Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive, drug-free method used to manage bladder control issues. The battery-operated device delivers mild electrical pulses through electrode pads placed on the skin’s surface. It offers a convenient option that can be used alongside established treatments, such as lifestyle changes and pelvic floor exercises.
How TENS Therapy Targets Incontinence
TENS therapy works by sending electrical signals that interact with the nerves controlling bladder function and the pelvic floor muscles. For individuals with urge incontinence, where the bladder contracts involuntarily, the stimulation targets nerves to help calm this overactivity. The electrical impulses interfere with the signals traveling from the bladder to the brain, which can help suppress the sudden, strong urge to urinate.
This nerve modulation is often achieved by stimulating the posterior tibial nerve near the ankle, a technique known as Transcutaneous Tibial Nerve Stimulation (TTNS). Since the tibial nerve shares nerve roots with the nerves controlling the bladder, the electrical current inhibits the reflex causing unwanted contractions. This method helps increase the bladder’s capacity to hold urine and reduces the frequency of needing to use the restroom.
For stress incontinence, which involves leakage caused by physical pressure like coughing or sneezing, TENS focuses on muscle strengthening. The electrical current stimulates the pelvic floor muscles directly, causing them to contract and relax repeatedly. This forced exercise helps improve the tone and strength of these muscles, which are responsible for supporting the bladder and maintaining urinary control.
Essential Pre-Use Safety and Preparation
Before starting TENS therapy, consult with a healthcare professional, such as a physician or a pelvic floor physiotherapist. They can accurately diagnose the type of incontinence and determine if TENS is appropriate. A professional will also provide guidance on the correct device settings and electrode placement, which are necessary for effectiveness.
Certain medical conditions and implanted devices prohibit the use of a TENS machine. You should not use TENS if you have a cardiac pacemaker, an implantable defibrillator, or other active electronic implants, as the electrical currents could interfere with their function. TENS is also contraindicated during pregnancy, over areas of known malignancy, or if you have epilepsy.
It is also important to prepare the skin and the device before each session to ensure optimal electrical conduction. The electrode pads must be applied to clean, dry, and unbroken skin to prevent irritation and ensure the current is delivered effectively. Before starting, check that the device is charged or has fresh batteries, and that all lead wires are securely connected to the unit and the electrode pads.
Step-by-Step Application and Device Settings
The specific placement of the electrodes depends on the type of incontinence being treated. For urge incontinence, the most common external placement is Transcutaneous Tibial Nerve Stimulation (TTNS). One pad is placed on the inside of the ankle just above the bony prominence, and the second pad is placed about two inches higher up the calf. An alternative is sacral nerve stimulation, where pads are placed on either side of the spine at the lower back, over the sacral nerves.
For strengthening the pelvic floor muscles to treat stress incontinence, some devices use an internal vaginal or anal probe, which is inserted and coated with a water-based lubricant. If using external pads for muscle stimulation, one electrode is often placed between the anus and the genitals, with the other positioned at the base of the spine near the tailbone. A healthcare provider should confirm the precise placement for your needs.
Once the electrodes are secured, the device settings must be adjusted for the target condition. For urge incontinence and nerve calming, settings involve a low frequency, typically 10 Hertz (Hz), with a pulse width of approximately 200 microseconds (µs). For stress incontinence and muscle strengthening, a higher frequency, usually 10 to 50 Hz, is used to elicit a strong, yet comfortable, muscle contraction.
Start the session by turning the intensity dial up slowly until you feel a distinct tingling sensation or a noticeable muscle contraction, depending on the goal. The intensity should be strong but remain comfortable and never painful. If the sensation is sharp or stinging, lower the intensity immediately.
Establishing a Consistent Treatment Schedule
Consistency in the treatment schedule is essential for achieving positive results with TENS therapy for incontinence. Most clinical recommendations suggest performing sessions daily, or at least three to five times per week, during the initial phase. Each session should typically last 20 to 30 minutes.
This regular routine helps ensure the nerves are consistently modulated and the pelvic floor muscles receive sufficient stimulation to adapt and strengthen over time. Patients should maintain this schedule for a minimum period of 6 to 12 weeks before evaluating the full effectiveness of the treatment.
Many individuals begin to notice an initial reduction in urgency or frequency within a few weeks of consistent use. If no improvement is observed after approximately 12 weeks, it is necessary to review the treatment plan, settings, and electrode placement with a healthcare professional. Continuing the therapy beyond the initial period, often at a reduced frequency, may be recommended to maintain the improved bladder control.