Skip to main content

Advertisement

SpringerLink
Log in

Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence: A Literature Review

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Biofeedback is efficacious in the training of the pelvic floor musculature in order to enhance continence. This article reviews the anatomy and physiology of micturition as the underlying rationale for pelvic floor muscle biofeedback in the treatment of urinary incontinence. It critically reviews 28 studies published in peer reviewed journals from 1975 to 2005 that were prospective, randomized studies with parametric statistical analyses, operationally defined patient selection criteria, treatment protocols and outcome measures. The overall mean treatment improvement for patients undergoing biofeedback for urinary incontinence was 72.61%. In 21 of 35 (60%) paired comparisons, biofeedback demonstrated superior symptomatic outcome to control or alternate treatment groups. Larger studies and a standardization of technology and methodology are required for more conclusive determinations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abrams, P., Blaivas, J. G., Stanton, S. L., & Andersen, J. T. (1988). International Continence Society committee on standardization of terminology of lower urinary tract function. Neurourology and Urodynamics, 7, 403–417.

    Google Scholar 

  • Aksac, B., Aki, S., Karan, A., Yalcin, O., Isikoglu, M., & Eskiyurt, N. (2003). Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Gynecologic and Obstetric Investigation, 56, 23–27.

    Article  PubMed  Google Scholar 

  • Andersson, K. E., & Wein, A. J. (2004). Pharmacology of the lower urinary tract: Basis for current and future treatments of urinary incontinence. Pharmacological Reviews, 56, 581–631.

    Article  PubMed  Google Scholar 

  • Aukee, P., Immonen, P., Laaksonen, D. E., Laippala, P., Penttinen, J., & Airaksinen, O. (2004). The effect of home biofeedback training on stress incontinence. Acta Obstetricia et Gynecologica Scandinavica, 83, 1–6.

    Article  Google Scholar 

  • Aukee, P., Immonen, P., Penttinen, J., Laippala, P., & Airaksinen, O. (2002). Increase in pelvic floor muscle activity after 12 weeks’ training: A randomized prospective pilot study. Urology, 60, 1020–1023.

    Article  PubMed  Google Scholar 

  • Bales, G. T., Gerber, G. S., Minor, T. X., Mhoon, D. A., McFarland, J. M., Kim, H. L., & Brendler, C. B. (2000). Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology, 56, 627–630.

    Article  PubMed  Google Scholar 

  • Berghmans, L. C. M., Frederiks, C. M. A., de Bie, R. A., Weil, E. H. J., Smeets, L. W. H., van Waalwijk van Doorn, E. S. C., & Janknegt, R. A. (1996). Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence. Neurourology and Urodynamics, 15, 37–52.

    Article  PubMed  Google Scholar 

  • Blaivas, J. G. (1985). Pathophysiology of lower urinary tract dysfunction. Clinics in Obstetrics and Gynaecology, 12, 295–309.

    PubMed  Google Scholar 

  • Brown, C. (2001). Pelvic floor reeducation: A practical approach. In J. Corcos & E. Schick (Eds.), The Urinary Sphincter (pp. 459–473). New York: Marcel Dekker.

    Google Scholar 

  • Brown, J. S., Grady, D., Ouslander, J. G., Herzog, A. R., Varner, R. E., & Posner, S. F. (1999). Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Obstetrics & Gynecology, 94, 66–77.

    Article  Google Scholar 

  • Burgio, K. L., Goode, P. S., Locher, J. L., Umlauf, M. G., Roth, D. L., Richter, H. E., Varner, R. E., & Lloyd, L. K. (2002). Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: A randomized controlled trial. The Journal of the American Medical Association, 288, 2293–2299.

    Article  Google Scholar 

  • Burgio, K. L., Locher, J. L., Goode, P. S., Hardin, J. M., McDowell, B. J., Dombrowski, M., & Candib, D. (1998). Behavioral vs. drug treatment for urge urinary incontinence in older women. Journal of the American Medical Association, 280, 1995–2000.

    Article  PubMed  Google Scholar 

  • Burgio, K. L., Robinson, J. C., & Engel, B. T. (1986). The role of biofeedback in Kegel exercise training for stress urinary incontinence. American Journal of Obstetrics and Gynecology, 154, 58–64.

    PubMed  Google Scholar 

  • Burns, P. A., Pranikoff, K., Nochajski, T. H., Hadley, E. C., Levy, K. J., & Ory, M. G. (1993). A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. Journal of Gerontology, 48, M167.

    PubMed  Google Scholar 

  • Burton, J. R., Pearce, K. L., Burgio, K. L., Engel, B. T., & Whitehead, W. E. (1988). Behavioral training for urinary incontinence in elderly ambulatory patients. Journal of the American Geriatrics Society, 36, 693–698.

    PubMed  Google Scholar 

  • Chung, A. K., Peters, K. M., & Diokno, A. C. (2001). In J. Corcos & E. Schick (Eds.), The Urinary Sphincter (pp. 183–191). New York: Marcel Dekker.

  • Critchley, H. O., Dixon, J. S., & Gosling, J. A. (1980). Comparative study of the periurethral and perianal parts of the levator ani muscle. Urologia Internationalis, 35, 226–232.

    Article  PubMed  Google Scholar 

  • DeLancey, J. O. (2001). Anatomy. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 111–124). London: Isis Medical Media.

  • Dorey, G., Speakman, M., Feneley, R., Swinkels, A., Dunn, C., & Ewings, P. (2002). Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction: A randomized controlled trial. Urologic Nursing, 24, 490–512.

    Google Scholar 

  • Dougherty, M. C., Dwyer, J. W., Pendergast, J. F., Boyington, A. R., Tomlinson, B. U., Coward, R. T., Duncan, R. P., Vogel, B., & Rooks, L. G. (2002). A randomized trial of behavioral management for continence with older rural women. Research in Nursing & Health, 25, 3–13.

