In my clinical practice I see that most patients tolerate symptoms for years before asking for help. Yet urinary incontinence is treatable in a large proportion of cases – pelvic floor muscle training (PFMT) is the first-line, non-surgical therapy according to international guidelines.1
Key idea
Urinary incontinence is a symptom, not a disease. It may be caused by pelvic floor muscle weakness, bladder overactivity or neural regulatory disturbance. If you treat the underlying cause, the symptom can improve.
Types of urinary incontinence
To choose the right treatment it is important to know which type you have. The three main forms require different therapeutic approaches:
Urine is lost when coughing, sneezing, laughing, lifting or running. The cause is weakness of the pelvic floor muscles and the urethral sphincter. This is the most common type in women – especially after childbirth, menopause or gynecological surgery. In men it can occur after prostate surgery.
A comprehensive Cochrane review (29 reviews, 8,975 women) found high-level evidence that pelvic floor muscle training effectively improves stress incontinence.1 The 2023 Ghaderi meta-analysis (29 RCTs, 2,601 participants) also supports physiotherapy as first-line treatment.2
A sudden, intense need to urinate arises and you cannot reach the toilet in time. The cause is overactivity of the bladder muscle (overactive bladder). The bladder contracts involuntarily before it is full.
The Cochrane review found moderate-to-high level evidence of benefit from electrical stimulation for urgency incontinence. A combination of electrical stimulation + PFMT may yield better results than PFMT alone.1
Stress and urgency incontinence occur together. This is the most common combination in older age groups. Treatment requires a complex approach: a combination of pelvic floor muscle training and bladder training can be effective.
When electrical stimulation is supplemented with biofeedback, the chance of lasting improvement is higher. A 279-participant study showed favorable results at 3-year follow-up.3
Important
An accurate diagnosis is a medical task. If you have symptoms of urinary incontinence, consult your general practitioner, urologist or gynecologist. Home devices can be used as complements to specialist care.
Why does it develop?
There are several possible causes behind urinary incontinence. The most common risk factors are:
| Risk factor | Affected group | Type |
|---|---|---|
| Pregnancy and vaginal delivery | Women | Stress |
| Menopause (estrogen deficiency) | Women 50+ | Stress, mixed |
| Gynecological surgery (hysterectomy) | Women | Stress |
| Prostate surgery (radical prostatectomy) | Men | Stress |
| Overweight, obesity | Both sexes | Stress, mixed |
| Neurological diseases (MS, Parkinson's) | Both sexes | Urgency |
| Chronic cough (COPD, smoking) | Both sexes | Stress |
| Age | Both sexes | Mixed |
How can it be treated?
Treatment for urinary incontinence is possible on several levels. International guidelines recommend conservative (non-surgical) therapy as the first step:
Pelvic floor muscle training (PFMT) – also known as Kegel exercises – aims to improve sphincter function. If you cannot voluntarily contract these muscles (about 30% of affected individuals), electrical stimulation (ES) can help: low-intensity impulses trigger muscle contractions.
Clinical trials show that combining the two methods is more effective than either alone.1
Biofeedback provides real-time feedback on muscle activity (EMG or pressure measurement). This way you can see if you are performing exercises correctly and objectively measure your progress. Zhang et al.'s 3-year follow-up study showed that biofeedback-supplemented electrical stimulation can produce lasting improvement in stress incontinence.3
Bladder training is the key element in treating urgency incontinence. Its principle is consciously delaying the urge to void with gradually increasing time intervals. The Cochrane review found high-level evidence for the effectiveness of bladder training in urgency incontinence.1
The combination of PFMT + bladder training may produce better results than either method alone.
What to expect?
