Conservative Treatment

Electrical Stimulation

Although Kegel’s exercises remain a better choice as first-line conservative therapy, another treatment option for USI or OAB is the use of electrical stimulation (ES).

The use of electrical stimulation for the treatment of urinary and fecal incontinence and other related problems such as interstitial cystitis spans a 40-year period. ES is a very popular treatment modality and has this treatment become part of medical practice for these conditions.

The use of electrical stimulation for the treatment of urinary and fecal incontinence and other related problems such as interstitial cystitis spans a 40-year period. ES is a very popular treatment modality and has this treatment become part of 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.

The pelvic floor muscles are directly stimulated 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. Muscle contraction form PFES is a useful addition to weakened pelvic muscles.

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.

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
  • Pregnancy or planning/attempting pregnancy
  • Rectal or vaginal bleeding
  • Active infection (UTI/vaginal)

In our long practice since 1980, particular attention must be paid to the following requirements:

  • The duration of the impulse should be as short as possible but long enough to elicit a contraction;
  • Use of biphasic current is better than monophasic;
  • In case of weakness, a duty cycle ratio of 1:3 may be appropriate;
  • The length and frequency of sessions depends on the severity of the incontinence;
  • To reduce the problem of discomfort, the amplitude of the stimulus is progressively delivered.

Women who require electrical stimulation to activate their pelvic floor muscles use small home units. There are many different types of units and vaginal sensors available. The vaginal sensor- needs to lie as closely as possible to your pelvic floor muscle group

Different probes have been designed to provide good muscle contact. It also has a space that accommodates any weakness of the front or back vaginal walls (prolapse)

Electrical stimulation should not be painful. Women often describe the sensation as a ‘tingling’ or ‘buzzing’ that is felt around the pelvic floor muscle area. The metal part of the vaginal sensor needs to have a coat of lubricating gel such as KY or aquagel. This gives really good contact between the sensor plates and makes stimulation more comfortable.

Very weak muscles become tired very easily. Units should activate your muscles for a few seconds and then give you at least double rest time. If the stimulation lasts for 5 second then you need 10 seconds to allow the muscle to relax before the next stimulation phase.

Stimulation is part of a pelvic floor rehabilitation process. Any unit is best used under the guidance of a physiotherapist or health professional caregiver in pelvic floor health.

A new method of stimulation does not involve any insertion devices and is safe and convenient to use in the comfort of your own home. The device stimulates the nerve tree as it branches throughout the pelvic floor. Targeted impulses are sent via conductive pads producing over 180 perfect contractions per session. Users can actually feel their entire pelvic floor muscles being “lifted” without having to do any voluntary activation.

Extracorporeal Magnetic Innervation. This technology produces highly potent magnetic fields which vary in time and intensity. The field is able to penetrate deep into the perineum, activating the pelvic floor muscles by stimulating all branches of the pudendal and splanchnic nerves.