3Indications of P.E.S.
3.1 - Stress incontinence,
frequently due to sphincter deficiency. Symptoms
include leaking of urine, caused by a strain (such as
coughing, rising from a chair, etc), in absence of
detrusor activity. Stress incontinence is usually
treated with relatively high frequency electrical
pulses (from 35 to 100 pulses per sec. (p.p.s.)
depending on patients and therapist preference),
this exercises the phasic components of the muscle
fibres which provide strong but short contractions.
The treatment should be performed for about 20
minutes daily starting with relatively short work
periods and gradually building up endurance by
increasing the contraction time as the muscles
strengthen. Pulse widths may be selected between
100 to 400 microseconds, depending on the patient.
3.2 - Urge incontinence,
caused by detrusor instability. Here the most
appropriate frequency is between 5 and 10 Hz, with
a pulse-width of between 250 and 400
microseconds. The treatment is best performed on a
daily basis for the first week, then 2 to 3 sessions
per week for the next 3 or 4 weeks. The therapy may
be conducted at home.
3.3 - Mixed Incontinence,
accounts for about 40% of all cases of incontinence
and is characterised by episodes of incontinence
when straining, along with or alternating with
episodes of incontinence due to detrusor instability
causing urgency.
Depending on the predominance of the first or the
second kind of incontinence, one can decide to use
a relatively high frequency for greater effect on the
muscle tone or lower frequencies to give greatest
effect on detrusor inhibition. Urge incontinence
usually responds more quickly than stress so this is
usually treated first. Alternatively two treatments per
day, one for urge and the other for stress may be
carried out.
