the number of complaints they have decreased by 2 times. When compared with the baseline data, the number of complaints decreased by more than 3 times, and the incidence of symptoms of stress urinary incontinence - 5 times. In patients of the 2nd group, in the process of dynamic monitoring of their condition, a decrease in the number of complaints was also observed, but only by 1.5 times. After 1 month. the number of complaints decreased 2 times from the initial level, the same situation was observed with stress urinary incontinence.

Conclusions. Thus, analyzing all the results obtained, we can conclude that the effectiveness of the proposed method of electrobalneotherapy is higher compared to the known method of vaginal electromyostimulation with biofeedback therapy for a 2-week course of treatment. Frequency of symptoms within 1 month dynamic observation decreases, and the tone of the muscles of the perineum is gradually restored, but much more slowly with the vaginal method of exposure than with the use of electrobalneotherapy. Therefore, in order to treat the prolapse of the pelvic floor muscles of the 1st and 2nd degrees, it is advisable to use the method of electrobalneostimulation of the pelvic floor muscles at the initial stages of rehabilitation, which reliably faster restores their tone. In addition, our proposed method is incomparably more comfortable for patients than the well-known intravaginal technique.

Claims (9)

A method of stimulating the muscles of the pelvic floor by the method of electrobalneotherapy , including an electrostimulating effect, characterized in that the exposure procedure is carried out for women in a bath with fresh water with a volume of 200-220 liters, which has built-in plate electrodes for supplying electric current, after a hygienic shower, the patient is immersed in a bath filled with fresh water at a temperature of 35-36 ° C, so that the affected area - the pelvic area with the perineum - is completely covered with water, then a faradic current with an intensity of 120 mA and a frequency of 20 Hz is applied to two electrodes located transversely in the bath wall in the projection area of the patient's pelvis, the intensity of the current is gradually increased until a sensation of vibration and muscle contractions appears in the pelvic area, external and internal groups of the femoral muscles, then, within 3-5 minutes, continue to gradually increase the intensity of the current, maintaining the sensation of muscle contractions, but no more than 240 mA, focusing on the subjective state of the patient - avoiding unpleasant sensations, the total duration of the procedure is 10-15 minutes, after its completion, the patient leaves the bath, wipes herself with a towel and rests in the supine or reclining position for 20-25 minutes, 10-12 procedures are carried out per course every day or 2 days in a row with alternating one day of rest.