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NMES for Postpartum pelvic floor rehab

I and my colleagues are Pelvic, Obstetric & Gynaecologcial physiotherapists. A colleague recently went on a course where it was advised that NMES for the pelvic floor should not be used in the first 6 months post partum as it could be detrimental to nerve regrowth. We are waiting for her to forward any evidence that was given for this but wondered if anyone else had an opinion/ evidence about this. Many thanks

Claire (Senior Physiotherapist, Western Sussex Hospitals NHS Foundation Trust)

Claire Barfoot

1 month ago

Back to General Electrotherapy

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claire.barfoot269
claire.barfoot269

Thank you for your replies and references, they are very helpful and make sense to me. We wait until 6 weeks post partum to ensure bleeding has stopped and allow for any tissue healing for infection control and comfort mainly but good idea about surface electrodes. We are still trying to track down the original source of this concern.

Prof Gad Alon
Prof Gad Alon

You can make a about 5 X 9 cm WATER BASED electrode placed over the perineum and the other (can be self adhesive) placed over the sacrum area and I predict the stimulation will be much less uncomfortable leading to better pelvic floor muscle contraction. To prepare the water based electrode you take a self adhesive electrode and place a layer of hygiene cotton (or non- insolated feminine pad) then wet is with water. You then must secure the electrode to the floor by means of a rolled towel or feminine straps to hold it in place

Fiona Rogers
Fiona Rogers

I haven't heard it as a contraindication either - thank you for the above references ! My understanding was not until post partum bleeding has ceased for infection reasons .

Prof Gad Alon
Prof Gad Alon

Sorry for the typos

Prof Gad Alon
Prof Gad Alon

I am not sure why this concerns resurface from time to time. While not have clinical a study to support the concern recent studies (albeit animal) prove the contrary. example: Willand, M. P. Chiang, C. D. Zhang, J. J. Daily Electrical Muscle Stimulation Enhances Functional Recovery Following Nerve Transection and Repair in Rats. Neurorehabil Neural Repair 2015;29:690-700. BACKGROUND: Incomplete recovery following surgical reconstruction of damaged peripheral nerves is common. Electrical muscle stimulation (EMS) to improve functional outcomes has not been effective in previous studies. OBJECTIVE: To evaluate the efficacy of a new, clinically translatable EMS paradigm over a 3-month period following nerve transection and immediate repair. METHODS: Rats were divided into 6 groups based on treatment (EMS or no treatment) and duration (1, 2, or 3 months). A tibial nerve transection injury was immediately repaired with 2 epineurial sutures. The right gastrocnemius muscle in all rats was implanted with intramuscular electrodes. In the EMS group, the muscle was electrically stimulated with 600 contractions per day, 5 days a week. Terminal measurements were made after 1, 2, or 3 months. Rats in the 3-month group were assessed weekly using skilled and overground locomotion tests. Neuromuscular junction reinnervation patterns were also examined. RESULTS: Muscles that received daily EMS had significantly greater numbers of reinnervated motor units with smaller average motor unit sizes. The majority of muscle endplates were reinnervated by a single axon arising from a nerve trunk with significantly fewer numbers of terminal sprouts in the EMS group, the numbers being small. Muscle mass and force were unchanged but EMS improved behavioral outcomes. CONCLUSIONS: Our results demonstrated that EMS using a moderate stimulation paradigm immediately following nerve transection and repair enhances electrophysiological and behavioral recovery.

Hope it helps

luisef258
luisef258

In fact is seams that some authors do have that opinion but on pregnancy, and I quote CPA (1), “Houghton et al. (2) indicate that NMES is contraindicated ‘‘anywhere’’ on pregnant women” but CPA also refer that “however, there appears to be no evidence for this”.

On postpartum I can’t find no references to contraindicate NMES.

The CPA document is an excellent reference for this issue.

1- Canadian Physiotherapy Association: ELECTROPHYSICAL AGENTS Contraindications and Precautions: An Evidence-Based Approach to Clinical Decision Making in Physical Therapy. VOLUME 62 NUMBER 5 SPECIAL ISSUE 2010 ISSN-0300-0508 E-ISSN-1708-8313

2- Houghton PE, Radman A. Effect of therapeutic ultrasound on fetal limb development in vitro. Physiother Theory Pract.2000;16:119–34

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