Urinary Incontinence and Overactive Bladder in Middle-Aged Women: What Role Can Electrotherapy Play?

Urinary leakage and overactive bladder symptoms affect many women, particularly as they age. Although common, these conditions should not be considered an inevitable consequence of aging or menopause.

Their impact often extends beyond urinary symptoms, affecting sleep, confidence when leaving home, physical activity, social participation, and overall quality of life. Some women even plan their activities around access to washrooms or avoid certain activities altogether for fear of urinary leakage.

Pelvic floor rehabilitation, behavioural interventions, and lifestyle modifications play a central role in management. However, when symptoms persist or certain muscle functions are difficult to develop, can electrotherapy help support rehabilitation, particularly at home between physiotherapy sessions?

Understanding the Different Types of Urinary Disorders

Urinary incontinence encompasses several types of symptoms that do not necessarily share the same underlying mechanisms.

Stress urinary incontinence occurs when increased abdominal pressure causes urine leakage, such as during coughing, lifting, or physical activity. It may be associated with impaired urethral support or dysfunction of the mechanisms responsible for urethral closure.

Urgency urinary incontinence refers to urinary leakage accompanied by a sudden, difficult-to-defer need to urinate. It is frequently associated with overactive bladder (OAB), a syndrome characterized by urinary urgency, usually accompanied by increased urinary frequency and nocturia, with or without urinary incontinence.

Mixed urinary incontinence involves symptoms of both stress and urgency urinary incontinence.

In middle-aged women, hormonal changes, obstetric history, changes in pelvic tissues, and certain medical conditions may contribute to urinary symptoms. However, an individualized assessment remains essential to identify the underlying mechanisms and guide appropriate interventions.

Effective Treatments, but Some Needs Remain Unmet

Pelvic floor muscle training is a first-line intervention for stress and mixed urinary incontinence. Bladder training and behavioural interventions are also recommended for managing urgency symptoms [1, 2].

However, some patients have difficulty contracting their pelvic floor muscles correctly, while others continue to experience symptoms despite conservative interventions.

Medication may be an option for overactive bladder, but it is not always desired, well tolerated, or sufficiently effective. Antimuscarinic medications, in particular, may cause adverse effects such as dry mouth and constipation. In some older women, anticholinergic burden and comorbidities must also be considered [2].

Access to specialized care may also involve waiting periods. In this context, exploring non-pharmacological strategies that can support patients throughout their care journey becomes particularly relevant, without delaying necessary medical investigations.

TENS, TTNS, PTNS, and NMES: Complementary Mechanisms

Electrotherapy encompasses several approaches, each with different objectives depending on the structures being stimulated.

NMES (neuromuscular electrical stimulation) is intended to produce muscle contractions. In pelvic floor rehabilitation, it may help activate the pelvic floor muscles, particularly when a patient has difficulty achieving an effective voluntary contraction. It can therefore complement motor learning and muscle training.

TENS (transcutaneous electrical nerve stimulation) uses electrodes placed on the skin to stimulate nerve structures. Depending on the stimulation parameters and application site, it may be used for different purposes, including pain modulation and neuromodulation.

In the management of overactive bladder, two tibial nerve stimulation techniques should be distinguished:

• TTNS (transcutaneous tibial nerve stimulation) uses surface electrodes, generally positioned near the ankle. Its purpose is to modulate the neural pathways involved in bladder control.
• PTNS (percutaneous tibial nerve stimulation) has a similar objective but uses a fine needle inserted near the nerve. It requires a procedure performed by a qualified healthcare professional.

These neuromodulation approaches should not be confused with pelvic floor muscle stimulation. They are also not necessarily interchangeable in terms of clinical effectiveness.

What Does the Scientific Evidence Tell Us?

Studies on pelvic floor electrical stimulation suggest potential benefits in reducing urinary leakage and improving certain quality-of-life measures, particularly in women with stress urinary incontinence. However, findings remain variable depending on the techniques and protocols studied [3, 4].

For overactive bladder, recent studies investigating TTNS have reported improvements in urinary urgency, urinary frequency, and certain episodes of urinary incontinence [5, 6].

A randomized study published in 2026 comparing TTNS with solifenacin in 118 women reported improvements in symptoms in both groups, with some outcomes favouring TTNS [6].

These findings are encouraging, but the optimal treatment protocols, long-term sustainability of benefits, and precise role of TTNS within the treatment pathway remain to be established.

Professional guidelines are not entirely consistent in their recommendations. The AUA/SUFU guideline recognizes TTNS among non-invasive treatment options, whereas NICE does not recommend its use for overactive bladder [1, 2].

Continuing Rehabilitation at Home: The Potential Benefits of the EVA Device

Pelvic floor rehabilitation extends beyond interventions provided in a clinical setting. Between appointments, patients continue their exercises, bladder control strategies, and lifestyle modifications as recommended by their physiotherapist.

Electrotherapy can be integrated into this ongoing rehabilitation process when supported by a specific therapeutic objective.

The EVA device, offered by SET, combines TENS and NMES functions in a single unit. It includes programs designed for stress urinary incontinence, urgency urinary incontinence, mixed urinary incontinence, and transcutaneous tibial nerve stimulation.

This versatility may facilitate the integration of different electrotherapy strategies into home-based rehabilitation, according to the needs identified by the treating healthcare professional. However, it does not mean that every patient needs to use both modalities.

Home use requires appropriate patient education, screening for precautions and contraindications, and monitoring of the clinical response. SET can support this learning process in collaboration with the physiotherapist to help ensure that use of the device remains consistent with the patient's rehabilitation program.

An Additional Tool, Not a Replacement for Care

The value of electrotherapy lies not only in its ability to produce muscle contractions or stimulate nerves. More importantly, it depends on how it contributes to the patient's goals: reducing urinary leakage, improving urgency control, increasing tolerance for daily activities, or regaining greater freedom in everyday life.

NMES and TTNS may offer complementary options, particularly when home use allows patients to continue an individualized intervention between physiotherapy sessions.

Electrotherapy does not replace clinical assessment, pelvic floor muscle training, bladder training, or lifestyle modifications. However, it may serve as an additional tool within an individualized care plan aimed at improving urinary function and quality of life.

Scientific References

1. National Institute for Health and Care Excellence (NICE). Urinary incontinence and pelvic organ prolapse in women: management. Guideline NG123. 2019. https://www.nice.org.uk/guidance/ng123
2. Cameron AP, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. Journal of Urology. 2024;212:11–20. https://doi.org/10.1097/JU.0000000000003985
3. Han X, et al. Efficacy and safety of electrical stimulation for stress urinary incontinence in women: a systematic review and meta-analysis. International Urogynecology Journal. 2022;33:789–799. https://doi.org/10.1007/s00192-021-04928-2
4. Yu TY, et al. Comparison of nonimplantable electrical stimulation in women with urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials. Scientific Reports. 2024;14:26957. https://doi.org/10.1038/s41598-024-78358-7
5. Vaca-Benavides DA, et al. The importance of electrical parameters on transcutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Age and Ageing. 2025;54. https://doi.org/10.1093/ageing/afaf203