Ehlers-Danlos syndromes (EDS) are a group of hereditary connective tissue pathologies characterized by:

• Articular hypermobility

• Cutaneous hyperelasticity

• Fragile connective tissue

EDS is mainly caused by abnormalities in the biosynthesis and structure of the extracellular matrix, in particular collagen. [1]

Among patients with hypermobile EDS, the following bladder and bowel problems are frequently found:

• Dysuria

• Nocturia

• Prolapse of the bladder, uterus or rectum

• Vesicoureteral reflux

• Recurrent urinary tract infections

The cause of dysuria problems is explained by urodynamics as resulting from detrusor hypocontractility. Constipation, a frequent symptom among patients with SED, and which may or may not be associated with the use of morphine as an analgesic, can also provoke these symptoms of dysuria. [2]

Studies show that improved bladder perfusion can affect detrusor hypocontractility. [3] Additionally, in conjunction with appropriate treatment [4], the stimulation of fibroblasts promotes the production of collagen with better elastic qualities.

The goals of Winback treatment:

• Improve the biosynthesis of collagen

• Improve bladder perfusion

• Support perineal rehabilitation

• Fight against constipation

As a result of its biological and diathermic effects, Winback improves bladder perfusion and collagen stimulation [5] [6]. Combined with perineal rehabilitation, Winback therapy optimizes the treatment offered to EDS patients presenting with dysuria.

The first stage of treatment involves application of the CET electrode in dynamic mode with strong diathermy, targeting the bladder to stimulate perfusion and fibroblast production. A careful perineal assessment will indicate any issues with tone (hypertonia or hypotonia of the pelvic floor), and will guide the treatment and its associated level of Winback energy. Relaxation will be obtained more quickly, or awareness of the pelvic floor will be optimized; the use of Winback energy will also have an analgesic effect alongside these biological and diathermic effects.

The protocol for treating constipation can also be offered to patients presenting with transit constipation, whether or not this has been induced by morphine treatment, in order to improve intestinal perfusion (DEEPCET) and stimulate peristalsis (abdominal massage with the RET bracelet).

Studies cited:

[1] Protocole national de diagnostic et de soins (PNDS) Syndromes d’Ehlers-Danlos Non Vasculaires, Centre de Référence des Maladies Osseuses Constitutionnelles (MOC) Sites constitutifs pour les syndromes d’Ehlers-Danlos Non Vasculaires, Filière de santé maladies rares de l’os, du calcium et du cartilage (OSCAR) ; Mars 2020

[2] Etude urodynamique des troubles vésicosphinctériens dans le syndrome d’Ehlers-Danlos

1. Dragomir Kirchner, N. Bayle, E. Hutin, C. Hamonet, J.-M. Gracies, C.-M. Loche, Annals of Physical and Rehabilitation Medicine 56S (2013)

[3] Kershen R.T., Azadzoi K.M., Siroky M.B. Blood flow, pressure and compliance in the male human bladder J Urol 2002 ; 168 : 121-125

[4] Abnormal formation of collagen cross-links in skin fibroblasts cultured from patients with Ehlers-Danlos syndrome type VI. Proc Assoc Am Physicians. 1997 Jan; 109(1):33-41.

[5] Does the Application of Tecar Therapy Affect Temperature and Perfusion of Skin and Muscle Microcirculation? A Pilot Feasibility Study on Healthy Subjects; Ron Clijsen, Diego Leoni, Alessandro Schneebeli, Corrado Cescon, Emiliano Soldini, Lihui Li, Marco Barbero ; J Altern Complement Med, 2020 Feb;

[6] TECAR therapy for Peyronie’s disease: a phase-one prospective study. Great evidence in patients with erectile dysfunction]; Carlo Pavone 1, Davide Castrianni, Salvatore Romeo, Enrica Napoli, Manuela Usala, Giuseppa Gambino, Dalila Scaturro, Giulia Letizia Mauro; Urologia; Avril-Juin 2013Your Content Goes Here