Outcomes of Vaginal Electrogalvanic Stimulation Treatment for Pelvic Floor Disorders: A Pilot Study
Jennifer Schmitt, DO, Randina Harvey-Springer, CNP, Felecia Fick, PA, John A. Occhino, MD, MS
Pelvic floor muscle dysfunction is prevalent among women of all ages and manifests with a variety of symptoms, which include bowel, bladder, and sexual dysfunction as well as pelvic pain.
Starr, et al. reported 80% success with their pelvic floor rehabilitation which included management of urinary and defecatory dysfunction, pelvic pain and dyspareunia using behavioral modification, pelvic floor muscle training, biofeedback, vaginal electrogalvanic stimulation (EGS), and constipation management.
The aim of this pilot study was to evaluate a similar rehabilitation program including pelvic floor biofeedback and vaginal EGS on the short-term outcomes of patients with a variety of pelvic floor disorders.
This is an IRB-approved retrospective cohort study that evaluated patients between 10/2014 and 3/2015 who underwent behavioral modification and biofeedback with EGS for treatment of the following pelvic floor disorders: urinary urgency and incontinence (urgency/stress), fecal urgency and incontinence, pelvic pain/dyspareunia.
Sessions utilized a vaginal probe for biofeedback and strengthening or relaxation of the musculature. Each session included 30 minutes of EGS utilizing the regimen outlined by Starr, et al. Daily home exercises, stretches and heat therapy were recommended. Treatment sessions were every two weeks, on average, and each patient completed between 4 and 8 sessions.
Participants completed a survey at each session evaluating urinary, bowel and pelvic pain symptoms. A 10cm visual analog scale (VAS) was used to evaluate subjective improvement.
Twenty-seven patients began therapy and 7 were excluded from this analysis: 3 had not completed their treatment at the time of submission and 4 were excluded for other reasons, none of which were lack of therapeutic efficacy. All 20 patients received treatment for urinary dysfunction. Nine (45%) had defecatory dysfunction and 7 (35%) had pelvic pain or dyspareunia.
At baseline, the average number of urinary leaks per day was 3.9, which decreased to 2 by the last session. At baseline, 100% of patients reported urinary urgency; this persisted in 75%. The subjective change in urinary symptoms showed improvement by an average of 62.5% from baseline (median 70%; range 0-95%). One patient reported no improvement. The subjective change in bowel symptoms showed improvement by an average of 69.8% (median 70%; range 40-98%).
Patients were asked to rate their pelvic pain over the last week. Mean baseline score was 5.6 and was reduced to 3 with treatment. The subjective change in pelvic pain symptoms showed improvement by an average of 67.5% (median 70%; range 12.5-95%).
During our pilot study, twenty patients completed their pelvic floor rehabilitation treatment course. Urinary urgency, frequency, leaking episodes, and overall subjective symptoms improved after treatment. Similarly, pelvic pain and subjective improvement of both bowel dysfunction and pelvic pain improved. Each domain improved by 62.5-70% from the first to final session.
This study supports the use of EGS in conjunction with biofeedback for nonsurgical management of pelvic floor dysfunction. Further investigation into the long term outcomes is indicated.