WHAT IS ELECTRICAL STIMULATION?
Intravaginal or external electrical stimulation is utilized to facilitate a pelvic floor contraction to regain motor control. The electrical stimulation or “estim” recruits the dormant musculature to regain motor pathways to the brain. The use of estim in conjunction with verbal and tactile cueing from the physical therapists allows for return of voluntary contraction.
WHO CAN BENEFIT FROM ELECTRICAL STIMULATION?
Electrical stimulation is indicated for patients with very poor strength and motor control. This means when the pelvic floor physical therapist grades the patient with a manual muscle test they score a 0 or 1 out of a possible 5, or these patients have little to no ability to contract the pelvic floor voluntarily (poor motor control) and potentially bear down (forcefully lengthen) or recruit other musculature to compensate (inner thighs, abdominals, gluteals). A true pelvic floor contraction should be performed in isolation with a ‘squeeze and lift’ movement and should take as little effort as opening and closing your fist. Indications for use include urinary incontinence including stress, urge, and mixed incontinence, and fecal incontinence. Contraindications for use include: active infection, pelvic pain, pregnancy, postpartum or post surgical (6 weeks), atrophic vaginitis, dyspareunia (painful intercourse), menstrual period, and pacemaker.
There are similar devices sold over-the-counter such as the “INTONE”, however, caution should be used before purchasing these devices. Only a trained professional can assess if you are properly contracting the pelvic floor muscles. Without a professional evaluating your ability to recruit the pelvic floor muscles you could be practicing incorrectly and potentially worsening the condition. It is also worthy to note that not everyone is a candidate for Kegels especially someone experiencing pelvic pain. As a general rule, if you experience pelvic pain avoid Kegel exercises and any electrical stimulation.
I have had several patients come in to my office who use an APP of some kind to “practice their Kegels” or the INTONE device that were actually bulging their pelvic floor instead of contracting. It’s no wonder they were not getting better. Unless a physical therapist gives you an internal exam there is no guarantee you are performing Kegels correctly.