Treatment May Be Non-Invasive; Hi-Tech Biofeedback
Leonard S. Marks, M.D.
Fall, 1997 - Millions of people -- usually women, but sometimes men, too -- develop a chronic urinary condition known in lay terms as a"weak bladder." Symptoms include urinary frequency, urgency, and if severe, various degrees of leakage. A sensation of pelvic pressure is often described. Even extensive medical work-up reveals no specific pathology. This condition, most often known as urethral syndrome, may be very bothersome, but it is not life-threatening. A wide variety of treatments have been used previously, with varying degrees of success.
Using new, completely non-invasive technology, we have begun a study of modern biofeedback in patients with urethral syndrome. The premise is straightforward: if both urethral resistance and bladder capacity are increased, great symptomatic relief can be achieved. The novel aspect of this program is that both aspects of the condition -- urethral resistance and bladder capacity -- are addressed together. The advantages of this approach include lack of side-effects, direct involvement of the patient with his (or her) own condition, and the potential for a permanent re-training of bladder habbit. No drugs, injections, or urethral dilations are required.
Pelvic floor musculature is strengthened first by active, instructed, and monitored muscle contractions. A laptop computer is used to tell the patient (1) if the proper muscles are being used, and (2) the efficiency of the muscular contractions. Low voltage muscle stimulation is also used to passively improve tone of the pelvic floor. Active and passive muscle contractions lead to improve urethral resistance.
Bladder capacity is improved by use of a small, portable ultrasound device that is placed by the user over the lower abdomen. The device tells the patient how much urine is in the bladder at any given time. This is done in the privacy of the patient's own home. If the bladder contains only a little urine, the patient will know that any desire to urinate is a "false signal." If the bladder is full, the desire to urinate is recognized as an appropriate or "true" signal. Learning to distinguish between true and false signals should lead to increased bladder capacity, and the interval between urination lengthens.
A USRF-sponsored study, published recently in the peer-reviewed medical literature, has established the accuracy and reliability of the new bladder ultrasound mechanism. The abstract of that study, "3-D Ultrasound Device for Rapid Determination of Bladder Volume" is also online.
The combination of increased muscle tone and bladder capacity offer great promise for the life-altering urinary problems of urethral syndrome.
Patients interested in participating in this novel project may send e-mail inquiries to us by a click here or may call USRF at (310) 838-6347.