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Pelvic floor biofeedback

Elimination Disorders

INCONTINENCE

Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). Incontinence is a widespread condition that ranges in severity from just a small leak to complete loss of bladder or bowel control.

BLADDER

Urinary Incontinence

 

Urinary incontinence or underactive/overactive bladder control is a common condition that is frequently associated with pregnancy, childbirth, menopause or a range of chronic conditions such as asthma, diabetes and arthritis.

 

Poor bladder control can range from the occasional leak when you laugh, cough or exercise to the complete inability to control your bladder, which may cause you to wet yourself. Other symptoms you may experience include the constant need to urgently or frequently visit the toilet. This may be associated with “accidents”.

 

There are different types of incontinence with a number of possible causes. The following are the most common: stress incontinence, urge incontinence, giggle incontinence, incontinence associated with chronic retention and functional incontinence.

 

Urinary incontinence may be caused by many factors, but it can be treated, better managed and in many cases cured. For this reason, it is important to talk to your doctor or a continence advisor about your symptoms to get on top of the actual problem.

BOWEL

Faecal Incontinence

 

People with poor bowel control or faecal incontinence have difficulty controlling their bowels. This may mean the passing of faeces or stools at the wrong time or in the wrong place. In addition, wind may be passed involuntarily, or there may be staining of underwear.

 

About one in 20 people experience poor bowel control. It is more common in older people, but a lot of young people also have poor bowel control. Many people with poor bowel control also have poor bladder control (wetting or soiling themselves). Faecal incontinence can have a number of possible causes.

 

The following are the most common: weak back passage muscles due to childbirth, age, some types of surgery or radiation therapy, constipation or severe diarrhoea.

 
Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) causes abdominal pain, bloating and alternating constipation and / or diarrhoea. The cause is often unknown. However, factors such as dysfunctional pelvic floor muscles, emotional stress, infection and some foods can aggravate the condition. Treatment options include dietary modifications and stress management. A mixture of a few small controlled studies, a moderate number of small clinical studies, and many clinical case studies provide reasonably convincing evidence that biofeedback can effectively reduce or cure this problem.

 
Constipation

The normal range for bowel movement frequency is from three times per day to three times per week. Generally, chronic constipation is having fewer than three bowel movements per week on a regular basis. Excessive straining, incomplete evacuation, and hard stools usually accompany the infrequent bowel movements. Many people experience constipation from time to time, but chronic (ongoing, unrelenting) constipation, indicates disease, trauma, post-surgery, or age-related changes in the body which may interrupt our ability to command this crucial body function and affects up to 34% of the population. (Rome III diagnostic criteria & Bristol stool scale).

Overview & Efficacy

Several comparative and controlled studies and numerous clinical studies have shown that muscle tension and pneumatic biofeedback can be highly effective for the treatment of most types of fecal incontinence (as long as the nerve paths are intact), and constipation is due to malfunctioning anal muscles (as opposed to dehydration).

 

Why biofeedback would help this problem

The muscles of the pelvic floor (including those controlling the anus) can become weakened due to overall loss of conditioning with age, stretching during delivery, etc. These muscles may be in good shape but they may have to resist more pressure than they can handle during a cough or jump. Many people do not have a good sense of when they need to defecate and are either fooled by sensations that are just warnings or miss the warnings entirely. Most people tense or relax the wrong muscles when they are trying to avoid leaking.

Biofeedback is a neuromuscular re-education tool used by therapists that can be used to tell if certain processes in our bodies are working correctly. Biofeedback therapy may be used to treat several bowel disorders such as constipation, elimination, and painful anal spasms of the pelvic floor muscles.

 

The pelvic floor muscles mediate bowel, bladder and sexual activity. The role of the pelvic floor muscles is to help to preserve these activities. Biofeedback of the pelvic floor has been proven to assist in improving these activities and / or assisting in correcting them if there are pelvic floor disorders.  It is important to mention that biofeedback needs to be used in conjunction with prescribed medical treatment and behavior modifications.

Elimination Disorders
Sexual dysfunction
Irritable Bowel
Syndrome
Vulvar vestibulitis
Constipation
Pelvic Pain
Acute and Chronic
Biofeedback for hypertonic pelvic floor
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Sexual dysfunction

Biofeedback-based interventions have the potential to serve as first-line treatments for sexual dysfunction concerns among men and  women.

 

Biofeedback has been employed in the treatment of various domains of sexual dysfunction, including sexual pain and arousal in women and erectile function in men. Specifically, electromyographic (EMG) biofeedback is widely considered an effective tool to ameliorate sexual pain in women. Though EMG biofeedback has shown efficacy in several studies, biofeedback is well-accepted as a primary or adjunctive treatment for specific sexual concerns in women and may be useful for improving erectile function in post-operative men.  However, biofeedback would likely be best utilized as a part of a multidimensional treatment model, including psychological, pharmacological steps.

