A therapist can also stimulate your pelvic floor muscles directly with electrical stimulation through a small probe that can be inserted into the vagina or rectum. The vaginal probe is slightly larger than a menstrual tampon. The rectal probe is about the diameter of a forefinger. The electrical energy discharged into the muscle can slowly desensitize the nerves in the area or even cause muscle contraction and then relaxation.
For those who experience too much discomfort with a probe inserted into the vagina or rectum, surface electrodes can be placed above the pubic bones and/or at the sacrum. Electrical stimulation delivered this way can calm pain and spasms, although it cannot cause your pelvic floor muscle to contract and relax. Different kinds of electrical stimulation devices are available for home use, both for internal stimulation with a probe or external stimulation, such as a transcutaneous electrical nerve stimulation (TENS) or similar unit, to ease pain.
The use of electrical stimulation (ES) for the treatment of urinary and fecal incontinence and other related problems such as interstitial cystitis spans a 30-year period. ES is a very popular treatment modality outside the US but only over the past 5 years has this treatment become part of US medical practice for these conditions.
Electrical stimulation is often referred to as pelvic floor muscle electrical stimulation (PFES) or functional ES. PFES is the application of an electrical current to the pelvic floor muscle. PFES combined with biofeedback may prove useful in that the electrical stimulation provides a passive contraction that increases awareness of pelvic floor muscle contractions in general. Applying a low grade electrical current to pelvic floor muscles stimulates the pelvic muscle to contract. Muscle contraction form PFES is a useful addition to pelvic floor exercises in the rehabilitation of weakened pelvic muscles, It can be very beneficial for both men and women who are unable to contract these muscles on command as it may teach the correct action. These electrical currents stimulate and contract the same muscles as Kegel exercises.
PFES is applied to the body by using skin electrodes around the anus or by vaginal or rectal sensors (probes) and may be used in conjunction with biofeedback. The electrical stimulation heightens perception of the pelvic muscle activity and biofeedback reinforces a person’s efforts to control the bladder.
Electrical stimulation is usually combined with a pelvic muscle exercise program.
There are contraindications for PFES and persons with the following conditions should not use electrical stimulation:
- Complete denervation of the pelvic floor (will not respond)
- Demand cardiac (heart) pacemaker
- Unstable or serious cardiac arrhythmia
- Pregnancy or planning/attempting pregnancy
- Broken/irritated peri-anal skin
- Rectal bleeding
- Active infection (UTI/vaginal)
- Unstable seizure disorder
- Swollen, painful hemorrhoids
Therapy for urinary incontinence may be more successful when combined with some life-style changes including weight loss, decreased caffeine, regular bowel movements, hormone replacement, medications, stopping smoking, and drinking 6-8 glasses of water a day. It may be used with active muscle exercise, hormone replacement therapy in women, medication, biofeedback, or other treatments.