Dr. Kelly’s Tool Shed: Pelvic Floor Muscle Stimulators

Jul 31, 2023

If you’ve ever leaked pee, or been pregnant, or had a baby, or menopause, you’ve likely heard about pelvic floor muscle stimulators.

Hey there! 👋 It’s me, Dr. Kelly Sadauckas, one of handful of Doctors of Physical Therapy IN THE WORLD who are Double Board Certified in Pelvic Health & Orthopedics. And today, I’m going to attempt to demystify Pelvic Floor Muscle Stimulators for you!!

What is a Pelvic Floor Muscle Stimulator?

This is one of the most common questions I get, with real-life clients, as well as with followers on social media, or general media inquiries.

A Muscle Stimulator, in general, is a device that uses ‘something’ (pads on skin, needles, probes inserted into vaginas or rectums), to deliver an electrical current to a targeted area. If the unit is set up for pain relief, it is called TENS, and if it is set up to contract a muscle, it is called NMES.

(Geek alert: TENS = Transcutaneous Electric Nerve Stimulation; NMES = Neuromuscular Electrical Stimulation)

In an NMES unit, when you increase the input level to a certain point (which you ought to be in control of), it forces the muscle to contract, thereby improving the muscles strength…

They are commonly used on your inner thigh muscles (vastus medialis obliquus, if you want bonus points in Scrabble) after ACL or Total Knee Surgeries. Less common in pelvises. BUT...this doesn’t mean they have no benefit. I fricking LOVE THEM WHEN USED IN A VERY PARTICULAR WAY. Let’s discuss…

Do Pelvic Floor Muscle Stimulators Work?

So here’s the thing, chicken-wing: We know that MOST pelvic problems arise from the pelvic floor muscles being TOO TIGHT, rather than TOO LOOSE. It’s true. Read about it here.

So if my brain is disconnected, and holding the muscles too tight all the time, so the muscles are unhealthy and causing leaks…do I really want to tighten the muscles more? (If it confuses you how a tight muscle can be weak, PLEASE read this blog, or WATCH these funny 1 minute Instagram videos I made that explains it better than words ever could: this one relates to wall sits, and this one to holding a bag of flour all day)

Furthermore, the instructions on most Pelvic Stimulators are THE SAME INSTRUCTIONS that you would use for a THIGH MUSCLE. Namely “crank it up to max tolerance, or forced muscle contraction, then let it run on: 10 seconds, off 20-seconds, for 20-30 minutes.”

Ummm…is that how your pelvic floor muscles work in real life?? 30 minutes of MAXIMAL CONTRACTION for 10-seconds, every 30-seconds. NO!!! It’s not remotely functional. And in my humble opinion, that’s why “adding NMES” to the Pelvic Floor never adds therapeutic benefit to ANY study…but I do believe that if we changed the focus to sensory threshold, that we would see a HUGE therapeutic difference. I’m studying this, in fact, with good initial results. Stay tuned.

But I digress – Dr. K, if you don’t want us to use the Pelvic Stimulator 10-sec on, 20-sec off, to max tolerance/contraction for 20-30 minutes…first off, THANK YOU…but second off, then “how” do we use it?

How do I Use a Pelvic Floor Muscle Stimulator Effectively?

Let's break it down in a super easy way! Here is a 9-minute video, giving you a 3-dimensional view of what we’re talking about, and then supportive text follows, for those of us that learn better from words!

1. Get Comfy:

Find a cozy spot—if doing this vaginally, be semi-reclined with knees supported (pillows work wonders).
If doing this rectally, be sidelying, with a long pillow between your knees.
Just don't do it in the water; it's an electricity thing 😯.

2. Privacy Matters:

Lock the doors and make sure you have some alone time. This is your personal wellness journey! Ideally you’ll have at least 30 minutes–tell your kids that you are cleaning the fans, or deep cleaning the carpet–that should guarantee you privacy.

3. Lube It Up:

Water-based lube is your friend. Don't be shy; a dry probe is a no-go. Use a generous amount for a pain-free experience.
My favorite lubes are Good Clean Love and Slippery Stuff

4. Insert the Probe:

Orient yourself and use the Pelvic Floored Pelvic Clock as a guide. Insert the probe with the shiny metal bits at 12 and 6 o'clock (toward your pubic bone and tailbone).

5. Pick Your Setting:

Options like Stress, Urge, Tone, or Train might be on your device. If you deal with Stress Incontinence, go for the stress setting—it usually calms your bladder too.
If unsure, pick “Train”...the goal is that it is a setting, that once you STOP adjusting intensity numbers, that the signal comes on for 5-10 seconds, then off for 10-20 seconds.

