evoStim P incontinence stimulator/pressure-biofeedback/ETS

The evoStim P is a versatile, high-performance therapeutic medical device designed for perineal (pelvic floor) stimulation. It combines pressure-based biofeedback with ETS for treating stress, urge and mixed incontinence, as well as vaginismus.

The evoStim® P offers single-channel electrical stimulation for perineal treatment using vaginal or rectal probes. It also features an additional pressure sensor channel that detects pelvic floor muscle activity.

Its therapeutic goal is to improve voluntary control of the perineal muscles in stress incontinence and to reduce muscle activity in urge incontinence, as well as both in mixed incontinence.

While electrical stimulation of the pelvic floor muscles is passive and effort-free, pressure biofeedback is an active therapy that responds to the patient’s voluntary contractions and relaxations.

The evoStim P provides real-time graphical and/or audible feedback on muscle contractions and relaxations as they occur, motivating the patient to stay aware of their effort and progress. The pressure biofeedback uses a special internal probe with electrodes and a built-in inflatable silicone balloon. The pressure applied to the balloon by pelvic floor contractions is displayed in real time on the LCD display as visual biofeedback, helping the patient understand and stay motivated.

The pressure-based biofeedback function makes pelvic floor exercises more effective.

The ETS function goes further: when the pressure from a voluntary contraction reaches a threshold, the device adds electrical stimulation to boost effectiveness.

We offer various probe types with ring or lateral electrodes. Each allows the most suitable waveform for maximum comfort and best results.

A touchscreen and a rotary knob ensure professional flexibility and performance.

Five main program groups (stress, urge, mixed, pain and relaxation) each include the Intellistim function, which lets you change the stimulation frequency without altering other parameters.

Five quick-select buttons can each be linked to any of the nine available programs instead of the standard one. Although there are nine predefined programs for each incontinence type, each can be customized and fine-tuned for maximum results.

Perineal electrostimulation is performed using special vaginal or rectal probes.

Treatments target the perineal muscle group, especially the pubococcygeus and puborectalis muscles.

The evoStim® P perineal electrostimulation unit (PES) is designed for professional use. Under professional guidance, patients can use it independently at home.

Its purpose is the prevention or treatment of various forms of incontinence and pelvic pain. Treatments can be done with internal probes or surface electrodes, though internal treatment is more effective and faster.

The effectiveness of stimulation is supported by studies:

Pelvic floor strengthening – Electrical stimulation significantly increases muscle activity. When manual muscle testing (PC test) scores 1 (barely perceptible contraction) or 2 (weak contraction), endovaginal stimulation improves it by at least two levels. The effect is due to increased muscle tone and blood flow.

Effect on urethral closure pressure – Studies show that stimulation significantly raises urethral closure pressure.

Effect on bladder structure – There is a clear improvement in bladder tone and a marked reduction in involuntary contractions (detrusor overactivity) with stimulation.

evoStim P at a glance

• Single-channel electrical stimulator with pressure biofeedback.
• Triggered stimulation.
• Five preset, editable 30-minute programs (adjustable 5–90 min): urge incontinence, stress incontinence, mixed incontinence, pelvic pain and EVO rehab program with contraction-triggered stimulation.
• Pressure biofeedback program.
• Large LCD touchscreen with six quick-select buttons.
• Easy to use with multicolor backlight.
• Visual biofeedback (circular and bar charts).
• Audible biofeedback.
• Rotary knob for easy intensity adjustment and quick on/off or pause.
• Battery powered (3 × AAA).
• CE 0051 Medical Device.
• 2-year warranty.
• Made in Italy.

Technical specifications

• Channels: 1 × stimulation and 1 × pressure biofeedback.
• Power supply: 3 × 1.5 V AAA alkaline batteries (LR03), approx. 20 h runtime.
• Waveforms: selectable biphasic symmetric or biphasic asymmetric.
• Stimulation output: 1–99 mApp in 1 mA steps at 1 kΩ load.
• Frequency: 1–150 Hz (± 5 %).
• Resting frequency: 3–5 Hz (± 5 %).
• Pulse width: auto 50–400 μs in 10 μs steps (± 5 %).
• Rise/fall time: 0.3–1 s (auto).
• Plateau time: 1–60 s in 1 s steps (± 1 %).
• Rest time: 0–60 s in 1 s steps (± 1 %).
• Session time: 5–90 min adjustable in 5 min or continuous steps.
• Biofeedback scale: 2–199 cm H₂O selectable.
• Dimensions: 73 × 147 × 25 mm.
• Weight: approx. 200 g with batteries.
• Operating conditions: 5–40 °C, 15–93 % RH, 700–1060 hPa.

Probe options

All electrodes combine plastic and metal. Surfaces are coated with a thin gold layer, suitable even for metal allergies.

Incontinence therapy includes stress and urge urinary incontinence as well as fecal incontinence. Mixed incontinence can be treated with a custom program or by sequential use of stress and urge programs.

For vaginismus treatment, the thin PeriSphera At probe is recommended.

Main probes

• PeriSphera O – vaginal use. General incontinence treatment. For single-channel devices. Compatible with evoStim UG/E/P, Biolito, BioBravo, Myolito, MyoBravo, SineBravo, DuoBravo.
• PeriProbe Analis – rectal use. Fecal incontinence and male urinary dribble treatment. For single-channel devices. Compatible with evoStim UG/E/P, Biolito, BioBravo, Myolito, MyoBravo, SineBravo, DuoBravo.
• PeriProbe VBFT – vaginal use. For pressure biofeedback only. Assessment and exercise enhancement. Non-stimulating. Compatible with evoStim P and for manometry.
• PeriProbe V2STFW – vaginal use. For pressure biofeedback devices. Pressure-triggered ETS treatment. Compatible with evoStim P.
• PeriProbe ABFT – rectal use. For pressure biofeedback only. Assessment and sphincter strengthening exercises. Non-stimulating. Compatible with evoStim P and for manometry.

Main forms of incontinence

Stress incontinence – caused by sphincter deficiency or weakness. Leakage occurs with minor effort (e.g., coughing). Treatment uses high frequencies (35–100 Hz) targeting phasic fibers, with pulse width 100–400 μs based on patient sensation.

Urge incontinence – involuntary bladder contractions prevent reaching the toilet. Stimulation uses low frequencies (5–20 Hz) and pulse width 250–400 μs. Daily in the first week, then 2–3 times weekly for 3–4 weeks. Home use is possible.

Mixed incontinence – about 40 % of cases, combining stress and urge symptoms. Treatment depends on predominant symptoms: low frequency for detrusor inhibition, high for muscle tone. Often urge is treated first, or two daily sessions (urge and stress).

Contraindications for electrotherapy

Electrotherapy (TENS, EMS, MENS, FES, ETS, CES, microcurrent, iontophoresis, denervated, selective, Kotz, interferential, etc.) is safe and side-effect free.

However, any electrotherapy is strictly contraindicated for patients with a pacemaker or implanted defibrillator.

• Do not use within 3 months postpartum.
• Avoid in kidney disease, lower urinary infections, urinary tumors, vesico-ureteral reflux, complete denervation (e.g., post-spinal injury), or midcycle vaginal bleeding.
• Do not use during pregnancy.
• Consult a physician before use in epilepsy.
• Do not use in children under 12 except under strict medical supervision.

Other conditions are not absolute contraindications, but benefits and risks should be assessed by a physician.

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

It is often believed electrotherapy is not suitable for metal implants, prostheses, plates or screws. This is outdated. Read Dr. Zátrok’s article on implants and electrotherapy: Click here.