evoStim P incontinence stimulator/pressure-biofeedback/ETS

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

The evoStim® P provides one-channel electrostimulation for perineal (genital and perineum area) treatment using vaginal or anal probes. It also features an additional pressure sensor channel that detects pelvic floor muscle activity.

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

While the electrical stimulation of the pelvic floor muscles is passive and effortless, the pressure biofeedback is an active therapy method based on voluntarily repeated contractions and relaxations of the pelvic floor muscles by the patient.

The evoStim P shows muscle contractions and relaxations in real time with graphical and/or audible signals, motivating the patient to be aware of their effort and progress. The pressure biofeedback is achieved using a special internal probe equipped with electrodes and a built-in compressible silicone balloon. The pressure exerted by the pelvic floor muscles during voluntary contractions is visually represented on the LCD display as visual biofeedback to aid patient understanding and motivation throughout therapy.

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

The ETS function goes beyond that. If the pressure increase triggered by voluntary muscle contraction reaches a threshold, the device enhances effectiveness through electrical stimulation.

Various types of probes are recommended for the device, including ring or lateral electrode placements. Each probe supports the selection of the most suitable waveform for maximum treatment comfort and best therapeutic outcome.

The touchscreen and rotary knob facilitate use and ensure professional flexibility and performance.

The five main program groups (stress, urge, mixed, pain, and relaxation) each include an Intellistim function, allowing adjustment of the stimulation pulse frequency without modifying other parameters.

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

Perineal (pelvic floor) electrostimulation is performed using special vaginal or anal probes.

The treatments target stimulation of the perineal muscle group, especially the pubococcygeus and puborectalis muscles.

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

The device is intended to prevent or treat various forms of incontinence and pelvic area pain. Treatments can be performed with internal probes or surface (adhesive) electrodes, though internal treatment is more effective and faster in yielding results.

The stimulation effect is supported by various studies:

Pelvic floor strengthening – Electrostimulation significantly increases muscle activity. When manual muscle function testing (PC test) scores 1 or 2 (1 = barely perceptible contraction, 2 = weak contraction), endovaginal electrostimulation results in at least two-point improvements. The efficacy stems from excitomotor effects that increase muscle tone and improve local circulation.

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

Effect on bladder structure – Stimulation leads to clear improvement in bladder tone and significant reduction in involuntary overactivity (bladder contractions).

Summary of evoStim P

• Single-channel electrical stimulator with single-channel pressure biofeedback.
• Trigger-activated stimulation.
• Five pre-set, editable 30-minute stimulation programs adjustable between 5-90 minutes: urge incontinence, stress incontinence, mixed incontinence, pelvic pain, and EVO program for pelvic floor sphincter rehabilitation with voluntary contraction-triggered stimulation.
• Pressure biofeedback program.
• Large LCD touchscreen with 6 quick-select touch buttons.
• Easy to use with multi-color backlight.
• Visual biofeedback (circle and bar charts).
• Audible biofeedback.
• Rotary knob facilitates intensity changes and quick on/off or pause.
• Battery operated (3 x AAA batteries).
• CE 0051 Medical Device.
• 2-year warranty.
• Made in Italy.

Technical Specifications

• Channels: 1 stimulation and 1 pressure biofeedback.
• Power supply: 3 x 1.5 V AAA alkaline batteries (LR03), average battery life 20 hours.
• Waveform: selectable between biphasic symmetric and biphasic symmetric alternating waveform.
• Electrical stimulation output: 1 - 99 mApp in 1-step increments at 1KΩ load.
• Frequency: 1 to 150 Hz (± 5%).
• Rest frequency: 3-5 Hz (± 5%).
• Pulse width: auto-adjustable between 50-400 μs in 10-step increments (± 5%).
• Ramp up/down time: 0.3 - 1 second (auto set).
• Plateau time: 1-60 seconds in 1-second steps (± 1%).
• Rest time: 0 - 60 seconds in 1-second steps (± 1%).
• Session duration: adjustable from 5 to 90 minutes in 5-minute or continuous steps.
• Biofeedback scale: selectable 2-199 cm H2O.
• Dimensions: 73 x 147 x 25 mm.
• Weight: approx. 200 g with batteries.
• Environmental conditions: 5 - 40°C / 15 - 93% relative humidity / 700 hPa - 1060 hPa.

Probe Selection

All electrodes are a combination of plastic and metal, with surfaces coated with a thin layer of gold, allowing safe use for metal allergies.

Incontinence therapy covers stress, urge, and fecal incontinence treatment. Mixed incontinence is also treatable using customized programs or sequential application of stress and urge programs.

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

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 Analis		For anal use. Treatment of fecal incontinence and male urine dribbling. For single-channel devices.	evoStim UG / E / P, Biolito, BioBravo, Myolito, MyoBravo, SineBravo, DuoBravo
PeriProbe VBFT		For vaginal use. For pressure-biofeedback devices only. For condition assessment and enhancing pelvic floor exercise effectiveness. Non-stimulating!	evoStim P also for manometric measurement
PeriProbe V2STFW		For vaginal use. For pressure-biofeedback devices. Pressure-triggered ETS treatment.	evoStim P
PeriProbe ABFT		For anal use. For pressure-biofeedback devices only. For condition assessment and sphincter strengthening exercises. Non-stimulating!	EvoStim P also for manometric measurement

Main Incontinence Types

Stress incontinence - usually caused by sphincter deficiency or weakness. Characterized by urine leakage during minor efforts (even coughing), caused by lack of sphincter muscle activity. Treatment is typically at higher frequencies (35–100 Hz), targeting phasic innervated muscle fibers. It acts intensively and quickly. The pulse width applied ranges between 100 and 400 μs based on patient perception.

Urge incontinence due to unstable bladder – The bladder muscle contracts hyperactively and rapidly, causing the patient not to reach the toilet in time and leak urine. Treatment uses low frequencies (5–20 Hz), with pulse widths between 250 and 400 μs. Daily treatment is recommended initially (daily during the first week), then 2-3 times a week over the next 3-4 weeks. Therapy can be continued or performed at home if needed.

Mixed incontinence – about 40% of cases, combining symptoms of stress and urge incontinence, or alternating symptoms. Based on dominant symptoms, low frequency is chosen to better inhibit detrusor reflexes; high frequency better improves muscle tone. Urge incontinence often responds better to treatment and is recommended to be treated first. Alternatively, two daily treatments with different programs (urge and stress) may be applied.

Contraindications of electrotherapy treatments

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

There are very few contraindications. According to current data, electrotherapy treatments are STRICTLY FORBIDDEN for patients with pacemakers or implanted defibrillators.

• Do not use within 3 months post childbirth.
• Do not use with kidney disease, lower urinary tract infections, existing urinary tumors, vesicourethral reflux, full denervation (e.g., post spinal injury incontinence), or vaginal bleeding between menstruations.
• Do not use during pregnancy.
• If you have epilepsy - consult your physician before using any electrical stimulator.
• Do not use in children under 12 years unless under strict medical supervision.

Other conditions are not exclusion criteria but require weighing benefits and risks by the physician.

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

It's a common misconception that electrotherapy devices cannot be used with metal implants, prostheses, bone plates, or screws. This is outdated. Read Dr. Zsolt Zátrok's article on implants and electrical treatment. Click here.