6. Gradually Increase Intensity TO JUST YOUR FIRST SENSATION (or <20):

Stop when you FIRST FEEL a light sensation. Tune into relaxing those spots (front and back at this first “o’clock pair”) with each inhale and exhale, and focusing on if you can feel the device come “on” then “off” accurately.
STOP increasing if you get to 20 and don’t feel anything. Just let the machine run here for 2 minutes, looking at the machine to see that it is in fact, turning on and off, and think to yourself “that’s sure interesting that I can't feel a thing…maybe that’s why I’m having a hard time controlling my muscles!”
STOP if you feel your pelvic muscles tightening and STOP if you feel pain. In these cases, REDUCE the intensity until you no longer feel pain, or you no longer feel the muscles contracting. Sometimes, this might mean turning the unit down to a level that “you can’t feel.” This just means that your brain is not on speaking terms with your muscles…and it needs to be! Similar to the last bullet, leave the probe in place for 2-3 minutes and look to see when it’s on and off, and think “that’s interesting that it’s on, and I feel nothing.”.

7. Focus on “Paired O'Clocks”:

Like fine wines with fab dinners (if you’re into that type of thing), when using a pelvic probe, vaginally, there will be metal parts (electrodes) on two opposing sides.
The rectal probes, or gold ones, usually have metal in a continuous ci (read this post for all about probes). Spend two minutes at 12 and 6 o'clock (focusing on the points at the far front of the vag/rectum, and the far back—the point closest to your pubic bone…and the point closest to your tailbone).
Once you have the initial sensation (or are at level 20, OR are at the level BELOW where it hurt/made the muscles tighten), spend 2-3 minutes focusing on relaxing those muscles with breath… Then, after 2-3 minutes, rotate to another “pair of o’clocks”.

8. Keep It Going:

If you have a rectal probe, or a circular eletrode, you don’t have to physically turn the probe….you just need to change where your mind is focusing on sensations.
If you have a vaginal probe, or a probe with only two, opposing, electrodes, turn the probe a little bit, so that the front goes to the “front-left” corner of your pelvis, and the back goes to the “back right” corner.
Adjust the intensity to “first sensation” (remember it must be less than 20, and must be painfree and not causing a kegel!), then focus on relaxing those two quadrants for 2-3 minutes.

9. Adjust again…and again…

After 2-3 minutes in “upper left, bottom right” focus…
Move to 2-3 minutes in “side to side” focus, so the probes (or attention) is directly to left and right sides.
Then move (probe or attention) again, so that probe/attention is in “back left” and “upper right” quadrants
And, viola, we are back to front/back, 12/6 position again! Wow!!

10. Clean Up and Celebrate:

If we take 2-3 minutes per “pair of o’clocks”, doing these 4-5 positions should take 10-15 minutes, tops!
In the future, if you want more, you can add in other specific exercises, like your Pelvic PT, or my online Pelvic Wellness programs instruct you in!
Wash the probe with soap and water, and give yourself a pat on the back for connecting with your pelvic floor!
Try to channel the “pelvic relaxation” you felt during use and focus of the unit, during daily tasks, even when you are activating your tummy.

How often should I use my pelvic floor muscle stimulator?

For best reprogramming of any muscle, evidence recommends routine use 2-3 times a week for 4-6 weeks, sometimes up to 12-weeks, and sometimes reducing frequency after 6 weeks.

But I have a secret…pelvic dysfunction isn’t like tendonitis. You don’t ‘have’ to do the thing perfectly to elicit changes in the body. Whatever you DO do for your pelvic floor, is a value add, and something to be celebrated.

So if you ‘can do’ the stim unit once a week–heck, even once a month, after your monthly flow (which should be pain free, did you know? ) that is a million percent better than NEVER using the unit.

In general, I tell my clients, use the unit 2-3x/wk (or whatever frequency you can) to supplement what you are doing in your daily life, and your other exercises. Once you are symptom free, continue using the NMES unit for 4 additional weeks at whatever frequency lead you to your gains, then you can put it away in a safe place, in case you need it in the future (or want to do a check in).

I personally use my NMES unit 2x/year–once after my annual gyne visit, and once after a 6-month later breast MRI. This is to keep me up to do date on instructions to give to my people, but also as proactive checks. Generally, there’s no issue, but once or twice, I’ve done a ‘check in’, and low and behold, found 2-3 spots where I had NO SENSATION!! That would have lead to leaks if I hadn’t addressed it! But since I noticed it, I was able to use my unit 1-2x/wk until sensation normalized, then put it away until the next check.

That’s empowerment, if I’ve ever heard about it!!

Thanks, Dr. Kelly! But I Want MORE Pelvic Floor Gains Than I Can Get From a Free Blog Post!

I CAN HELP YOU!

I would love to work with you one:one, either in-person or online! Visit my scheduling site to grab the first available appointment that works for you!

I have a full catalogue of streamable pelvic wellness courses, designed to help nearly any human achieve the pelvis of their dreams! Courses can be completed at your own speed, from the comfort and privacy of your own house, at a fraction of the price of a one:one visit of Pelvic PT! All courses are streamable on your computer, phone and tablet (download the FREE Kajabi app for the latter two--it looks like a blue K, wherever you get your apps from!!), so you have your own personal pelvic coach with you at home, at the gym, or whenever you need a reminder about awesome pelvic tips!!

AND…for every 4 online courses that are sold, 1 is donated to someone in need through our People Before Profits program…improve your pelvis, and improve another person’s life! What else could we ask for?

Thanks for reading!

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