Will Electrical Stimulation (E-Stim) Help My Pelvic Floor?

Electrical stimulation (e-stim) of the pelvic floor muscles is often used in clinic or at home to help improve incontinence and prolapse symptoms. Pelvic floor muscles are an essential part of our body that provide support to the bladder, bowel, and uterus. When the pelvic floor muscles are not working as optimally as they could be it can lead to a range of challenges such as urinary incontinence, pelvic organ prolapse, and even pelvic pain. Fortunately, there are several ways to strengthen and optimize these muscles, and one of them is electrical stimulation.

What is Electrical Stimulation?

When electrical stimulation (e-stim) is applied to the body, it creates a flow or current of electrically charged particles, which in turn creates physiological changes in the tissue through which the charge flows. Electrical stimulation of the pelvic floor is a non-invasive treatment method that involves the use of electrical current to stimulate the pelvic floor muscles. This can be achieved through the use of a device that sends electrical impulses to the pelvic floor muscles through electrodes attached to the skin or through a probe inserted into the vagina. The electrical impulses cause the muscles to contract and relax, which can help to strengthen them over time. Pelvic floor electrical stimulation is usually a pulsed “bi-directional and biphasic” current. This means that charged particles move in one direction, drop to zero, and then change direction. This type of current reduces the chance of skin and tissue irritation. Different frequencies and other parameters of stimulation are used for different goals. For example, we may use different settings for calming an urgent bladder compared to those we would use to strengthen the pelvic floor muscles.

How is Electrical Stimulation Delivered?

ES : Electrical Stimulation or E-Stim can be delivered via several different options and can be external or intravaginal.

• NMES : Neuro Muscular Electrical Stimulation : used to cause muscle contractions eg when strengthening the pelvic floor muscles
• FES : Functional Electrical Stimulation : causes a muscle contraction that is functional, or the same as one we use in everyday life eg bending your elbow to bring hand to mouth.
  This is most often used in stroke rehabilitation.
• TENS : Transcutaneous Electrical Nerve Stimulation: stimulates sensory (feeling) nerves via skin (cutaneous) electrodes. This is most often used for pain and calming bladder an bowel urgency
• SNS / SNM : Sacral Nerve Stimulation / Sacral NeuroModulation: two names for the same thing : implanted stimulators that affect the sacral nerve roots. This is most often used for bladder and bowel urgency and incontinence.
• SNS: Spinal Nerve Stimulation : an implanted stimulator that directly affects the spinal nerves. This type is most often used for pain.
• PENS : Percutaneous Electrical Nerve Stimulation : stimulates nerves via needles inserted near the nerve : often used in clinics or hospitals by pain specialists for spinal nerve stimulation with the patient sedated
• PTNS: Posterior tibial nerve stimulation : is done by inserting a very small electrode through the skin of your lower leg. The electrode is connected to an electrical stimulator (pulse generator) outside your body. The stimulator sends pulses to the electrode, which stimulates the tibial nerve in your leg. That electrical current then affects the nerve in your lower back that controls bladder and pelvic floor function.

Both PTNS and SNM have been shown to be effective in managing urinary incontinence. A study published in the International Journal of Urology found that PTNS was effective in reducing the number of incontinence episodes in women with overactive bladder syndrome. Another study published in the Journal of Urology found that SNM was effective in reducing urinary incontinence in patients with refractory urgency urinary incontinence.

What Does Pelvic Floor Muscle Electrical Stimulation Help With?

Research suggests that electrical stimulation can:

• Increase the proportion of fast twitch fibers of the pelvic floor muscles
• Increase the number and strength of slow twitch fibers of the pelvic floor muscles making it easier to achieve stronger pelvic muscle contractions
• Help reduce bladder over-activity and bladder contractions that cause urge incontinence, and frequency problems
• Help reduce anal incontinence and urgency
• Help reduce the experience of pelvic pain

What Are The Benefits of Electrical Stimulation For The Pelvic Floor?

There are several benefits to using electrical stimulation to optimize the pelvic floor muscles. It is a non-invasive treatment method, meaning that it does not require surgery or medication. Additionally, it is a relatively quick and painless process that can be done in the comfort of your own home or local clinic. Electrical stimulation of the pelvic floor is particularly useful for people who have difficulty performing Kegel exercises, which are the most common way to strengthen the pelvic floor muscles. Kegel exercises involve contracting and relaxing the pelvic floor muscles repeatedly, but many people find it difficult to identify and engage these muscles. Research shows that intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles. 

