Electrical stimulation is effective for individuals who have difficulty identifying or voluntarily contracting their pelvic floor muscles (Kegel exercises). This method uses a device to cause the muscles to contract, strengthening them and improving muscle awareness. This guide provides instructions on how to correctly set up and use the appropriate electrical stimulation device.
The Difference Between TENS and NMES
The device used for strengthening the pelvic floor is often mistakenly called a TENS unit, but the correct technology is Neuromuscular Electrical Stimulation (NMES). TENS (Transcutaneous Electrical Nerve Stimulation) is primarily designed to relieve pain by stimulating sensory nerves. This stimulation produces a tingling sensation but does not cause a strong muscle contraction.
NMES, in contrast, targets motor nerves responsible for activating muscle fibers. When NMES delivers an electrical impulse, it causes the pelvic floor muscles to contract involuntarily, mimicking a Kegel exercise. This induced contraction builds strength, improves muscle function, and increases muscle awareness. Therefore, pelvic floor strengthening requires a device capable of NMES settings, often labeled as an EMS or NMES unit.
Electrode Placement and Preparation
The electrical current must be delivered directly to the pelvic floor muscles using two main methods: internal probes or external surface electrodes. For the internal approach, a slim, specialized vaginal or rectal probe targets the muscles directly. Before insertion, the probe must be thoroughly cleaned and coated with a water-based lubricant gel to ensure comfortable insertion and efficient electrical current transmission.
The probe is inserted, typically positioning the conductive metal plates to face the sides of the pelvis. This maximizes stimulation of the levator ani muscles, the main components of the pelvic floor.
Alternatively, external surface electrodes can be placed on the skin, often used when an internal probe is contraindicated. One common external placement involves placing one electrode pad over the lower abdomen, approximately one inch above the pubic bone. The second external pad is usually positioned on the lower back, near the sacrum or tailbone. This surface method works indirectly by stimulating the sacral nerves that innervate the pelvic floor. Ensure the electrodes are securely placed and the skin is clean for optimal conductivity.
Operational Settings and Treatment Protocol
Properly setting the operational parameters is necessary for achieving muscle strengthening rather than just sensory stimulation. For pelvic floor strengthening, the electrical frequency should be set between 30 and 50 Hertz (Hz). This range promotes a tetanic or sustained muscle contraction, which is necessary for hypertrophy and strength gains.
The pulse width, which dictates the duration of each electrical pulse, is typically set between 200 and 300 microseconds (µs). Setting the pulse width within this range, often around 200-250 µs, helps ensure a therapeutic effect while maintaining comfort. If the pulse width is too narrow, a much higher intensity may be required to elicit a contraction, potentially causing discomfort.
The intensity, measured in milliamperes (mA), must be increased gradually until a strong, yet comfortable, muscle contraction is felt. The goal is to reach the maximum tolerated intensity without causing pain, as higher intensities recruit more muscle fibers for strengthening.
The treatment protocol follows a work-rest cycle to mimic effective exercise. A common cycle is a 10-second “on” period (contraction) followed by a 10-second “off” or rest period, allowing the muscle to recover and minimize fatigue. Each session should last between 15 and 20 minutes. Perform these sessions three to five times per week to achieve measurable improvements in muscle strength.
Important Safety Considerations
Before beginning electrical stimulation therapy, consult with a healthcare professional to ensure the treatment is appropriate. Electrical stimulation should not be used in several conditions.
- During pregnancy or if trying to conceive.
- If you have an active implantable device, such as a cardiac pacemaker or defibrillator, as the current can interfere with their function.
- If you have any active infection, broken skin, or tissue irritation where the electrodes or probe will be placed.
- If using an internal probe with certain types of metal-containing intrauterine devices (IUDs); medical advice should be sought.
Stop the treatment immediately and consult a professional if you experience sharp pain, burning, or increased discomfort during a session.