Electrostimulation in the therapy of the pelvic floor muscles

2020-09-07

EMS neuromuscular electrostimulation is a very effective method in which muscles or motor nerves are stimulated using electrical impulses. When nerve-muscle connections are broken or weakened as a result of an injury, childbirth, or surgery, the natural mechanism of the nervous system triggered by consciousness is unable to cause contraction. In such a situation, the muscles can be stimulated to work intensively by stimuli coming from the electrostimulator. Interestingly, the muscles do not distinguish the origin of the stimulus, i.e. whether it is physiological or artificial.

Electrostimulation allows you to regenerate damaged innervation, strengthen muscle strength and, at the same time, learn to contract them by your own will - involuntary contractions, caused by electrostimulation, help to locate individual muscles and control them consciously. Electrostimulation is used, among others, in in pelvic floor muscle therapy (MDM). The effect of electrostimulation in MDM therapy may be relatively quick. Significant muscle strengthening should occur even after 2-3 weeks of daily treatments lasting several minutes. This depends of course on the degree of muscle weakness and the nature of the medical condition leading to, for example, urinary incontinence.

HOW DOES THE ELECTROSTIMULATION SESSION WORK?

The electrostimulation treatment in the treatment of pelvic floor muscles can be performed both in the office under the supervision of a specialist and at home. A special electrostimulator is used for this, as well as a vaginal probe for women or a rectal probe for men with urinary or fecal incontinence. Often the electrostimulator is equipped with self-adhesive electrodes glued to the skin in the vicinity of the muscle that will be rehabilitated.

Just get comfortable and then insert the probe. The most common positions are lying-sitting (in the case of vaginal stimulation) and lying on the side (in the case of rectal stimulation). Then the parameters of the treatment should be set or use those set by the urogynecological physiotherapist. Electrostimulators dedicated to MDM therapy are equipped with predefined treatment programs characterized by specific parameters regarding the electrical impulse and treatment time, including those dedicated to, for example:

treatment of particular types of urinary incontinence, i.e. mixed, stress and pressure incontinence
pain relief
reducing the degree of prolapse of the reproductive organs
improving the condition of the muscles after pregnancy and childbirth
improving sexual sensitivity
improve the functioning of the pelvic floor muscles during menopause
endurance exercise
relaxation of the pelvic floor muscles

After activating the electrostimulator, the appropriate intensity current stimulates the muscles to work. The therapeutic session usually lasts about 20-30 minutes, and its course is painless and comfortable, so during this time you can read a book or watch your favorite TV program.

After just a few weeks of regular exercise, your muscles should be stronger. The effect that we get is of course dependent on the degree of muscle weakness and the diseases the patient has to deal with, which may affect urinary incontinence.

Some devices also offer the biofeedback method, i.e. the feedback of the biological function of the organism. It allows the user to identify and modify body functions to improve self-control. Muscle activity is measured during muscle contraction and relaxation, by detecting EMG signals of the order of microvolts sent by the muscles (in the case of EMG biofeedback) or by measuring the air pressure in the balloon compressed in the vagina (pressure biofeedback). This activity is visualized on the screen on an ongoing basis. This helps to increase awareness of muscle work and control over them, which motivates further treatment.

IS ELECTROSTIMULATION EFFECTIVE?
One of the studies showing the effectiveness of electrostimulation in urinary incontinence is Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study. In this study, a group of 359 women with urinary incontinence (207 stress urinary incontinence, 33 SAE, and 119 mixed MNM urinary incontinence) were subjected to vaginal electrostimulation for 20–30 minutes a day, 5 days a week for 10 weeks. The test results speak for themselves:

Complete recovery occurred in:

65.7% of women with SUI
57.6% of women with NNM
61.3% of women with MNM

Significant improvement was reported by:

14.6% of women with SUI
24.2% of women with NNM
15.1% of women with MNM

Chêne, G., Mansoor, A., Jacquetin, B., Mellier, G., Douvier, S., Sergent, F., ... & Seffert, P. (2013). Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 170 (1), 275-280.

WHO IS ELECTROSTIMULATION FOR?
The indications for the electrostimulation treatment are:

stress urinary incontinence, i.e. leakage of urine during exercise, e.g. coughing, sneezing, lifting, jumping, running, laughing, etc.
overactive bladder, i.e. sudden and difficult to control pressure occurring in stressful situations or at night and forcing frequent visits to the toilet.
vulvudynia
widened or lowered vagina
decreased sexual sensations
vulva pain
fecal incontinence

However, the contraindications of Kegel muscle electrostimulation include: