Comparison of the effectiveness of biofeedback-assisted pelvic floor muscle training and hypopressive exercises in women with pelvic organ prolapse: a randomized controlled study

Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis

Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder

Efficacy of biofeedback-assisted pelvic floor muscle training in females with pelvic floor dysfunction

Comparison of the effectiveness of biofeedback-assisted pelvic floor muscle training and hypopressive exercises in women with pelvic organ prolapse: a randomized controlled study

Early postpartum biofeedback assisted pelvic floor muscle training in primiparous women with second degree perineal laceration: Effect on sexual function and lower urinary tract symptoms

BackgroundMixed urinary incontinence (MUI) is a common underreported problem among females; it has a major effect on patients’ quality of life. Treatment may be difficult since a single modality cannot be enough to alleviate both the urge and the stress symptoms. Biofeedback-assisted pelvic floor muscle training (PFMT) has a great role in strengthening the pelvic floor muscles especially when accompanied by electrical stimulation. Neuromodulation is another safe well-tolerated method that may improve symptoms of female voiding dysfunction. There are no previous studies that assessed the efficacy of biofeedback-assisted pelvic floor muscle training versus two different types of peripheral neuromodulation which are transcutaneous posterior tibial nerve stimulation (TPTNS) and anogenital neuromodulation in the treatment of mixed urinary incontinence among women. The aim of this work is to study the effectiveness of biofeedback-assisted pelvic floor muscle training with electrostimulation versus two different methods of peripheral neuromodulation techniques in the treatment of women with MUI. Patients were subjected to history taking, assessment questionnaires (Questionnaire for female Urinary Incontinence Diagnosis (QUID), Australian Pelvic Floor Questionnaire (PFQ), and International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF)), clinical examination, and manometric pressure assessment. The patients were allocated randomly into three groups. Group I received biofeedback-assisted pelvic floor muscle training and faradic electrical stimulation, group II received posterior tibial neuromodulation, and group III received anogenital neuromodulation.ResultsThe present study included 68 non-virgin female patients with mixed urinary incontinence. Significant improvement was noticed in the three studied groups on the subjective and objective levels. No statistically significant difference was reported between the studied groups following the different types of intervention.ConclusionsBiofeedback-assisted pelvic floor muscle training with electrostimulation is as effective as anogenital neuromodulation and posterior tibial neuromodulation in the treatment of mixed urinary incontinence among females.Trial registrationPACTR, PACTR202107816829078. Registered 29 July 2021 - Retrospectively registered.

Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy.Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching.Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises.Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1–2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill.Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

ABSTRACTPurpose:To compare the effectiveness of biofeedback-assisted pelvic floor muscle training (PFMT) and PFMT alone on voiding parameters in women with dysfunctional voiding (DV).Materials and Methods:The patients in group 1 (34 patients) were treated with biofeedback-assisted PFMT, and the patients in group 2 (34 patients) were treated with PFMT alone for 12 weeks. The 24-hour frequency, average voided volume, maximum urine flow rate (Qmax), average urine flow rate (Qave), post-void residual urine volume (PVR), and the validated Turkish Urogenital Distress Inventory (UDI-6) symptom scores were recorded before and after 12 weeks of treatment.Results:At the end of treatment sessions, the Qmax and Qave values of the patients in group 1 were significantly higher than those in group 2, and the PVR in the patients in group 1 was significantly lower than those in group 2 (p=.026, .043, and .023, respectively). The average UDI-6 symptom scores of the patients in group 1 were significantly lower than those in group 2 (p=.034). Electromyography activity during voiding, in group 1 was significantly lower than in group 2 (41.2 vs. 64.7, respectively, p=.009).Conclusion:Biofeedback-assisted PFMT is more effective than PFMT alone in improving clinical symptoms, uroflowmetry parameters, and EMG activity during voiding.

Biofeedback-Assisted pelvic floor muscle training combined with a short-duration drug regimen is safe and effective in women with overactive bladder: A randomized controlled trial

The objectives of the present review was to present and discuss evidence for pelvic floor muscle (PFM) training on female stress urinary incontinence (SUI), pelvic organ prolapse (POP) and sexual dysfunction. This manuscript is based on conclusions and data presented in systematic reviews on PFM training for SUI, POP and sexual dysfunction. Cochrane reviews, the 4th International Consultation on Incontinence, the NICE guidelines and the Health Technology Assessment were used as data sources. In addition, a new search on Pubmed was done from 2008 to 2011. Only data from randomized controlled trials (RCTs) published in English language is presented and discussed. There is Level 1, Grade A evidence that PFM training is effective in treatment of SUI. Short-term cure rates assessed as <2g of leakage on pad testing vary between 35 and 80%. To date there are 5 RCTs showing significant effect of PFM training on either POP stage, symptoms or PFM morphology. Supervised and more intensive training is more effective than unsupervised training. There are no adverse effects. There is a lack of RCTs addressing the effect of PFM training on sexual dysfunction. PFM training should be first line treatment for SUI and POP, but the training needs proper instruction and close follow-up to be effective. More high quality RCTs are warranted on PFM training to treat sexual dysfunction.

