Treating Pelvic Disorders with NMES

Recent studies have found using neuromuscular electrical stimulation (NMES) to treat pelvic disorders can have a multitude of benefits.

NMES is a technology used to send electrical impulses to nerves in your body. The impulses cause your muscles to contract, building up their strength. NMES is now being used to treat a number of pelvic disorders, such as urinary and fecal incontinence and postpartum neuromuscular damage.

Pelvic muscle issues can have a significant impact on your life and overall health, and can often feel embarrassing to speak about. But it's important to address the problem by speaking to your healthcare professional.

It's common for muscles in the vagina to lose their elasticity, especially after surgery or childbirth, or as you get older. As the vaginal walls begin to thin, you may begin to struggle with bladder control or feel as if you're not as "tight" down there as you used to be. Using a NMES device can aid in strengthening these muscles and increasing blood flow in the area, encouraging collagen production, reducing elasticity and increasing sensitivity.

While your pelvic floor muscles can be located and exercised without technology (see Kegels), NMES can help locate the right muscles.

"Sensations created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles," explained Amanda Savage, a specialist physiotherapist and advisor at Kegel8 in Cambridge, England.

There are variations of NMES devices. Some use sticky electrode pads applied directly to the surface of the skin, while others use an electrode probe for intravaginal or anal insertion. The pads or probes are positioned over the muscles so the electrical pulses can stimulate the muscles and cause them to contract.

Each electrical pulse lasts around five to 10 seconds. The experience is usually not painful, creating more of a tightening or vibrating sensation.

The benefits of NMES

NMES is a fairly new treatment, and studies on its effectiveness are ongoing, but so far, the results are promising. According to Savage, NMES is less invasive than surgical treatment.

Women who were previously unable to voluntarily contract their pelvic floor muscles found that after eight weeks of consistent intravaginal electrical stimulation, voluntary contraction attempts improved significantly—and the impact of urinary incontinence on quality of life was also improved—according to a 2022 study published in the Journal of Physiotherapy.

Similarly, a 2020 clinical trial conducted on women who had reported weak pelvic muscle strength after childbirth suggested that transvaginal electrical stimulation improved muscle contraction control and increased strength in the muscular wall.

Another benefit of NMES therapy is the customizable nature of the devices.

"It's possible to change the settings to favor different types of muscle fiber and to do exercises in different ways, [for example,] for longer or shorter muscle holds," Savage explained.

While your pelvic floor muscles can be located and exercised without technology, NMES can help locate the right muscles.

As your pelvic muscles get stronger, you can transfer those skills to use outside of the machine.

"You can practice contracting your muscles along with the machine to prepare for 'real life' scenarios where you won't have access to the device," Savage said. "You can use the skills learned when working with the machine to improve pelvic floor practice when exercising without it.

"There is a great deal of anecdotal evidence to support the use of NMES. As a result, the range of devices that are being marketed as pelvic floor rehabilitation devices by means of enhancing or stimulating pelvic floor muscle exercises is increasing," Savage added.

While the limited research on the use of NMES for vaginal issues is promising, further research needs to be done.

Savage explained that in 2019, the Pelvic, Obstetric & Gynaecological Physiotherapy, a United Kingdom professional network, reported there is insufficient evidence to recommend that NMES should be an addition to pelvic floor muscle training, but acknowledged evidence suggesting NMES can be useful, especially in cases where a patient cannot perform a successful pelvic floor muscle contraction by themselves.

"The statement from the POGP also reported that there is some empirical evidence to suggest that NMES alone is as useful as pelvic floor muscle training and can be beneficial in the management of overactive bladder symptoms," Savage said.

The side effects of NMES

NMES has its advantages, but it's advised you only use it alongside the help or advice of a specialist. While it can help improve your pelvic floor muscles, it's important not to become solely reliant on NMES devices and continue to practice pelvic floor exercises on your own.

"There are no significant side effects with this treatment, but more of contraindications," advised Olga Bachilo, M.D., a board-certified plastic surgeon and vaginal rejuvenation expert in Houston. "Women with vaginal piercings, copper IUDs, with existing sexually transmitted diseases, or who are pregnant or nursing are not candidates for the treatments where electromagnetic stimulation is used.

"I also encourage my patients to drink plenty of fluids to stay hydrated during treatments since, just like with any workout, muscles need water," Bachilo said.

If you're suffering from weak pelvic floor muscles, NMES might be worth exploring. Talk to your doctor about the treatment to see if it's right for you.