When is electrical stimulation of the pelvic floor muscles used or recommended?
Electrical stimulation is commonly used or recommended to:
• Help a woman locate, identify and isolate her pelvic floor muscles
• Increase the strength of her pelvic muscle squeeze
• Help to relax the pelvic floor muscles
In Australia today, electrical stimulation is most frequently used and recommended for women who have reduced pelvic floor muscle tone, sometimes with nerve damage, and who cannot locate and identify their pelvic floor muscles voluntarily. For these women electrical stimulation is often recommended as a first step in a therapy programme; once they can feel and voluntarily contract their pelvic floor muscles for themselves, these women have the choice of continuing with the stimulation to gain strength, or switching to a feedback-assisted or unassisted exercise program.
Electrical stimulation can be used alone, or alongside biofeedback therapy.
What's the science behind electrical stimulation?
Research suggests that electrical stimulation can:
- Increase the proportion of fast twitch fibers of the pelvic floor muscle
- Increase the number and strength of slow twitch fibers of the pelvic floor muscle make it easier for a woman to achieve stronger pelvic muscle contractions.
- Help reduce the bladder activity and bladder contractions that cause urge incontinence, and frequency and urgency problems
How does electrical stimulation work?
When electrical stimulation 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. Therefore if you apply electrical stimulation to the pelvic floor muscles, you can create changes in these muscles.
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 irritation.
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Who can benefit from electrical stimulation of the pelvic floor?
Electrical stimulation may be able to help people with:
• Stress and urge urinary incontinence
• Bladder urgency
• Pain during urination
• painful sexual intercourse
• Period pain
Who should not use electrical stimulation?
Some people cannot use electrical stimulation including those with
• Complete denervation of the pelvic floor, as they will not be able to get a response
• 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
Terms associated with electrical stimulation of the pelvic floor and what they mean.
Electrical stimulation is described in terms of four settings:
- Amplitude is the measure of intensity of the electrical current, and is usually expressed as mA. Electrical stimulation devices allow a user to control the level of intensity, which should be at a level that can be felt but should not cause discomfort. Evidence suggests that, in order for the stimulation to be effective, the mA must be sufficiently high for the anus to contract reflexively.
- Ramping is the speed at which the electrical current reaches the muscle . The more slowly the current rises to its maximum intensity, the more comfortable the stimulation will usually feel. With a faster ramp, it is more likely that the user will feel some discomfort.
- Frequency refers to the number of pulses that are generated per second and is expressed as HZ and pronounced “hertz”. The best frequency for electrical stimulation varies according to the nerve being targeted and this depends on the condition being treated. Generally, stress urinary incontinence is treated with frequencies between 35-50HZ and urge incontinence with frequencies between 10-15HZ.
Higher frequencies build strength by bulking up muscle and therefore increasing the ability of the pelvic floor muscle to close the urethra and prevent the leakage associated with stress incontinence. Low frequencies have a calming effect on the bladder muscle and therefore reduce bladder contractions. However, patients with urge incontinence can often benefit from high frequency treatment, as well as low frequency, as increased muscle strength also helps with controlling the urge to urinate.
- On/off time. On time is the amount of time that the electrical stimulation is active. Off time is the amount of time when there is no electrical current from the device to the muscle. Off time is important to allow the muscle to recover. Pre-set programs are often based on an equal amount of on/off time (for example, 5 seconds on, five seconds off) but some use a 1:2 ratio (eg 5 seconds on, 10 seconds off).
