METHODS FOR TREATING URINARY AND FECAL INCONTINENCE

• US 20090076565A1
• Filed: 09/19/2007
• Published: 03/19/2009
• Est. Priority Date: 09/19/2007
• Status: Abandoned Application

• Current Assignee: State of Incorporation
• Original Assignee: State of Incorporation
• Inventors: Surwit, Earl A.
• Application Number:
  US11/857,872
• Publication Number:
  US 20090076565A1
• Time in Patent Office: Days
• US Class Current: 607/41
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control

Abstract

Non-surgical methods for treating pelvic floor muscular dysfunctional disorders are provided. The method combines pelvic floor muscle training (PFMT), biofeedback and pelvic floor exercises, pudental and hypogastric nerve neuromodulation (electrical stimulation), and tibial nerve neuromodulation (PTNS).

Claims

1. A method for rehabilitating the pelvic floor of a patient with incontinence, wherein the patient is performing pelvic floor exercises comprising:

electrically stimulating with a neuromodulator the pudental and hypogastric nerves; and

electrically stimulating with a neuromodulator the tibial nerve until the patient has sufficient stimulation to induce flexion of the great toe.

2. The method of claim 1 further comprising providing biofeedback by electrical stimulation of the pelvic floor muscles when the patient is performing pelvic floor exercises.

3. The method of claim 1, comprising electrically stimulating the tibial nerve by placement of an electrode on the tibial nerve above the anlcle to deliver an electrical impulse to the sacral plexus and to Onuf'"'"'s nucleus.

4. The method of claim 1, wherein between 5 and 100 Hz is used to electrically stimulate the pudental and hypgastric nerves.

5. The method of claim 1, wherein the pudental and hypogastric nerves are electrically stimulated for about 15 minutes to 1 hour.

6. The method of claim 1 wherein the amplitude of the neuromodulator applying stimulation to the pudental and hypogastric nerves is increased from a setting of zero milliamps to 9 milliamps until the patient had a flexion of the great toe.

7. The method of claim 1 comprising applying between 0.1 and 15 mA electrical stimulation to the tibial nerve.

8. The method of claim 1 wherein the pelvic exercises and neuromodulation are performed on the same day.

9. The method of claim 8 wherein neuromodulation of the pudental and hypogastric nerves and the tibial nerve are performed on the same day.

10. The method of claim 1 wherein the patient is treated with electrical stimulation biofeedback by administration of 100 Hz intravaginally or trans-anally to the whole pelvic floor musculature until there is a sustained contraction of the pelvic floor muscles.

11. The method of claim 1 comprising 10 Hz electrical stimulation of the hypogastric nerve by insertion of a vaginal probe into the vagina, or anal probe into the rectum, with the pulse amplitude turned up from 0 in 5 second intervals, until the patient can feel a comfortable tingling, wherein the pulse width is 1, and the pulse type is balanced, biphasic, and without a dc component, for a treatment duration of 30 minutes.

12. The method of claim 1 wherein percutaneous tibial nerve modulation is administered for 30 minutes

13. The method of claim 14 wherein the tibial nerve modulation is administered with a low voltage (9 volts) stimulator having an adjustable pulse intensity of 0 to 9 mA, a fixed pulse width of 200 microseconds and a frequency of 20 Hz, wherein the electrode is placed above the ankle to deliver an electrical impulse via the tibial nerve to the sacral plexus and to Onuf'"'"'s nucleus, and wherein the amplitude of the neuromodulator is then increased from a setting of zero milliamps to 9 milliamps until the patient had a flexion of the great toe.

14. The method of claim 1 wherein the patient is treated with twice weekly treatments of biofeedback, neuromodulation of the pudential and hypogastric nerve, followed by neuromodulation of the tibial nerve.

15. The method of claim 1 wherein the pelvic floor-related disorder is selected from the group consisting of urge incontinence and stress incontinence.

16. The method of claim 1 wherein the patient is treated for a condition selected from the group consisting of pelvic organ prolapse, fecal incontinence, pelvic pain, constipation with fecal impaction, post-radical prostatectomy incontinence, and intrinsic sphincter deficiency.

17. The method of claim 1, wherein the tibial nerve stimulation is performed trans-cutaneously.

18. The method of claim 17 using a microcurrent pad stimulator, a microcurrent probe stimulator, an interferential device using a form of electrostimulation that utilized four electrodes surrounding the part of the body to be treated, with each set of two electrodes at a frequency out-of-phase with the other set;

a high-intensity form of interferential current, or a Russian stimulation device.

19. The method of claim 17 using therapeutic microcurrent stimulation at a level several hundred to a thousand times less intense than conventional milliamp electro-stimulators using specific electrodes to treat specific points on the body with microcurrent stimulation and measuring skin impedance to confirm optimal electrical conductivity and placement.

20. The method of claim 1 wherein the patient is a woman.

21. The method of claim 1 wherein the patient is a man.