Did you know that you can use electrical stimulation to calm a sensitive bladder?
Many women know about stimulation to exercise their pelvic floor muscles. You will find lots of adverts on the internet for electrical stimulation machines to help weak pelvic floor muscles to develop through exercise. You connect a small battery powered device to an internal (vaginal or anal) part (usually called an electrode or probe). Use daily for about half an hour:
- impulses help your brain to correctly identify the location of your pelvic floor muscles
- impulses stimulate the muscles to work, different settings favour different muscle fibres
- you practice exercises with the machine to learn how to contract your muscles without help
- the machine can help you to hold a muscle contraction while you concentrate on learning to breathe or move
Pelvic floor exercise machines can also use electrical stimulation to calm a sensitive bladder.
They do this by sending soothing messages along the nerves which supply the bladder. Think about how you might stroke an anxious cat until it calms down. Your repeated stroking settles the cat’s nervous system. We think the stimulation current does a similar thing for our nervous system.
This is an often overlooked treatment option for overactive bladder syndrome.
What is a sensitive bladder?
Many people have symptoms such as the urgent and frequent need to urinate, or experience strong urge and bladder leakage before they can make it to the toilet. These leaks can be small or very big. Whereas stress incontinence leakage is predicatable (associated with coughing, sneezing, laughing or exercise), sensitive bladders tend to behave more erratically. Many people have “good days” and “bad days”. Or you may have better days than nights or vice versa.
If you have mostly symptoms of urgency, frequency and urge leakage this is usually caused by a condition called Overactive Bladder (OAB). You will only be given a formal diagnosis of OAB if you have had a bladder test, called a cystometrogram (CMG). This test would show that your bladder muscle (the detrusor muscle) is firing off too early, either during the filling cycle (when it should be resting) or as soon as you start thinking of needing a wee. However, you can still treat for OAB (sensitive bladder) based on symptoms, without a formal label.
Can you fix a sensitive bladder?
A sensitive bladder is a long-term condition without a simple cure or fix. You need to develop a package of strategies to manage the problem.
- Your GP may have already suggested you try some medication to calm the bladder nerves and muscle.
- Take time to understand how a bladder works and then carefully review your fluid management and your bladder training habits.
- You should definitely also do traditional exercises to strengthen and tone your pelvic floor muscles. You can do independent exercises or use a stimulation machine to help you if your muscles are weak or fatigue easily. Healthy pelvic floor muscles improve your ability to “hold on” when you experience urge and give you better ability to delay when you need to.
- You can also use a stimulation machine to calm the nerves to the bladder muscle. This treatment is called neuromodulation.
In this video I discuss how to choose the right programme to treat overactive bladder. Also how the stimulation works and what to expect to feel:
What is neuromodulation?
also known as e-stim/NMES/TENS/PTNS or TTNS!
Neuromuscular modulation (also termed neuromodulation) is a conservative (non-invasive) treatment for symptoms of urgency, frequency and/or over-sensitive bladder.
A low frequency electrical current is directed to the nerves which supply the bladder system. For about half an hour daily or twice daily. If using an internal electrode we suggest you start with alternate days initially. Just until these more delicate tissues get used to the process.
There are several different ways to get close to the bladder nerves. You can use a vaginal/anal probe (with the benefit of stimulating the pelvic floor muscles at the same time). Or put skin electrodes on your lower back or skin electrodes at the ankle. Yes you read that correctly! The tibial nerve, running from the back to the ankle, also interacts with the bladder nerve, making this a clever outpost to influence the bladder!
Stimulation to calm a sensitive bladder is known by too many names!
Confused? Your excused!
This treatment for bladders has so many variations and abbreviations such as NMES, TENS, TNS, PTNS & TTNS !! You are right to feel confused.
Nerve stimulation has the same purpose of calming the nerves to the bladder, as the medication for oversensitive bladders. The medications (termed anticholinergics) are notorious for side effects such as dry mouth and constipation. If you are not afraid of tech, muscle stimulation is a low cost, home applied treatment with very few side effects. Yet, these stimulation treatments might only be offered as a last resort.
You can buy electrical stimulation devices directly from the internet. However, I would highly recommend that you work with a physiotherapist for best results. Our clinic has machines you can try before you buy
Neuromodulation with an internal electrode
The advantage of an internal (anal or vaginal electrode) is that you get very close to the nerve supply to the bladder and the pelvic floor muscles. If you need to strengthen and tone your pelvic floor muscles as well you can do both jobs in succession, using different programmes on your machine.
Neuromodulation with skin electrodes
Because these systems have developed overtime, their names can be confusingly different even though the priniciple of the treatment, and how well they are thought to work is considered pretty similar.
In the UK we tend to use all these different words:
For calming the bladder nerves using skin electrodes on the lower back:
- TENS (transcutaneous electrical nerve stimulation)
- SNS (sacral nerve stimulation
- NMES (neuromscular electrical stimulation)
For calming the bladder nerves using electrodes at the ankle to stimulate the tibial nerve,
- TTNS (transcutaneous tibial nerve stimulation) runs the electrical current through surface skin electrodes.
- Note: PTNS (percutaneous tibial nerve stimulation) runs the electrical current through an acupuncture needle at the ankle. This system is usually accessed through a hospital or clinic because it involves needles. Recent research suggests TTNS and PTNS have equivalent effect.
Because it is so easy to reach the ankle to place electrodes by yourself without help TTNS is becoming a popular first option to try.
What programme of stimulation do I use?
Electrical stimulation machines designed for people with bladder problems will come with “pre-set” programmes. You will need to check the instructions for the individual machine. Usually this is a programme called “urge” or “frequency” or “OAB”. These machines may also allow you or your physiotherapist to set a programme customised for you.
Electrical stimulation machines designed for people who mainly want to relieve pain are usually called TENS machines. These machines can also be set to offer the correct current for neuromodulation for the bladder nerves. You will likely need advice from your physiotherapist to set this up.
- The type of stimulation used for bladder neuromodulation is usually a low frequency (10-20Hz) biphasic continuous current. Or a pattern with intermittent short rests eg 8s on/2s off).
- Treatment is usually for about half an hour daily, or twice daily (5 hours + apart). If using an internal electrode we suggest you start with alternate days initially. Just until these more delicate tissues get used to the process.
- You will likely feel a “tingling” sensation during treatment. It should never be sore or uncomfortable or make you want to “back away”. You will not feel muscles working or contracting. This is not a muscle exercise programme.
What else can I do to improve a sensitive bladder problem?
Earlier, I mentioned that stimulation would be part of a package of things you would do to manage this long term condition.
You will also get benefit from
- Keeping bowels regular to prevent pressure and irritation on the pelvic area. See “3 Ps of a Perfect Poo” !
- Understanding how the bladder likes to fill and empty and adjusting our drinking and weeing habits to make the bladder happy
- Improving the strength and holding ability of your pelvic floor muscles
- Supporting your bladder from the front by working on your abdominal/core muscles (have you tried Pilates?!)
- Supporting your bladder from the front by wearing support underwear
- Many women find using washable continence underwear less irritating than bleached pads
Have you tried electrical stimulation to calm your sensitive bladder – or one of the other strategies?
Do inspire other readers by sharing your story below. Or don’t hesitate to ask questions!
