Lower urinary tract symptoms in Parkinson's disease effectiveness of pelvic floor muscle exercises and electrical stimulation

In the Netherlands, 63.500 people suffer from Parkinson's Disease(PD). PD is
predominantly a movement disorder. In addition, PD is associated with non-motor
and autonomic symptoms. Over 75% of PD patients, experience lower urinary tract
symptoms (LUTS), one of the most common autonomic symptoms. LUTS consists of
urgency, frequency and nocturia with or without urinary incontinence(UI). More
than 60% of PD patients experience nocturia. LUTS have a negative impact on
Quality of Life(QoL), increases the risk of falls, are a barrier to exercise
and reduce social activities. Therefore, this potentially increases healthcare
related costs.
Treatment options for LUTS in the general population are conservative therapy
and medication, botox in the bladder muscle and neuromodulation ( kind of
pacemaker, providing electrical stimulation on the nerve to reduce urge).
In people with Parkinson's disease, medications do not work as well and produce
more side effects such as dry mouth and difficulty defecating.
Conservative therapy consists of e.g. behavioral advice, bladder training
provided by a pelvic physical therapist(PPT), and, electrical stimulation(ES).
Two small studies show that pelvic physical therapy has a positive effect.
Knowledge of the effectiveness of conservative treatment options for LUTS in PD
is limited. Although ES is used effectively in patients with LUTS, it has not
yet been studied in PD patients. ES has hardly any side effects, but there is
uncertainty about optimal ES parameters.

Pelvic physical therapy with electrical stimulation can be promising treatment
option for LUTS in Parkinson's disease

Objective: To study the effectiveness of pelvic physical therapy and ES in
patients with PD suffering from LUTS. Which are the most effective parameters
for ES.


Intervention:
Intervention: 8 treatment sessions of 30 minutes pelvic physical therapy over a
12 week period. The intervention consists of bladder- and behavioural advice,
pelvic floor muscle exercises (PFME), urge suppression techniques, biofeedback
and ES with an intra anal or intra vaginal probe. The group is divided into 3
groups. Group 1: ES with phase duration 200µs/20hz, group 2: ES with 1000µs/8hz
and, group 3: (control group) receiving ES 200µs/100Hz,(2 sec active
stimulation 20 sec no stimulation) sham ES.

Randomized control trial , single blind

Pelvic physical therapy
All patients: bladder training , toilet behavioral, biofeedback assisted pelvic
floor muscle exercises

Randomization in three groups:
group 1 : electrical stimulation, pulse duration 1000 microsec /8 Hz for 20
min
group 2: electrical simulation, pulse duration 200 microsec e/20 Hz for 20 min
group 3: electrical stimulation, (2 sec active stimulation 20 sec no
stimulation) pulse duration 200 microsec /100Hz sham for 20 min

All groups 8 treatment sessions

-Very low risks

-Burden :
Online questionnaires : total 59 questionnaires at T0-T1-T2-T3 ( four times,
about 15 minutes)
bladder diary, before and after pelvic physical therapy, T0-T1



2 visits to a research pelvic physical therapist , 30-45 min each visit
8 treatment sessions , pelvic physical therapy, 30 min per treatment session,
one a week, (8 treatment sessions in 10 weeks)