Efficacy and safety of high-intensity electromagnetic stimulation in the prevention of recurrence of rectocele after surgical treatment

Abstract

The etiology of rectocele is diverse and can be caused by gynaecological and extragenital diseases, but the exact mechanisms of formation of anatomical, functional defects of the pelvic floor and methods of effective treatment from the position of prevention of recurrences remain quite contraversive. Complex postoperative rehabilitation after surgical treatment of rectocele is aimed at restoration of normal function of pelvic floor muscles and prevention of recurrences. It seems relevant to study the effectiveness of new methods of physiotherapy, such as high-intensity electromagnetic stimulation of the pelvic floor muscles, as a potential non-invasive, innovative option to reduce the recurrence rate of rectocele and related symptoms. This fact determined the focus of our study. Materials and мethods. 69 patients with rectocele and pelvic floor muscle insufficiency of hypokinetic phenotype (mean age 35.47±6.83 (95% CI 33.83–37.11) were included in the study. After surgical treatment, the patients of the study cohort were randomised into two groups: the main group (n=35) was treated with high-intensity electromagnetic stimulation of the pelvic floor muscles on the DR. ARNOLD device (DEKA M.E.L.A., Italy) to prevent recurrences, and the comparison group (n=34) was treated with cavity electrostimulation. Electromyography was used to objectively assess the state of pelvic floor muscles; accordingly, the quality of life and sexual function of the patients in the study cohort were analysed on the basis of specially adapted perineological questionnaires PFDI-20 and PFIQ-7. Results. Electromyography revealed a 1.4-fold increase in maximum and average contraction, increased endurance and normalisation of pelvic floor muscle tone in the study cohort (p<0.05). In addition, the patients of the main group, after high-intensity electromagnetic stimulation there was a persistent improvement in the quality of life and sexual function on the questionnaires PFDI-20 and PFIQ-7 after treatment and after 3 and 6 months, compared with baseline data and the comparison group (p<0.05). The results of the study showed that the use of high-intensity electromagnetic stimulation of the pelvic floor muscles on the DR. ARNOLD device (DEKA M.E.L.A., Italy) significantly reduces the frequency of recurrence of rectocele by 4.1 times in comparison with the cavity electrostimulation. Conclusion. The use of high-intensity electromagnetic stimulation (DR. ARNOLD, DEKA, Italy) is a highly effective and safe method of treatment of pelvic floor muscle insufficiency with hypokinetic phenotype in female patients after surgical treatment of rectocele, which contributes to the reduction of clinical symptoms, improvement of functional state of pelvic floor muscles, improvement of quality of life and sexual function, as well as reduction of recurrence rate.

Keywords

• rectocele
• pelvic floor muscle insufficiency
• high-intensity electromagnetic stimulation
• postoperative rehabilitation
• dr. arnold
• electromyography
• quality of life