biofeedback as an incontinence treatment

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Biofeedback is a type of urinary incontinence treatment where people are trained to improve their health by using signals from their own bodies. Biofeedback is a group of therapeutic procedures that utilizes electronic or mechanical instruments to accurately measure, process, and provide 'feedback' to persons about neuromuscular and or other body activity.

Biofeedback therapy has been used for the past thirty years and is widely used to treat many medical problems like headaches, pain, high blood pressure, paralysis and fecal incontinence. Biofeedback has been used successfully to treat muscle dysfunction and is often used in behavioral therapy for the treatment of urinary incontinence (UI). Dr. Arnold Kegel developed the perineometer, which is a pressure sensitive vaginal biofeedback device, to help the woman both identify, train, and feel successful at pelvic muscle rehabilitation.

Biofeedback has been used to help people with pelvic floor dysfunction. The 1992 & 1996 AHCPR (Agency for Health Care Policy and Research) Guideline on Urinary Incontinence listed biofeedback as a useful treatment option for reducing the symptoms of urinary incontinence and should be used with other behavioral therapies. However, biofeedback therapy is only one of several methods used in teaching pelvic muscle exercises. This form of therapy provides immediate auditory or visual information to the person about the status of the pelvic muscle function. It has proven to be helpful in 8 out of 10 people. Biofeedback therapy is most useful when the person is motivated, wants to be actively involved in therapy, can follow directions, and when there is a readily identifiable and measurable response.

Goal of Biofeedback Therapy for Urinary Incontinence

The goal of biofeedback therapy in the treatment of urinary incontinence is to modify a person's behavior and train her in methods to help gain bladder control. Persons are taught to alter physiologic responses of the detrusor (bladder) and pelvic muscles that are involved in urine loss. New skills are learned for maintaining continence or to assist in relearning previous control behaviors. Biofeedback therapy is a vital component of any behavioral program which deals with restoration of pelvic muscle dysfunction.

Biofeedback Methods Used in Treating Urinary Incontinence

For urinary incontinence, biofeedback therapy uses computer graphs or lights as a teaching tool to help you identify and learn to control the correct muscles. Biofeedback helps you locate the pelvic muscles by changing the graph or light when you squeeze (tighten) the right muscle. Optimal biofeedback therapy includes visualization of both pelvic and abdominal muscle movement, thus a two channel system is preferable.

Multi-channel systems can allow for both pressure and electromyograph (EMG) channels. These systems can allow the clinician to be most versatile in the approach to biofeedback. For example, the clinician could choose to monitor bladder pressure, sphincter muscles, and abdominal muscles. Biofeedback teaches you not to squeeze the other muscles.

The instrument used for delivering biofeedback therapy must be appropriate for you. If you are older and have poor eyesight, the visual displays must be able to be seen by the aged eye. For older persons, a system that has auditory components must have a lower frequency sound which the aging ear can appreciate.

How is Biofeedback Therapy for Urinary Incontinence Performed?

In women, a small probe is inserted into the vagina (similar to a tampon). In men, and sometimes in women, an even smaller probe is inserted into the rectum. This probe senses the muscle activity. Sometimes surface electrodes (sticky patches) are placed around the outside of your rectum instead of using a probe.

The biofeedback sessions are usually 20 to 30 minutes long. The average number of biofeedback sessions is six, but you may need as many as six to get the best results. In the beginning, you may need to come to the office once a week, or more, for your biofeedback session.

See also:

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Posted December 2003
Updated July 2009

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