Transcutaneous electrical neuromuscular stimulation for urinary incontinence

Evidence-based recommendations on transcutaneous electrical neuromuscular stimulation for urinary incontinence in adults. This involves stimulating nerves and muscles in the pelvic floor to strengthen the muscles and reduce urine leaks.

# Recommendations
Evidence on the safety of transcutaneous electrical neuromuscular stimulation for urinary incontinence raises no major safety concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do transcutaneous electrical neuromuscular stimulation for urinary incontinence should:
Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Further research should include randomised controlled trials. These should compare transcutaneous neuromuscular electrical stimulation plus pelvic floor muscle exercises with pelvic floor muscle exercises alone.# The condition, current treatments and procedure

# The condition
Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements such as coughing, sneezing and laughing. Urge urinary incontinence is involuntary urine leakage with a feeling of urgency (a sudden need to urinate that is difficult to delay) during or just before the leakage. Mixed urinary incontinence is involuntary urine leakage associated with both urgency and exercise, effort, sneezing or coughing.

# Current treatments
NICE's guideline on urinary incontinence and pelvic organ prolapse in women has recommendations for the management of urinary incontinence in women, with a patient decision aid to promote shared decision making. NICE's guideline on lower urinary tract symptoms in men has recommendations for the management of urinary incontinence in men. Conventional treatment is conservative and includes lifestyle changes such as weight loss and pelvic floor muscle training. Surgical options are only offered if conservative measures and drug treatments do not help.

# The procedure
The procedure uses non-implanted electrodes connected to an external neuromuscular electrical stimulator device to stimulate muscles and nerves, to make the pelvic floor muscles contract. The electrical stimulation is delivered through the skin, typically with sticky pad electrodes. The number and placement of electrodes varies according to the system being used. This includes a design in which the electrodes are incorporated into a body garment worn like a pair of shorts. A controller is used to vary the intensity and frequency of stimulations, to achieve a lifting sensation throughout the pelvic floor.
The device is typically used in sessions. The number and frequency of advised sessions varies, but the treatment period is typically 6 to 12 weeks.
The aim of the procedure is to reduce symptoms associated with stress or urge urinary incontinence.