ABSTRACT
Background:
By 1995 it was evident from the surgical data that a substantial percentage of chronic pelvic pain, bladder & bowel dysfunctions in the female could be cured by surgical repair of the pelvic suspensory ligaments.
Aims:
Using a squatting-based regime, we aimed to strengthen the 3 directional muscle forces and the ligaments against which they contract, to improve urethral closure (incontinence) opening (bladder emptying), support of the bladder base stretch receptors (urge incontinence) and, Frankenhauser and Sacral nerve plexuses (chronic pelvic pain).
Results:
The standard regime comprised four visits in 3 months. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks with a 50Hz probe placed into the posterior fornix of the vagina, squeezing 3x12 per day, reverse pushdowns 3x12 per day and squatting or equivalent up to 20 min per day as part of daily routine (such as household tasks). Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p=<0.005. Frequency, nocturia and pelvic pain were significantly improved (p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml (p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Approximately 3% of patients reported worsening of their stress incontinence and these were referred for surgery.
Conclusions:
The 50% dropout rate was a concern. Subsequently we performed a small pilot study (unpublished) using a simpler regime: electrotherapy, situps before getting out of bed, developing a “squatting culture” as part of a daily routine, sitting on a round fitball instead of a chair. The initial results suggested better compliance and equivalent improvement. This method, though promising, awaits rigorous scientific assessment.
