Biofeedback Pelvic Floor Therapy

Biofeedback training is a relatively new treatment for urinary incontinence, however the roots can be traced back to 1940. Dr. Arnold Kegel designed an exercise program to help strengthen the pelvic floor to treat urinary incontinence and pelvic floor problems like cystocele and rectocele. These exercises became known as "kegels." Unfortunately, many women do not do them correctly, or do not understand how to do them at all. Recent studies have shown that if done correctly, pelvic floor exercises are effective for the treatment of mild to moderate urinary incontinence and other conditions related to pelvic floor weakness.

How do I know if my pelvic floor is weak?
Your doctor or nurse should be able to tell you this at the time of your pelvic exam. You probably have a weak pelvic floor if you have been told that you have a "cystocele" (dropped bladder) or a "rectocele" (upward bulge from the rectum.)

How does biofeedback work?
Biofeedback helps to isolate the muscle groups in the pelvis similar to the machines used to isolate arm and leg muscles at the local gym. It is well known that the most rapid effect on the strength and size of muscles can be obtained when these muscles are isolated and exercised regularly with periods of rest in between. Biofeedback training helps by providing visual and auditory feedback in response to the activity of the muscles.

How is it done?
Biofeedback sessions are done in the office by a trained nurse specialist. A small sensor is placed either in the vagina, or on the skin of the outside of the vagina. Once in place, the patient can stay fully clothed for the remainder of the session. Additional sensors (similar to the pads placed for EKG's) are place on the abdomen or buttocks.

These sensors measure the minute electrical signals that all muscles produce when they contract. The sensors are connected to a computer that separates the incoming electrical signals and displays them on the computer screen. The patient can therefore see immediately when she is contracting the proper set of muscles and doing the exercise correctly. The computer can also measure the strength of the muscle and follow the progress as the pelvic floor gets stronger.

Why do I need biofeedback if I already do "Kegel" exercises?
Biofeedback is just a tool to make sure that you are doing the exercises correctly. Unfortunately, many women do not do "kegels" correctly and contract other muscles along with the pelvic floor muscles. When a pelvic floor contraction is done correctly, the pelvic floor moves up and into the pelvis. The most common problem is with the contraction of the abdominal muscles at the same time. When this occurs the abdominal muscles (which are bigger and stronger) push down on the pelvic floor and can actually make the problem worse.

What is involved?
Typically, there are weekly 30 minute sessions in the office for a total of 6 weeks. The first session may be a little longer for an initial evaluation. You will then be given specific exercises, customized for you, to do at home.

Are these treatments covered by my insurance?
In March 1996, the U.S. Dept. of Health and Human Services published an update to a guide for managing acute and chronic urinary incontinence. This guide recommends "Pelvic muscle rehabilitation and bladder inhibition using biofeedback therapy for patients with stress incontinence, urge incontinence and mixed incontinence." Since then, most insurance companies cover the cost of this treatment option. However, prior approval should be obtained if there are questions.

What if I need surgery?
Biofeedback in no way would cause a problem if surgery is done. Biofeedback training would only make the tissues of the pelvis stronger and can be used either before or after corrective surgery.

How do I start?
First, discuss your problem with your doctor. They cannot help you if they are unaware of your problem. You can obtain further information from our office, or schedule a consultation by calling-(704) 547-0858.