In my medical practice, I see that most patients tolerate their symptoms for years before asking for help. Yet urinary incontinence can be improved in a significant proportion of cases – pelvic floor muscle training (PFMT) is the first-line, non-surgical therapy recommended by international guidelines.1
Key message
Urinary incontinence is a symptom, not a disease. It may be caused by weak pelvic floor muscles, an overactive bladder or a problem with nerve regulation. If you treat the cause, the symptom may 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 treatment approaches:
Urine leaks when you cough, sneeze, laugh, lift something or run. 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 gynaecological surgery. In men, it may occur after prostate surgery.
A comprehensive Cochrane analysis (29 reviews, 8975 women) found high-level evidence that pelvic floor muscle training effectively improves stress incontinence.1 The 2023 Ghaderi meta-analysis (29 RCTs, 2601 participants) also supports physiotherapy as a first-line treatment.2
A sudden, intense urge to urinate occurs, and you cannot reach the toilet in time. The cause is overactivity of the bladder muscle (overactive bladder – „overactive bladder"). The bladder contracts involuntarily before it is full.
A Cochrane review found moderate-to-high-level evidence of a beneficial effect from electrical stimulation in urge incontinence. The combination of electrical stimulation and PFMT may produce better results than PFMT alone.1
Stress and urge incontinence are present together. This is the most common combination in older age groups. Treatment requires a comprehensive approach: combining pelvic floor muscle training with bladder training may produce results.
When electrical stimulation is combined with biofeedback, the chance of lasting improvement is greater. In a study of 279 people, the 3-year follow-up also showed favourable results.3
Important
An accurate diagnosis is a medical task. If you have symptoms of urinary incontinence, see your GP, urologist or gynaecologist. Home-use devices may be used as an addition to specialist treatment.
Why does it develop?
Urinary incontinence may have several causes. The most common triggers are:
| Risk factor | Group affected | Type |
|---|---|---|
| Pregnancy and vaginal childbirth | Women | Stress |
| Menopause (oestrogen deficiency) | Women 50+ | Stress, mixed |
| Gynaecological 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?
Urinary incontinence can be treated at several levels. International guidelines recommend conservative (non-surgical) treatment as the first step:
Pelvic floor muscle training (PFMT) – also known as Kegel exercises – aims to improve sphincter function. If you cannot tighten these muscles independently (around 30% of those affected), electrical stimulation (ES) may help: it triggers muscle contraction with low-intensity impulses.
According to clinical studies, using the two methods together is more effective than either method alone.1
Biofeedback provides real-time feedback about muscle activity (EMG or pressure measurement). This lets you see whether you are doing the exercises correctly and measure your progress objectively. Zhang et al.'s 3-year follow-up study showed that electrical stimulation combined with biofeedback may produce lasting improvement in stress incontinence.3
Bladder training is a key element in treating urge incontinence. Its essence is consciously delaying the urge to urinate at gradually increasing intervals. A Cochrane review found high-level evidence for the effectiveness of bladder training in urge incontinence.1
Combining PFMT with bladder training may produce better results than either method alone.
What should you expect?
Initial improvement can usually be noticed after 2–4 weeks of regular use. For a lasting result, a treatment cycle of at least 8–12 weeks is recommended, with 20–30 minutes of treatment daily. I have summarised the detailed protocols in this article: Treatment in practice →
Urinary incontinence in women
The most common causes of urinary incontinence in women are linked to different stages of life:
Incontinence during pregnancy and after childbirth
During vaginal childbirth, the pelvic floor muscles and nerves may stretch or become injured. Postpartum stress incontinence occurs in 30–50% of affected women. Gonzales et al.'s systematic review found moderate evidence that supervised physiotherapy with or without electrical stimulation effectively improves postpartum incontinence.4
Tip after childbirth
At your 6-week postpartum check-up, ask your obstetrician about pelvic floor muscle training. Starting early may produce better results. Home-use electrical stimulation devices may be used as an additional tool after consultation with a doctor.
Incontinence after menopause
A fall in oestrogen levels causes the vaginal and urethral tissues to thin, which may 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 stress incontinence after menopause.5
Recommended devices for women
- PFE for Women – programmes optimised for women →
- Biolito – 2-channel device with stress and urge programmes →
- Myolito - 2-channel device when several applications are needed →
- evoStim P – pressure biofeedback for complex cases →
- TensCare Kegel Toner – entry-level stimulator →
- TensCare Sure Pro - advanced stimulator with TIBN/tibial stimulation →
Urinary incontinence in men
The most common cause of urinary incontinence in men is post-prostatectomy incontinence. Urine leakage occurs in 5–60% of cases after radical prostatectomy. It usually improves over time, but targeted training may speed up recovery.
