TENS For Urinary Urgency
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Hey there, Bestie! In the past, we’ve talked a lot about urinary incontinence and other urinary dysfunctions. I’ve also touched on the use of a transcutaneous electrical nerve stimulation (TENS) unit for different diagnoses. Today, we’re diving deeper into the use of a TENS unit for urinary urgency and urge urinary incontinence (UUI). Here we go!
What is a TENS unit?
A TENS unit or TENS machine is a small, often battery-powered device that can be connected to sticky electrode pads. These pads can be placed on the skin to deliver an electrical current produced by the TENS unit to the body. These devices are typically used in the treatment of nerve-related pain and other nerve-related conditions. They are minimally invasive since they just use electrodes that stick on the skin and they are relatively cheap to buy. The ongoing costs associated with TENS units are battery replacements and electrode pad replacements for when the pads become less sticky. If you are pregnant, have a pacemaker, epilepsy, or altered skin sensation, a TENS unit may not be safe for you to use. Always check with your physician before initiating use of this type of electrical device.
TENS Unit
How can a TENS unit help urinary urgency and urge urinary incontinence?
While there is variable research supporting the use of TENS units for pain, there is ample evidence that supports the use of a TENS unit for urinary urgency (1). Urinary urgency and UUI are often the result of dysregulated nerve signals.
Let’s review how the bladder works to better understand how a TENS machine can help improve bladder function. We have discussed previously that the bladder is a muscle—the detrusor muscle. Normally, when the bladder is relaxed, it is able to fill with urine. When it is time to urinate, your brain will send a signal to the detrusor to tell it that it is time to pee, and the detrusor will contract (squeeze) to push out the urine. However, with urinary urgency or overactive bladder (OAB), the bladder muscle may spasm as the bladder is filling, giving you the sensation that you have to pee. This might lead you to urinate increasingly often (maybe even every 15 minutes), or it might lead you to experience UUI.
When dialed to specific settings, and placed in the correct spot, the TENS unit has been shown to reduce over activity of the bladder. It delivers a current near the nerves to change the signals being sent and received by the nerves. The reduction in bladder spasms helps the bladder to stay relaxed as it is filling and in turn, reduces the sensation of urinary urgency. TENS units have been shown to work just as well as more invasive procedures such as PTNS (posterior tibial nerve stimulation) (2).
How do I use the TENS unit?
There are two main things you will want to consider in the setup of your TENS unit. First, consider the location and placement of the pads or electrodes. The electrical pads for the TENS unit can be placed over the sacral spine, above the pubic bone (ie over the bladder), or along the lower limb (see graphics below). For the sacral spine setup, you can use two or four electrodes and you will want to place them 1.5-2 inches apart below the level of the back dimples. For the pubic bone setup, use two electrodes 1.5-2 inches apart just above the level of the pubic bone (where you no longer feel the bone but instead feel a squishier surface). For the lower limb setup, use two electrodes with one electrode pad behind and slightly higher than your ankle bone and the other midway up your leg behind your shin bone.
Secondly, you will want to consider the settings of the TENS unit. Different settings emit different current frequencies. For the treatment of urinary urgency and UUI, there are specific frequencies that have been shown to work best. I recommend using the following settings: Frequency of 10-12 Hz; Pulse Width of 200-250 microseconds, Amplitude (intensity) to comfort level (1).
Once you have your TENS unit set up with the correct electrode pad placement and correct settings, you can leave it running for fifteen minutes to an hour or so. I recommend using the TENS unit for one hour at a time most days a week (five out of seven). Most treatments last 8-12 weeks, but you may start to notice symptom improvement in as little as 2-3 weeks (1).
While using the TENS unit, you can carry on with your regular activities. The devices are typically small enough to fit in a pocket or may come with a clip on the back that you can clip onto your pants pocket. The hour you have the device running can be a good time to get any regular chores done or to just sit and relax. Remember not to use the TENS unit in the shower or bathtub as it is an electrical device.
Which TENS unit should I buy?
There are a ton of options out there for TENS units. This can make it really overwhelming when you are trying to find the device right for you. I personally always recommend the TENS 7000 from Amazon. It’s about $30 which is fairly affordable. It comes with batteries and electrode pads, so you don’t have to worry about stocking up on those right away. Most importantly, the TENS 7000 is a basic unit that allows you to change the settings to exactly the way you want them. Many of the units you will find on your search are fancy and may claim to work “the best,” but don't be fooled by this. In order for the TENS unit to give the results you want, you need to be able to program it to the settings I discussed above. Fancier units will have automatic settings that say things like “low back” and “shoulder,” but they do not provide the option of adjusting the actual settings.
I hope this chat enlighTENS you to the potential use of TENS in urinary conditions! Happy TENS-ing!
XOXO,
Your Pelvic Bestie
References:
1. Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG. Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J . 2010;21(9):1065-70.
2. Ramírez-García I, Blanco-Ratto L, Kauffmann S, Carralero-Martínez A, Sánchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: Randomized control trial. Neurourol Urodyn. 2019 Jan;38(1):261-268.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
