Neuromuscular Electrical Stimulation (NMES)

Your Physiotherapist will discuss whether this treatment is appropriate for you and the risks and benefits of using it. Once you have been allocated a machine, this leaflet should have all the information you need whilst using it at home. Should you have any queries or concerns about using the machine, please see the information below on how to contact us.

What is NMES?

Neuromuscular electrical stimulation (NMES) is a treatment that helps the pelvic floor muscles to squeeze. It can be used to strengthen your pelvic floor muscles.
NMES is often used for patients if they suffer from problems with pelvic floor weakness including bladder leakage, bowel leakage or prolapse. This is because the pelvic floor muscles play an important role in the control of bladder and bowel function as well as supporting the pelvic organs. The NMES helps to increase the awareness of what a pelvic floor contraction should feel like. Exercising your pelvic floor whilst using the NMES machine helps to strengthen the muscles, which can often help to improve your symptoms.

What does the treatment involve?

NMES is applied to the vagina or back passage using a probe that is specially designed for the muscles inside your vagina or back passage*. Once the probe is in position, a fully trained member of staff will attach the NMES machine to the probe.
This will have been set up individually to you, (based on the findings of your examination). The machine sends an electrical signal through the probe to the pelvic floor muscles. The intensity will be increased very gradually, once you feel the ‘tingling’ or ‘tapping’ sensation you will be given time to get used to how it feels. If you become used to it you may feel able to increase this yourself. The idea is to have the sensation of the machine working your pelvic floor muscle strongly but without any discomfort.
NMES is a very well tolerated treatment with no pain and it is very rare to experience discomfort. If discomfort is present treatment will be stopped immediately.
*please note one probe will be supplied per patient free of charge. Due to the cost of these probes lost or damaged probes will not be replaced this will be the patients’ responsibility to replace. Details can be provided on request.

What happens at the treatment appointments?

During the physiotherapy treatment session, your Physiotherapist will provide you with an electrode (probe) and if you feel happy they will teach you how to safely insert it. They will also teach you how to safely use the NMES machine. Please make sure you bring the electrode with you to each Physiotherapy appointment that you attend.
The number of sessions you attend should be determined by the Physiotherapist on the basis of an individual assessment.

Under close guidance you will be in control of turning up the intensity of the treatment. Treatment typically lasts between 10-20 minutes.

What happens when I have completed treatment in clinic?

NMES is a popular treatment and we sometimes have a waiting list. If you and the Physiotherapist are happy that you can use the machine independently and are compliant with pelvic floor exercises you will be added to the waiting list. When a machine is available you will be contacted by telephone and arrange a time to come and collect a machine to be able to use this at home. In order to take a machine home to use we ask that you pay a deposit of £25 and this will be refunded to you when you return the machine.

Alternately you may want to purchase your own machine and information regarding this can be provided by your physiotherapist.

Use of the machine at home

If you have collected a machine to use at home, you will use it 1-2 times per day for 6 weeks, (except during a period). You will then be given an appointment 6 weeks later. It is very important that you return the machine to us at 6 weeks to ensure that it can be loaned to another person on the waiting list.

What happens if I do not return the machine?

If you fail return your machine and or fail to attend follow up without contacting us you will be billed for the full amount of the machine.

Do not use the stimulator if you

• Have a Cardiac Pacemaker.
• Are Pregnancy/actively trying to conceive
• (i.e. may be pregnant).
• Have had recent trauma to the area.
• Are less than 12 weeks after childbirth, or gynae or abdominal surgery.
• Have active cancer in the pelvic or abdominal area that is currently being treated.
• Have had an abnormal recent smear test.
• Have broken skin in the area.
• Have skin damage.
• Have any undiagnosed severe pain.
• Have haemorrhoids or fistula.
• Have peripheral vascular disease.

Please discuss with you physiotherapist if you have

• A non-cardiac pacemaker (e.g. sacral nerve stimulator).
• An allergic reaction to electrode materials (i.e. Nickel) or gel.

Pericalm instructions for use

• Before treatment wash hands thoroughly in hot soapy water covering all areas, rinse and dry or use alcohol gel on physically clean hands.
• Use lubricating gel to cover the metal sides and top of the probe. Insert into the vaginal keeping the metal side to side.
• Connect the lead with the red and black ends to the leads on the probe (it doesn’t matter which colour end attaches to which lead).
• Make sure the lead is connected to the top of the simulation unit (it doesn’t matter which side).
• Turn the stimulation machine on by pressing the button on the top.
• The Physiotherapist has set the programme, it will appear on the screen, you do not need to alter this.
• Your programme is:
  this should be displayed on the screen.
• To start the programme and turn up the intensity press the + button on the same side as the lead connected into the top of the machine.
• Pressing the – button will turn down the intensity.
• Keep pressing the + button until you feel a ‘tingly’ or ‘tapping’ sensation, continue to increase the intensity as high as you can tolerate – it should not be painful (you will notice the pulsing sensation goes off intermittently.)
• You should try to squeeze your pelvic floor muscles when you feel the pulsing sensation.
• During treatment, as you get used to the sensation you will be able to turn it up higher. Keep adjusting it throughout the treatment.
• Treatment time is programmed by your physiotherapist, it is visible on the display screen.
• At the end of the treatment time the stimulation will stop, but remember to switch the unit off at the top.
• Remove the electrode, wash in warm soapy water, rinse and dry thoroughly.
• Repeat hand washing process as above.
• Use the machine once to twice a day at a convenient time for you.
• Please replace the battery if needed by sliding the back of the machine off (your programme will remain set into the machine).