The first improvement is usually noticed after 2–4 weeks of regular use. For lasting results a minimum 8–12 week treatment cycle is recommended, with daily 20–30 minute sessions. I summarized the detailed protocols in this article: Treatment in practice →
Urinary incontinence in women
The most common triggers of urinary incontinence in women are related to life stages:
Postpartum and postpartum incontinence
During vaginal delivery the pelvic floor muscles and nerves may be stretched or injured. Postpartum stress incontinence occurs in 30–50% of affected women. Gonzales et al.'s systematic review found moderate evidence that supervised physiotherapy ± electrical stimulation effectively improves postpartum incontinence.4
Tip after childbirth
At the 6-week postpartum check ask your obstetrician about pelvic floor muscle training. Starting early may yield better results. Home electrical stimulation devices, after medical consultation, can be used as adjuncts.
Post-menopausal incontinence
Declining estrogen levels lead to thinning of vaginal and urethral tissues, which can weaken sphincter function. Malinauskas et al.'s systematic review (715 postmenopausal women, 6 RCTs) confirmed that pelvic floor physiotherapy – including electrical stimulation – is effective for postmenopausal stress incontinence.5
Recommended devices for women
Urinary incontinence in men
The most common cause of male urinary incontinence is post-prostatectomy incontinence. After radical prostatectomy urinary dribbling occurs in 5–60% of cases; it generally improves over time, but targeted training can accelerate recovery.
Canning et al.'s systematic review (17 RCTs) showed that PFMT and electrical stimulation both effectively reduce post-prostatectomy incontinence – conservative treatment should be considered before early surgical intervention.6
After prostate surgery
Ideally pelvic floor muscle training should be started before the surgery (prehabilitation). After catheter removal, home electrical stimulation – with medical approval – can aid recovery.
Recommended devices for men
Which device is right for you?
When choosing, the type and severity of incontinence and the need for biofeedback are decisive. The comparison below helps orientation:
| Device | For whom? | Main advantage |
|---|---|---|
| TensCare Kegel Toner | Mild stress incontinence, prevention | Simple, affordable |
| Biolito | Moderate stress/mixed incontinence | 2 channels, good value |
| PFE for Women | Female stress/urgency incontinence | Programs optimized for women |
| PFE for Men | Post-prostatectomy incontinence | Designed for men |
| evoStim UG | Complex urgency incontinence | Clinician-grade programs |
| evoStim E | Severe incontinence, measurable progress | EMG-biofeedback |
| evoStim P | Complex cases, mixed incontinence | Pressure-biofeedback |
| Prosecca strap | Male stress incontinence | Mechanical, direct effect |
The full device range and detailed comparison can be found on the category page.
Scientific background
The effectiveness of conservative treatments for urinary incontinence is supported by numerous high-level clinical trials. Below I summarize the most important findings:
2022 – Overview by the Cochrane Collaboration (29 reviews, 8,975 women)
High-level evidence: PFMT effectively improves stress incontinence and quality of life. More intensive, individually supervised training may yield better results. Electrical stimulation is also effective for urgency incontinence.1
2023 – Ghaderi et al. meta-analysis (29 RCTs, 2,601 participants)
Physiotherapeutic treatment (PFMT + electrical stimulation + biofeedback) can be recommended as first-line therapy for stress incontinence. Urinary leakage decreased significantly in treated groups.2
2023 – Zhang et al. 3-year follow-up study (279 women)
The combination of biofeedback + electrical stimulation produced lasting improvement in stress incontinence. Quality of life remained significantly better in the treated group after 3 years.3
2022 – Alouini et al. systematic review (15 RCTs, 2,441 women)
PFMT alone or supplemented resulted in significant improvement or complete continence in 62% of participants. Biofeedback and electrical stimulation were similarly effective.7
2024 – Lunardi et al. meta-analysis (7 RCTs, 411 women)
Electrical stimulation did not prove superior to supervised PFMT alone – however, as an adjunct, especially for those unable to voluntarily contract the muscles, it can be useful.8
2022 – Canning et al. – post-prostatectomy incontinence (17 RCTs)
PFMT, electrical stimulation and pharmacotherapy all effectively reduce post-prostatectomy incontinence. It is worthwhile to try multiple conservative therapies before deciding on surgery.6
When not to use electrical stimulation?