 
Vulvar vestibulitis

Vulvar vestibulitis syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis, is vulvodynia - localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain. Until recently, “vulvar vestibulitis” was the term used for localized vulvar pain: the suffix “-itis” would normally imply inflammation, but there is little evidence to support an inflammatory process in the condition. “Vestibulodynia” is the term now recognized by the International Society for the Study of Vulvovaginal Disease.

Overview & Efficacy

Several small controlled studies have shown that muscle tension biofeedback from the pelvic floor is at least as effective as surgery and cognitive restructuring for improvements in sexual functioning and significantly reduced pain during intercourse among people with vulvar vestibulitis.

Why biofeedback would help this problem

The pelvic floor muscles do not behave normally when vulvar vestibulitis is present. There are more spasms and abnormal levels of tension. Psychophysiological recording techniques can record these patterns of muscle tension. Muscle tension biofeedback is used to show these patterns to the patient so the person can learn to recognize when patterns become abnormal and to normalize them. When the patterns of muscle activity become normal, symptoms are significantly reduced or eliminated.

Pelvic Pain - Acute and Chronic

Pelvic pain is a pain in the lowest part of the abdomen and pelvis. In women, pelvic pain might refer to symptoms arising from the reproductive, urinary, or digestive systems, or from musculoskeletal sources.

 

Depending on its source, pelvic pain can be dull or sharp; it might be constant or intermittent; and it might be mild, moderate, or severe. Pelvic pain can sometimes radiate to the lower back, buttocks, or thighs. Sometimes, pelvic pain may only be noted at certain times, such as during urination or sexual activity.

 

Pelvic pain can occur suddenly, sharply and briefly (acute) or over the long term (chronic). Chronic pelvic pain refers to any constant or intermittent pelvic pain that has been present for six months or more.

 

Chronic pelvic pain (CPP) is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy.

Chronic pelvic pain is poorly understood and, consequently, poorly managed. This condition is best managed using a multidisciplinary approach. Management requires good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems.

Overview & Efficacy

A significant number of these patients may have various associated problems, including bladder or bowel dysfunction, sexual dysfunction, and other systemic or constitutional symptoms. Other associated problems, such as depression, anxiety, and drug addiction, may also co-exist. Hundreds of controlled and clinical studies of various sizes, some with multi-year follow-ups, show that biofeedback can help and/or eliminate chronic pain either by rectifying the underlying problem causing the pain or by reducing the stress magnifying it.

Why biofeedback would help this problem

There are many different causes of chronic pain. In many instances, there is a specific problem that can be identified. In others, the body has become over sensitive to stimulation. Anxiety can also magnify pain tremendously. Psychophysiological assessments can frequently identify causes of chronic pain not diagnosable through other techniques. For example, the interaction between various muscle groups in the lower back can be detected as well as abnormal amounts of muscle tension. The combination of these frequently causes low back pain. Biofeedback treatments aimed at rectifying specific problems such as abnormal muscle tension in pelvic floor muscles causing pelvic floor dysfunction can be highly successful. Biofeedback to help people control their anxiety and, thus, reduce the overall amount of pain felt, can also be very helpful.

 
 
Biofeedback for hypertonic pelvic floor

Pelvic floor dysfunction is the inability to correctly identify the pelvic floor muscles. Patients with  pelvic floor muscle tightness or dyssynergia have difficulty in mediating the following functions; ​

  • Supporting the pelvic visceral structures

  • Provide passive and dynamic occlusive force at the urethra & anal canal at rest to maintain storage with increase in intra-abdominal pressure (e.g., cough or sneeze)

  • Inhibit activity in the smooth muscle of the bowel and bladder, to control urgency

  • Allow for the passage of stool and urine during evacuation

  • Disinhibition of colorectal and bladder activity to facilitate smooth muscle propulsive activity, which assists the evacuation of urine and stool

  • Participate in sexual arousal and orgasm

 

Why biofeedback will help die right pelvic floor muscle?

Biofeedback for tight pelvic floor muscle retraining is a treatment to help patients learn not only to strengthen but also to relax their pelvic floor muscles to improve bowel or bladder function and to decrease some types of pelvic floor pain.  Biofeedback is used to gain sensitivity, and, with practice, control over pelvic floor muscle function. With biofeedback, an individual can learn to stop using the incorrect muscles and instead use the correct ones.