Background: Pelvic floor muscle training (PFMT) with biofeedback is used widely in treating patients with stress urinary incontinence (SUI), despite unclear evidence. We conducted a meta-analysis of the literature to evaluate the efficacy of treatment after PFMT with and without biofeedback in SUI patients. Methods: We searched PubMed, CENTRAL, CINAHL, and Science Direct for randomized controlled trials (RCTs) of PFMT with and without biofeedback for SUI. RCTs were screened with our eligibility criteria, and the risk of bias was assessed according to the Cochrane risk of bias tool for randomized trials. The outcomes analyzed were pelvic floor muscle (PFM) strength, incontinence episode, daytime micturition, and nighttime micturition, all measured as mean difference (MD) with 95% confidence intervals (CIs). Heterogeneity and publication bias were analyzed using the I2 test and a funnel plot, respectively. Results and Discussion: Pooled analysis of five RCTs involving 207 patients showed that the difference in PFM strength and nighttime micturition between both groups was significant. Although PFM strength improvement favors biofeedback-assisted pelvic floor muscle training (BPFMT) (MD 12.29, 95% CI 2.33, 22.25, p=0.02), in contrast, nighttime micturition was significantly reduced in the PFMT group (MD 0.44, 95% CI 0.12 to 0.77, p=0.007). Differences in incontinence episode and daytime micturition were not significant (MD -0.08, 95% CI -0.57 to 0.41, p=0.75 and MD 0.55, 95% CI -0.36 to 1.46, p=0.24, respectively). Conclusion: This meta-analysis showed that BPFMT had a better outcome in improving PFM strength, while nighttime micturition was, on the contrary, better in PFMT only. Meanwhile, no significant differences in incontinence episodes and daytime micturition outcomes were noted between both groups. With the present evidence, routine use of BPFMT is not necessary for current clinical practice.

Introduction and hypothesisThis manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP.MethodsAn international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10).ResultsAfter exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT.ConclusionsThere are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.

Objective To investigate the clinical effect of pelvic floor muscle training (PFMT) combined with neuromuscular electrical stimulation (NMES) on patients with pelvic organ prolapse (POP). Methods A total of 150 patients with POP who were treated in Xuzhou Central Hospital from June 2015 to April 2018, were chosen as research subjects. They were divided into observation group (n=80) and control group (n=70) according to random digits table method. Patients in observation group were treated with PFMT combined with NMES, while patients in control group were only treated with PFMT. Quality of sexual life was evaluated by Pelvic Organ Prolapse /Urinary Incontinence Sexual Questionnaire Short Form (PISQ)-12. Quality of life (QoL) of patients was evaluated by Mos 36-Item Short form Health Survey. The pelvic floor muscle strength of patients was evaluated by neuromuscular stimulation therapy apparatus. The anxiety and depression of patients were evaluated by Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). The degree of POP of patients was evaluated by abdominal ultrasonography. The related indexes above mentioned before treatment and until one year of treatment of POP patients were compared intra-group or inter-group by t test or chi-square test. The study was carried out with the approval of Ethics Committee of Xuzhou Central Hospital (Approval No. 20150056). All patients had informed consent to the study. Results ① Comparison of quality of sexual life: PISQ-12 score of POP patients who had sexual life after treatment in observation group until one year of treatment was (24.5±8.0) scores, which was higher than that of (19.7±8.2) sores before treatment in observation group who had sexual life after treatment, also higher than that of (20.6±7.1) sores of POP patients in control group until one year of treatment, and the difference was statistically significant (t=8.326, P=0.037; t=7.422, P=0.042). ② Comparison of QoL: the score of physiological function (PF), role physiological (RP), bodily pain (BP), general health (GH), physical component summary (PCS), vitality (VT), social functioning (SF), role emotional (RE), mental health (MH) and mental component summary (MCS) of POP patients in observation group until one year of treatment were (88.0±13.4) scores, (91.9±22.6) scores, (98.4±22.6) scores, (88.1±9.5) scores, (90.8±21.7) scores, (92.1±19.6) scores, (91.6±18.5) scores, (92.1±21.6) scores, (91.2±27.4) scores and (91.9±14.5) scores, which were higher than those of (71.6±8.5) scores, (76.9±9.5) scores, (73.8±12.1) scores, (69.4±8.6) scores, (79.1±10.3) scores, (76.8±10.4) scores, (75.5±11.7) scores, (78.6±9.5) scores, (75.2±11.6) scores and (80.1±7.3) scores in control group until one year of treatment, and the differences were statistically significant (t=8.805, 9.537, 8.643, 10.335, 8.036, 8.605, 9.060, 8.254, 8.814, 8.541, all P<0.001). ③ Comparison of pelvic floor muscle strength: the proportion of grades of pelvic floor muscle strength of Ⅲ+ Ⅳ+ Ⅴ of POP patients in observation group until one year of treatment was 90.0%, which was higher than that of 44.3% in control group until one year of treatment, and the difference was statistically significant (χ2=12.652, P=0.011). ④ Comparison of anxiety and depression conditions: the score of HAMA and HAMD of POP patients in observation group until one year of treatment were (7.4±2.1) scores, (8.1±3.1) scores, which were lower than those of (10.3±2.3) scores, (10.1±3.1) scores in control group until one year of treatment, and the differences were statistically significant (t=5.170, P=0.041; t=5.352, P=0.039). ⑤ Comparison of degree of POP: the distance from bladder neck to baseline and from cervix to baseline of POP patients in observation group until one year of treatment were (0.71±0.62) cm, (1.5±0.8) cm, which were longer than those of (0.14±0.74) cm, (1.1±0.6) cm in control group until one year of treatment; the hiatus area of levator ani muscle of POP patients in observation group was (18.2±2.8) cm2, which was less than that of (22.5±4.9) cm2 in control group, and all the differences above were statistically significant (t=3.275, P=0.039; t=3.073, P=0.046; t=3.770, P=0.043). Conclusions PFMT combined with NMES for treatment of POP can improve the quality of sexual life, QoL and pelvic floor muscle strength of patients, also reduce the severity degree of POP, and relieve anxiety and depression. Key words: Pelvic organ prolapse; Electric stimulation; Pelvic floor, muscle tissue; Pelvic floor muscle training; Quality of life; Anxiety; Depression; Comparative effectiveness research; Female

Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

Factors predicting the response to biofeedback-assisted pelvic floor muscle training for urinary incontinence