Urinary incontinence is a widespread problem that affects seventy-five percent of women over 65, and 43% of women aged 50-64. Eighty percent of women who have incontinence are mothers, so it appears to be related to having babies. These are not just numbers, but a reality that many women face. I became interested in incontinence because, as a sex therapist, I know about the value of Kegel exercises for strengthening the pelvic floor. They enhance sexual function across the board in women - desire, arousal, lubrication, and orgasm, and they reduce sexual pain and vaginal laxity. In men, Kegels enhance erection, endurance, and orgasm, and relieve pain.
Kegels can prevent urinary incontinence, prolapse of pelvic organs, and the need for some hysterectomies and bladder surgeries that can have devastating consequences. Also, individuals can avoid having to take medications for incontinence, which can have side effects of dry mouth, constipation, and dizziness.
Kegel exercises involve contracting and relaxing the pelvic floor muscles, which are the muscles that support the uterus, bladder, and rectum. They can be done anywhere, anytime, and are a key part of pelvic floor physical therapy. However, many people find it difficult to follow through on Kegel exercises. They require concentration, and it is hard to remember to do them. When the pelvic floor is weak, it feels like they have no effect, so many women give up.
In France, where there is a relative openness to sex, every woman who gives birth has the option of receiving 20 pelvic floor physical therapy sessions, at government expense, starting about a month after delivery. During a housecall, a nurse inserts her gloved fingers into the woman’s vagina to make sure the woman is doing Kegel exercises correctly. Many women do not do them right. They push down instead of pulling up. They also do not breathe properly. They should exhale during the exertion part of the exercise (the pulling up) and inhale during the relaxation portion (letting go).
Physical therapists in France and the United States use biofeedback to monitor the strength of contractions and electrical stimulation to induce stronger contractions than women can do independently. Biofeedback monitors muscle activity, helping women learn to control their pelvic floor muscles. Electrical stimulation delivers a small electrical current to the pelvic floor muscles, causing them to contract without effort. These devices are available for purchase in the United States but are not covered by insurance.
Several new, non-invasive electrical or energy-based devices can help strengthen the pelvic floor, reduce incontinence, and provide sexual benefits.
These devices are considered integrative primarily because the practitioners who recommend them have an integrative orientation. They are not yet standard of care; they may have been FDA-approved for other indications but are considered experimental for sexual problems and urinary incontinence and are used off-label for these purposes. Questions of efficacy and safety remain about many of them, and most treatments are expensive and not covered by insurance. Several of these treatments are listed below.
Pulsed Electromagnetic Frequency (PEMF) Treatment acts by pulsing an electric current through a coil, creating a magnetic field. It increases nitric oxide production in the endothelial cells lining the blood vessels, causing them to relax. PEMF improves circulation and oxygenation, reduces blood pressure, promotes healing, and increases genital engorgement. Studies show that nitric oxide levels in plasma increase after PEMF application (Kim, 2019). PEMF stimulates cell growth and repair; may improve vulvovaginal atrophy, erectile disorder, and orgasmic difficulties; and help neurogenic overactive bladder and mixed incontinence (stress and urge) (Elhosary, 2022).
Emsella Pelvic Floor Treatment uses a form of PEMF called high-intensity focused electromagnetic technology to strengthen and tone the pelvic floor muscles (Samuels, 2019). It improves urinary incontinence, pelvic organ prolapse, and vaginal laxity in women and sexual function in men and women. Electromagnetic pulses stimulate the pelvic floor muscles as the individual sits in a chair, causing the muscles to contract repeatedly. Usually, six treatments are performed over two weeks.
Neuromuscular Electrical Stimulation devices are similar to transcutaneous electrical nerve stimulation (TENS) units. Electrodes deliver current to the pelvic floor, which causes the muscles to contract rhythmically, without conscious effort. The electrodes can be applied externally to the vulva via tight-fitting shorts, adhesive leads, or intravaginally through a probe (Dmochowski, 2019).
Radiofrequency Thermal Treatment is usually performed by gynecologists and involves inserting a probe in the vagina that delivers painless heat to the vaginal canal and external clitoral and labial tissues (Robinson, 2020). The claim is that it improves circulation and blood flow, stimulates new collagen production, and regenerates nerves. Women have reported improvements in postpartum healing, ability to orgasm, sexual pleasure, vaginal intercourse satisfaction, vaginal laxity, vaginal moisture during sexual activity, mild bladder prolapse, and urinary leakage. Three treatments a month apart are usually recommended.
Red Light Therapy uses red or near-infrared light to stimulate the mitochondria and enhance ATP production. Red light therapy promotes circulation, collagen formation, and healing and reduces inflammation. The light is directed toward the genitals using a wrap, a seat, or other methods. The study of its benefits in women is minimal. Some benefits are reported for vaginal concerns, but not for female urinary incontinence per se (Cleveland Clinic, 2021). Studies have shown that red light therapy can increase testosterone levels and improve penile blood flow, erectile dysfunction, and sexual satisfaction.
The technologies mentioned above have been reported to be helpful by clinicians and consumers, and there is some research to support their effectiveness. However, they are not yet FDA-approved for the treatment of urinary incontinence and sexual problems, and they are costly and may carry risks. If you want to receive these treatments, conduct thorough research, consult with consumers who have used them, and seek advice from specialists with no financial stake. I recommend first exploring diverse integrative and conventional interventions discussed in my book, “Integrative Sexual Health,” which is a volume in the [Dr. Andrew] Weil Integrative Medical Library. Be patient and do not give up on them prematurely.