How to use a Pelvic Floor Muscle Stimulator…which is not a Vibrator…
High up on the list of the most common questions I am asked on a daily basis is this one:
“Dr. Kelly, how do I use a [pelvic floor muscle stimulator]?
I put it in [ ] because people don’t know what to call these:
– Are they vibrators or ‘sex toys’? Nope.
– Are they NMES units? Yes
-Are they TENS units? Not really. But kind of.
In addition to being embarassed to ask what they are called, people are often REALLY embarassed to ask about how to use them…but they shouldn’t be.
Here’s a 9 minute video instructing you…and extra info after, if you have time.
How to use a Pelvic Floor Muscle Stimulator
1. Assume the Position
Semi-reclined, knees supported (pillows are good, as shown in video), but NOT IN THE WATER, as you will be using something with electricity. Water will break the unit, and maybe give you an unpleasant tingle (these are AA batteries, not power lines…but still…don’t be stupid).
2. Ensure you are Warm. Comfortable. Private.
There are times when it’s okay for your kids or partner to come in…maybe this isn’t one of them. Lock the doors, and ensure you have privacy.
3. Lubricate the Probe
Water-Based is best. We love Slippery Stuff and Good Clean Love, but there are others out there, too.
Don’t be bashful. A dry probe is a painful probe. Use quarter sized at tip if inserting vaginally, half-dollar sized if inserting rectally (remember, rectal tissues in general are drier). Use twice as much as you think you need the first time…then adjust from there.
4. Insert the Probe
Be oriented. Use the Pelvic Floored Pelvic Clock for guidance, and insert probe with electrodes (the shiny metal thingy’s) at 12 and 6 o’clocks (top and bottom; towards pubic bone and coccyx), to start.
5. Select Setting
Usual Options are Stress, Urge, Tone or Train. They all vary, but key point is that Stress setting USUALLY also include a setting that calms bladder, as well as gives sensory input to muscles. If you have Stress Incontinence (leaking with jumping, sneezing, laughing), and this is an option, choose it.
Otherwise, see if the settings have ‘on’ times and ‘off’ times. Usual Tone and Train are ‘on’ for 5 seconds and off for 8-10 seconds. This is better than ‘on’ all the time, becuase when it is ‘on’ all the time, you don’t get practice turning on and off the muscles.
6. Gradually Increase Intensity to Medium
Well…light is first sensation….high is muscle contraction and it hurts…medium is in between. Find it.
Medium may be different for each pair of o’clocks.
7. Spend 2 minutes at these o’clocks
You can just sit there and see if you can feel each of the two (12 and 6, to start). Or, you could try to do a slow kegel when you feel the stim occuring, hold for 3-5 seconds, then RELAX fully. Repeat this for the 2 minutes.
Remember, the relaxation is as important, if not moreso, than the contraction. Most dysfunctions are caused by the pelvic muscles being too active. Estim can actually help you learn to relax the muscles, but only if you do it appropriately! Be mindful of this and be sure your pelvic muscles are truly relaxing fully between each contraction.
If you’re unsure, or if you feel estim is making you worse, then consult a pelvic PT in person or via telemedicine.
8. Then turn to the next o’clocks, 2 minutes, then move
After 12 and 6, turn the probe ‘a bit’ to 1 and 7. This reaches new muscles, so you might need a new intensity level (higher or lower) to reach the medium sensation. (3 and 9 is directly sideways, so think of moving the prove 1/3 of the way from up and down to totally sideways, and you’re likely near 1 and 7.
9. Continue for 10-12 minutes, until you have reached all the muscles
After 2 minutes at 1 and 7, then move to 2 and 8, then 3 and 9; 4 and 10; 5 and 11; and viola back to 12 and 6! 12 minutes and you can be done!
10. Depending on time, you can be done, OR let probe rest for additional 8-10 minutes, for total of 20 minutes.
Studies are inconclusive on efficacy of muscle stim…but in my 16 years of practice (as of time of this initial writing), I think that is becuase the studies weren’t necessarily also instructing clients in the importance of RELAXING after each contraction. In practice, when I recommend these units to people, and they understand the point is to connect with their bodies and improve the tightening AND the relaxing (or in some cases, just working on relaxing), they work wonders.
11. Wash probe with soap and water, and congratulate yourself on connecting with your pelvic floor!
Easy disconnect. Clean with soap and water. Air dry. Done and ready for next time.
Most folks will benefit from doing this 2-3x/wk for 4 weeks, then 1x/wk for additional 4-8 weeks, until symptoms are controlled. Even 1x/wk for those 8 weeks can be hugely beneficial.
Once symptoms are controlled (meaning, YAY, you’re happy with where you are), keep doing that frequency of E-stim for one additional month, to cement the neuromotor gains.
This is generally safe for all non-pregnant people, and safe to begin at 4 weeks post-partum, assuming all tissues are healed. It is not cleared for use in pregnancy, due to lack of studies surrounding safety. So don’t use a vaginal Estim unit if you are pregnant.
Surface electrodes are okay for back pain, etc, in late pregnancy and delivery, BUT NO VAGINAL OR RECTAL PROBES until evidence tells us otherwise.
Thanks for Reading!
Check out my Pelvic Floored Signature Lecture Series for a much more in depth training of how your current pelvic floor musce status could be contributing to your pain, incontinence, constipation, pelvic organ pressure, or sexual dysfunction complaints. The program includes 12 mini lectures, and 12 progressive exercise programs that I developed based upon current research, as well as my 16 years of experience in pelvic health. You can stream them as often as you’d like from the privacy of your home
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