evoStim E incontinence stimulator / EMG-biofeedback / ETS

The evoStim® E is a professional EMG-biofeedback based ETS device designed for treating stress, urge, and mixed incontinence, as well as vaginismus.

The evoStim® E is dual-channel. One input channel acts as an EMG sensor, detecting the electrical activity of the pelvic floor muscles. The other is an output channel for perineal (genital, perineal area), vaginal or anal probe electrostimulation.

The muscle activity (EMG) based biofeedback function enhances the effectiveness of pelvic floor muscle exercises. It senses electrical activity generated during muscle contractions and provides feedback to ensure correct exercise execution.

The ETS function goes further. If the electrical potential generated by voluntary muscle contraction reaches a set threshold, the device increases effectiveness via electrical stimulation.

Various probe types are offered for the device, including ring-shaped or lateral electrodes. Each allows setting the ideal waveform for maximum treatment comfort and optimal therapeutic results.

Touchscreen and rotary knob assist usage while ensuring professional flexibility and performance.

Five main program groups (stress, urge, mixed, pain, and relaxation) are available, each with Intellistim function (allowing frequency adjustment of stimulation impulses without changing other parameters).

The five quick-access buttons can each be linked to any of the nine available programs instead of the standard program. Although there are nine predefined programs for each incontinence type, all can be customized and fine-tuned for maximum results.

Perineal (pelvic floor) electrostimulation uses special vaginal/anal probes with at least two circular electrodes.

The aim is to stimulate the perineal (pelvic floor) muscle group, especially the pubococcygeus and puborectalis muscles.

The evoStim® E dual-channel perineal electrostimulation unit (PES) is for professional use. Under professional guidance, patients can use it independently at home.

The treatment aims to prevent or treat various forms of incontinence and to manage pelvic pain. Treatments can be performed using internal probes or surface (self-adhesive skin) electrodes, though internal treatments are more effective and produce faster results.

The effectiveness of stimulation is supported by various studies:

Pelvic floor strengthening - Electro-stimulation significantly increases muscle activity. When manual muscle function tests yield low values (1=barely noticeable contraction, 2=weak contraction), endovaginal electrostimulation leads to at least two levels of improvement. Its effectiveness results from excitomotor effects that increase muscle tone and improve local circulation.

Effect on urethral closure pressure - Studies confirm stimulation significantly increases urethral closure pressure.

Effect on bladder structure - Significant improvement in bladder tone and marked reduction of involuntary hyperactivity (bladder contractions) occur due to stimulation.

Probe selection

All electrodes combine plastic and metal. Electrode surfaces are coated with a very thin layer of gold (smoky gold plating), making them safe for use even with metal allergies.

Incontinence therapy covers stress and urge incontinence, as well as fecal incontinence. Mixed incontinence can also be treated with customized programs or consecutive application of stress and urge incontinence programs.

Probe name	Image	Recommended use	Compatibility
PeriSphera O		For vaginal use. General incontinence treatment. For single-channel devices.	evoStim UG / E / P, Biolito, BioBravo, Myolito, MyoBravo, SineBravo, DuoBravo
PeriProbe Anal		For anal use. For fecal incontinence and male urinary dribbling treatment. For single-channel devices.	evoStim UG / E / P, Biolito, BioBravo, Myolito, MyoBravo, SineBravo, DuoBravo

Main forms of incontinence

Stress incontinence typically results from sphincter deficiency or weakness. Characterized by urine leakage with minor exertion, even simple coughing, caused by lack of sphincter muscle activity. Treatment uses relatively high frequencies (35-100 Hz) targeting phasic innervated muscle fibers. Intense, short bursts intervene rapidly. Pulse width varies between 100 and 400 μs depending on patient's subjective sensation.

Urge incontinence due to bladder instability involves hyperactive, rapid bladder contractions causing inability to reach the toilet in time, with leakage of all urine. Treatment uses low frequencies (5-20 Hz) with pulse widths of 250-400 μs. Recommended daily treatment initially (first week), then 2-3 times weekly over next 3-4 weeks. Therapy can be done or continued at home as needed.

Mixed incontinence accounts for about 40% of cases, showing symptoms of stress incontinence combined with urge incontinence or alternating symptoms. Depending on symptoms, low frequency (effective on detrusor muscle inhibitory reflexes) or high frequency (improving muscle tone) can be chosen. Urge incontinence generally responds better and is advised to be treated first. An alternative is two daily differing treatments: one for urge and one for stress incontinence.

Contraindications for electrotherapy treatments

Electrotherapy treatments (TENS, EMS, MENS, FES, ETS, CES, microcurrent, iontophoresis, denervated, selective stimulation current, Kotz, interferential, etc.) are safe and free of side effects.

Very few conditions are contraindications. Based on current data, electrotherapy is strictly PROHIBITED for patients with pacemakers or implanted defibrillators.

Other conditions are not exclusions but require weighing benefits and risks (by the attending physician).

If unsure about applicability, read Dr. Zsolt Zátrok's article on the Élethosszig Egészségesen blog. Click here.

A common misconception is that electrotherapy devices cannot be used with metal implants, prostheses, bone plates, or screws. This is outdated. Read Dr. Zátrok’s article on implants and electrical treatments. Click here.