Can electrical stimulation treat incontinence?

When it comes to treating incontinence, clinical guidelines recommend conservative interventions, targeted to the type of incontinence, as the first-line treatment approach.

Conservative treatment is defined as ‘interventions that do not involve use of drugs or surgery’ and includes different forms of electrical stimulation.

Electrical stimulation

Functional electrical stimulation (ES) may be used to treat urinary and faecal incontinence. Research evidence has shown that electrical stimulation can effectively treat:

• Stress urinary incontinence (SUI).
• Urge urinary incontinence (UUI).
• Mixed urinary incontinence (MUI).
• It is also used to treat faecal incontinence (FI).

Although the complete mechanism of action is not fully understood, there is an important difference in how ES produces its effects:

• ES used to treat SUI, MUI and FI affects the striated muscles, not the nerves.
• ES used to treat UUI and MUI affects the nerves controlling the bladder, not the muscles. This is also known as neuromodulation

How it works

Electrical stimulation (ES) commonly involves a programme of treatment sessions delivered via surface, intra-vaginal or intra-anal electrodes:

• Intra-vaginal ES causes the pelvic floor muscles to contract. This treatment may be used to enhance the effects of voluntary pelvic floor muscles exercises. ES builds strength and endurance of the striated pelvic floor muscles and their ability to respond quickly. This is useful in the treatment of SUI and MUI.
• Intra-anal ES targets the striated muscle of the external anal sphincter (EAS) to build the strength, endurance and reactivity of the sphincter and also to allow the person to increase their awareness of how pelvic floor muscle and sphincter contraction feels. This is useful in the treatment of FI.
• Transcutaneous posterior tibial nerve stimulation (TPTNS) targets the tibial nerve in the person’s ankle. It uses surface electrodes to stimulate the tibial nerve and access the sacral nerve plexus. Tibial nerve stimulation is thought to have two effects:
  1. It reduces the frequency and intensity of the urgency sensation
  2. It increases the person’s functional bladder capacity

  This type of stimulation is used to treat UUI and MUI.

Tibial nerve stimulation can also be given by inserting a needle into the person’s ankle, which is known as percutaneous tibial nerve stimulation.

Further reading

If you would like any further information, you may find the following websites useful:

• The Cochrane review of non-invasive electrical stimulation for treatment of stress urinary incontinence in women^[1]
• The Cochrane review of electrical stimulation with non-implanted electrodes for urinary incontinence in men^[2]
• The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review.^[3]

For a good summary of conservative treatment of faecal incontinence, including electrical stimulation:

• Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence^[4]

References

_{1. Stewart F, Berghmans B, Bø K, Glazener CMA. Non-invasive electrical stimulation for stress urinary incontinence in women. Cochrane Library. December 2017. [Cited 28 August 2018]. Available from: https://www.cochrane.org/CD012390/INCONT_non-invasive-electrical-stimulation-stress-urinary-incontinence-women}

_{2. Berghmans B, Hendriks E, Bernards A, de Bie R, Omar M. Electrical stimulation with non-implanted electrodes for urinary incontinence in men. Cochrane Library. June 2013. [Cited 28 August 2018]. Available from: https://www.cochrane.org/CD001202/INCONT_electrical-stimulation-with-non-implanted-electrodes-for-urinary-incontinence-in-men}

_{3. Booth J, Connelly L, Dickson S, Duncan F, Lawrence M. The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review. Neurourology and Urodynamics. 2017 July;37:2. [Cited 28 August 2018] Available from: https://doi.org/10.1002/nau.23351}

_{4. Scott M. Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence. Clinics in Colon and Rectal Surgery 2014;27(03):99-105. [Cited 28 August 2018] Available from:https://doi.org/10.1055/s-0034-1384662}