Electrostimulation therapy is generally safe, but it is not applicable in certain conditions:
- Pacemaker – impulses may interfere with pacemaker function
- Pregnancy – pelvic stimulation is not used during pregnancy
- Active malignancy in the treatment area
- Untreated epilepsy
- Acute inflammation or infection in the pelvic region
- Metal implant in the treatment area – consult your physician in case of hip prosthesis
Important
Home devices are intended as complements to medical treatment. Before starting therapy, consult your treating physician – especially if any of the above conditions apply to you.
Frequently asked questions
The first positive signs are usually observed after 2–4 weeks of regular daily use. For lasting results a minimum 8–12 week treatment cycle is necessary. Devices with biofeedback allow objective measurement of progress.
Kegel exercises can be started cautiously a few days after delivery. Electrostimulation devices are usually recommended to begin after the 6-week postpartum check with your obstetrician's approval.
Ideally pelvic floor muscle training should start before surgery. After catheter removal – with medical permission – electrostimulation is generally recommended for 3–6 months or until symptoms improve.
If you can voluntarily and correctly contract your pelvic floor muscles, Kegel exercises alone can be effective for mild-to-moderate stress incontinence. Electrostimulation is particularly useful if you cannot feel these muscles (~30% of affected individuals) or if you want more intensive training. Combined (exercise + stimulation) use can yield better results.1
Conservative treatment (PFMT + electrostimulation) offers the greatest chance of improvement in mild-to-moderate incontinence, but it is worth trying even in severe cases before surgical intervention. The Canning review recommends trying multiple conservative methods prior to surgery.6
Yes. Malinauskas et al.'s systematic review specifically examined postmenopausal women and found that all studied methods (PFMT, electrostimulation, biofeedback) were effective.
Read more
Treatment in practice – protocols →
Intimate exercise guide →
The adult diaper trap →
All incontinence devices →
Summary – Quick overview
Sources
- Todhunter-Brown A, Hazelton C, Campbell P, et al. (2022). Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 9(9):CD012337. DOI: 10.1002/14651858.CD012337.pub2
- Ghaderi F, Kharaji G, Hajebrahimi S, et al. (2023). Physiotherapy in patients with stress urinary incontinence: a systematic review and meta-analysis. Urol Res Pract. 49(5):293-306. DOI: 10.5152/tud.2023.23018
- Zhang L, et al. (2023). Long-term efficacy of pelvic floor biofeedback combined with electrical stimulation for stress urinary incontinence. J Cent South Univ (Med Sci). DOI: 10.11817/j.issn.1672-7347.2023.220401
- Gonzales AL, et al. (2021). Postpartum stress urinary incontinence treatment: systematic review. Female Pelvic Med Reconstr Surg. DOI: 10.1097/SPV.0000000000000866
- Malinauskas AP, Bressan EFM, de Melo AMZRP, et al. (2022). Efficacy of pelvic floor physiotherapy intervention for stress urinary incontinence in postmenopausal women: systematic review. Arch Gynecol Obstet. 308(1):13-24. DOI: 10.1007/s00404-022-06693-z
- Canning A, Raison N, Aydin A, et al. (2022). A systematic review of treatment options for post-prostatectomy incontinence. World J Urol. 40(11):2617-2626. DOI: 10.1007/s00345-022-04146-5
- Alouini S, Memic S, Couillandre A. (2022). Pelvic floor muscle training for urinary incontinence with or without biofeedback or electrostimulation in women: a systematic review. Int J Environ Res Public Health. 19(5):2789. DOI: 10.3390/ijerph19052789
- Lunardi AC, Foltran GC, Carro DF, et al. (2024). Efficacy of electrical stimulation in comparison to active training of pelvic floor muscles on stress urinary incontinence symptoms in women: a systematic review with meta-analysis. Disabil Rehabil. 47(13):3256-3267. DOI: 10.1080/09638288.2024.2419424