Canning et al.'s systematic review (17 RCTs) confirmed that both PFMT and electrical stimulation effectively reduce post-prostatectomy incontinence – conservative treatment should be considered before early surgery.6
After prostate surgery
Ideally, pelvic floor muscle training should begin before surgery (prehabilitation). After the catheter has been removed, home-use electrical stimulation may help recovery with medical approval.
Recommended devices for men
Which device is right for you?
The decisive factors when choosing are the type and severity of incontinence and whether biofeedback is needed. The comparison below will help you find your way:
| Device | Who is it for? | Main benefit |
|---|---|---|
| TensCare Kegel Toner | Mild stress incontinence, prevention | Simple, affordable |
| Biolito | Moderate stress/mixed incontinence | 2 channels, good value for money |
| PFE for Women | Female stress/urge incontinence | Programmes optimised for women |
| PFE for Men | Post-prostatectomy incontinence | Designed for men |
| evoStim UG | Complex urge incontinence | Specialist-level programmes |
| evoStim E | Severe incontinence, measurable progress | EMG biofeedback |
| evoStim P | Complex cases, mixed incontinence | Pressure biofeedback |
| Prosecca strap | Male stress incontinence | Direct mechanical action |
You can find the full range of devices and a detailed comparison on the category page.
Scientific background
The effectiveness of conservative treatment for urinary incontinence is supported by numerous high-level clinical studies. Below, I summarise the most important findings:
2022 – Comprehensive Cochrane analysis (29 reviews, 8975 women)
High-level evidence: PFMT effectively improves stress incontinence and quality of life. More intensive, individually supervised training may produce better results. Electrical stimulation is also effective for urge incontinence.1
2023 – Ghaderi et al. meta-analysis (29 RCTs, 2601 participants)
Physiotherapy (PFMT + electrical stimulation + biofeedback) may be recommended as first-line treatment for stress incontinence. Urine leakage decreased significantly in the treated groups.2
2023 – Zhang et al. 3-year follow-up study (279 women)
The combination of biofeedback and electrical stimulation produced lasting improvement in stress incontinence. Quality of life was still significantly better in the treated group after 3 years.3
2022 – Alouini et al. systematic review (15 RCTs, 2441 women)
PFMT alone or in combination with other methods produced significant improvement or complete continence in 62% of those affected. Biofeedback and electrical stimulation were similarly effective.7
2024 – Lunardi et al. meta-analysis (7 RCTs, 411 women)
Electrical stimulation was not shown to be more effective than supervised PFMT alone – but when used as an additional treatment, it may be useful, especially for people who cannot tighten their muscles independently.8
2022 – Canning et al. – post-prostatectomy incontinence (17 RCTs)
PFMT, electrical stimulation and medication all effectively reduce incontinence after prostate surgery. It is worth trying several conservative treatments before early surgery.6
When should electrical stimulation not be used?
Electrical stimulation therapy is generally safe, but it must not be used in certain conditions:
- Pacemaker – the impulses may interfere with pacemaker function
- Pregnancy – stimulation of the pelvic area must not be used during pregnancy
- Active cancer in the treatment area
- Untreated epilepsy
- Acute inflammation or infection in the pelvic area
- Metal implant in the treatment area – consult a doctor in the case of a hip replacement
Important
Home-use devices are intended to complement medical treatment. Before starting treatment, consult your doctor – especially if any of the conditions above apply to you.
Frequently asked questions
The first favourable signs can usually be noticed after 2–4 weeks of regular daily use. A treatment cycle of at least 8–12 weeks is needed for a lasting result. With devices that include biofeedback, progress can be measured objectively.
Kegel exercises can be started carefully a few days after childbirth. Electrical stimulation devices are generally recommended after the 6-week postpartum check-up, with the obstetrician's approval.
Ideally, pelvic floor muscle training should begin before surgery. After the catheter has been removed, electrical stimulation treatment is generally recommended for 3–6 months, or until symptoms improve, with medical approval.
If you can tighten your pelvic floor muscles independently and correctly, Kegel exercises alone may be effective for mild-to-moderate stress incontinence. Electrical stimulation is particularly useful if you cannot feel these muscles (around 30% of those affected), or if you want more intensive training. Combined use of exercises and stimulation may produce better results.1
Conservative treatment (PFMT + electrical stimulation) offers the greatest chance of improvement in mild-to-moderate incontinence, but it is also worth trying in severe cases before surgery. The Canning review recommends trying several conservative methods before deciding on surgery.6
Yes. Malinauskas et al.'s systematic review specifically examined pelvic floor physiotherapy in postmenopausal women, and all the methods studied (PFMT, electrical stimulation, biofeedback) proved effective.5
Read more
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
