Electrical Stimulation

Electrical stimulators are just recently beginning to become available to help strengthen the pelvic floor muscles. They are especially useful in patients that are unable to consciously contract the perivaginal muscles (i.e. they can't do kegals). A lot of time the muscles are so small or atrophied that the patient cannot even get them to contract a little. The electrical stimulators work directly on the muscles and get them to contract. With time, as the muscles get stronger the patient may be able to take over again and stop needing the stimulators.

• Studies have shown some benefit in all types of incontinence--mixed, urge, and stress.
• Unfortunately, many patients want a quick fix with minimal effort on their part and are willing to accept surgery before trying these more conservative techniques. Therefore, many centers do not routinely offer these services. Many physicians are also not that comfortable with these devices because they have not been available very long. They do require a degree of patient education and a qualified nurse is probably the best person to "teach" how to use these devices. This is also true for doing kegals exercises.

How electric simulation works: A small sensor is placed in the vagina and connected to a small portable unit that runs on a 9 volt battery. The device is made to gently stimulate the pelvic floor muscles to contract at various intervals. The intervals are selected by the physician and periodically changed. The muscles get stronger as they contract over and over again.

Women with stress incontinence will slowly notice a benefit as the pelvic muscles get stronger, similar to using biofeedback pelvic floor exercises.

Women with urge incontinence will notice a benefit quickly because of a "bladder reflex arc" that exists. As the pelvic floor muscles contract and the bladder neck muscles contract, there is a nerve impulse that goes to the spinal cord and actually makes the bladder relax and stop contracting. Women with urge incontinence leak because the bladder contracts when it is not supposed to. Therefore, this painless technique can work very well in retraining the nerves in the pelvis and help stop the unwanted bladder contractions.

Disadvantages of electric simulation: Electrical Stimulators are great for some people, however, no technique is perfect.

Initially treatments are started twice a day. Recent studies suggest that most women will benefit from just doing the treatments every other day. Even at this rate, some women do not have the time to spend doing the treatments. Women usually sit and read or watch TV during this time. However, some women can do other household chores while doing the treatments.

Medicaid recently decided not to cover the cost of most of these units. The cost is about $600 for the unit and is yours to keep once purchased. Many other insurance companies, however, do cover the cost of these units.

Lastly, women with stress incontinence that have very weak pelvic floor muscles may have to continue treatments for several weeks before noting improvement.