Research comparing pelvic floor muscle training vs electrical stimulation or in combination is conflicting.  One study showed that IVES can partially improve the symptoms of female patients with urinary incontinence compared with the control group. However, it still needs to be further evaluated through more high-quality research in the future. Another study showed that both surface electrical stimulation and intra-vaginal electrical stimulation are important treatments to improve the stress urinary incontinence. Both improved quality of life, urinary leakage, and strength and pressure of pelvic floor muscle contraction.  This small study did not find that the addition of electrical stimulation gave any additional benefit than pelvic floor muscle training alone but did find that electrical stimulation may provide benefit to hypertensive muscles.

Is Electrical Stimulation More Effective Than Kegels?

There have been several studies that have looked at standard pelvic floor muscle exercise and physiotherapy vs electrical stimulation.  This one did not find one more beneficial than the other. It will be interesting to see the results of this study that is looking to see if pelvic floor muscle training combined with electrical stimulation will increase effectiveness.  This study looked at PTNS compared with pelvic floor muscled training and electrical stimulation and found that PTNS was superior while this study showed no difference between PTNS and PTNS combined with pelvic floor muscle training.

Who Should Not Use Electrical Stimulation?

For external electrical stimulation, the following people should not use this treatment;

• Cardiac pacemaker or cardiac arrhythmia
• Pregnancy or planning a pregnancy
• Broken/irritated skin in the rectal, vaginal or perineal area
• Rectal bleeding or haemorrhoids
• Bladder or vaginal infections
• Seizure and dementia conditions

For internal electrical stimulation check with your health professional before using internal electrical stimulation if you have:

• an IUD - do not use with a copper IUD. Check with your doctor if you have a Mirena or similar.
• a pessary in place, you can remove it before and then replace it afterwards if you have been taught how - check with your treating health professional
• had hip joint replacement if using internally for pelvic floor - check with your doctor

Are There Home Use Devices?

The Yarlap device is a medical device designed to help women improve their pelvic floor muscle tone and strength. It is an FDA-cleared device that uses intravaginal neuromuscular electrical stimulation (NMES) to strengthen the pelvic floor muscles with contraction and relaxation. The device is easy to use and can be operated by anyone. To start, you need to insert the device into the vagina and turn it on. The device will then deliver a series of gentle electrical impulses to the pelvic floor muscles, which will contract and relax in response. These movements help to strengthen the muscles and improve their resting tone, which can help alleviate issues such as incontinence and pelvic pain. Kegels are evidence based and effective when done correctly and consistently.  Coordinating them into whole body movement is an effective way to reduce incontinence and prolapse symptoms.  The Yarlap is a great device to add to your pelvic health routine to compliment your kegel practice.

What is The Yarlap Story?

The Yarlap is a father/daughter team with amazing credentials.  Brent Reider is the creator and president of Yarlap^®. Brent Reider designs FDA Cleared Class II medical equipment (7 devices personally, including the Yarlap^®). Brent is internationally recognized as a leader in bio-mimicry electrostimulation including neuro plasticity device design. His devices are also used by the National Healthcare systems of France, Germany, Scandinavia and Great Britain. Brent’s patents are for patient safety and maximum exercise efficiency. Brent is an author and referee for medical and scientific peer review journals (the female orgasm is the subject he referees). “Role of Pelvic Floor Muscles in Female Orgasmic Response” (J Women’s Health Issues Care Vol: 5 Issue: 6) is a recent British peer review open access article.

MaryEllen Reider is the co-director of Yarlap^®. MaryEllen spends a lot of time researching and finding out what’s new in the pelvic floor world and the social media realm. She strives to empower women through their pelvic floor muscles. She enjoys getting to know her customers through social media and speaking events, and inspiring people about why the Kegel exercises and Yarlap^® are so important. MaryEllen and her dad have emerged as a leading voice in the pelvic floor and sex tech wellness space.

The Yarlap is;

• FDA cleared and clinically proven
• Small and comfortable
• Made with 100% medical grade components
• Users have experienced results in 2-12 weeks
• Can be customized in intensity so that users always feel comfortable

As with many things in health care, the use of e-stim is highly individualized.  We can use evidence to guide us, however, we need to consider the individual.  Electrical stimulation is a cost effective and easy to use treatment that can be used alone or in conjunction with other therapies.  There is not a ‘one size fits all’ approach and it is often a combination approach that can bring the most robust results. We must also consider what will allow the individual to be the most compliant because consistency will always be an essential component to the success of any therapy.

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