    Article  Google Scholar 

  • Fantl, J. A., Newman, D. K., Colling, J., DeLancey, J. O., Keeys, C., Loughery, R., et al. (1996). Urinary Incontinence in Adults: Acute and Chronic Management: Clinical Practice Guideline No. 2, 1996 Update. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 96-0682.

  • Floratos, D. L., Sonke, G. S., Rapidou, C. A., Alivizatos, G. J., Deliveliotis, C., Constantinides, C. A., & Theodorou, C. (2002). Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostectomy. BJU International, 89, 714–719.

    Article  PubMed  Google Scholar 

  • Franke, J. J., Gilbert, W. B., Grier, J., Koch, M. O., Shyr, Y., & Smith, J. A. (2000). Early post-prostatectomy pelvic floor biofeedback. The Journal of Urology, 163, 191–193.

    Article  PubMed  Google Scholar 

  • Glazer, H. I., Romanzi, L., & Polaneczky, M. (1999). Pelvis floor muscle surface electromyography: Reliability and clinical predictive validity. The Journal of Reproductive Medicine, 44, 779–782.

    PubMed  Google Scholar 

  • Goode, P. S. (2004). Behavioral and drug therapy for urinary incontinence. Urology, 63(3 Suppl. 1), 58–64.

    Article  PubMed  Google Scholar 

  • Haab, E., Sebe, P., Mondet, F., & Ciofu, C. (2001). Functional anatomy of the bladder and urethra in females. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 15–24). New York: Marcel Dekker.

    Google Scholar 

  • Hald, T., & Bradley, W. E. (1982). The urinary bladder: Neuology and dynamics. Baltimore: Williams & Wilkins.

    Google Scholar 

  • Harrison, G. L., & Memel, D. S. (1994). Urinary incontinence in women: Its prevalence and its management in a health promotion clinic. The British Journal of General Practice, 44, 149–152.

    PubMed  Google Scholar 

  • Johnson, T. M., Burgio, K. L., Redden, D. T., Wright, D. C., & Goode, P. S. (2005). Effects of behavioral and drug therapy on nocturia in older incontinent women. Journal of the American Geriatrics Society, 53, 846–850.

    Article  PubMed  Google Scholar 

  • Kegel, A. H. (1948). Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology, 56, 238–249.

    PubMed  Google Scholar 

  • Khullar, V., & Cardozo, L. (2001). History and examination. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 153–166). London: Isis Medical Media.

    Google Scholar 

  • Laycock, J., Brown, J., Cusack, C., Green, S., Jerwood, D., Mann, K., McLachlan, Z., & Schofield, A. (2001). Pelvic floor reeducation for stress incontinence: Comparing three methods. British Journal of Community Nursing, 6, 230–237.

    PubMed  Google Scholar 

  • McDowell, B. J., Engberg, S., Sereika, S., Donovan, N., Jubeck, M. E., Weber, E., & Engberg, R. (1999). Effectiveness of behavioral therapy to treat incontinence in homebound older adults. Journal of the American Geriatrics Society, 47, 309–318.

    PubMed  Google Scholar 

  • Morkved, S., Bo, K., & Fjortoft, T. (2002). Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstetrics and Gynecology, 100, 730–739.

    Article  PubMed  Google Scholar 

  • Myers, R. P. (2001). The male striated urethral sphincter. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 25–42). New York: Marcel Dekker.

    Google Scholar 

  • Pages, I.-H., Jahr, S., Schaufele, M. K., & Conradi, E. (2001). Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. American Journal of Physical Medicine & Rehabilitation, 80, 494–502.

    Article  Google Scholar 

  • Parekh, A. R., Feng, M. I., Kirages, D., Bremner, H., Kaswick, J., & Aboseif, S. (2003). The role of pelvic floor exercises on post-prostatectomy incontinence. The Journal of Urology, 170, 130–133.

    Article  PubMed  Google Scholar 

  • Resnick, N. M., & Yalla, S. V. (1987). Detrusor hyperactivity with impaired contractile function: An unrecognized but common cause of incontinence in elderly patients. The Journal of the American Medical Association, 257, 3076–3081.

    Article  Google Scholar 

  • Romanzi, L. J., Polaneczky, M., & Glazer, H. I. (1999). Simple test of pelvic muscle contraction during pelvic examination: Correlation to surface electromyography. Neurourology and Urodynamics, 18, 603–612.

    Article  PubMed  Google Scholar 

  • Schick, E. (2001). Physical examination. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 251–260). New York: Marcel Dekker.

    Google Scholar 

  • Schmidt, R. A. (2001). Pelvic floor: Lessons from our past. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 101–110). London: Isis Medical Media.

    Google Scholar 

  • Seo, J. T., & Kim, Y. H. (2004). A randomized prospective study comparing new vaginal cone and FES-biofeedback. Yonsei Medical Journal, 45, 879–884.

    PubMed  Google Scholar 

  • Shafik, A., Ahmed, I., Shafik, A. A., El-Ghamrawy, T. A., & El-Sibai, O. (2005). Surgical anatomy of the perineal muscles and their role in perineal disorders. Anatomical Science International, 80, 167–171.

    Article  PubMed  Google Scholar 

  • Sherman, R. A., Davis, G. D., & Wong, M. F. (1997). Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Military Medicine, 162, 690–694.

    PubMed  Google Scholar 

  • Singh, K., Reid, W. M., & Berger, L. A. (2002). Magnetic resonance imaging of normal levator ani anatomy and function. Obstetrics and Gynecology, 99, 433–438.

    Article  PubMed  Google Scholar 

  • Sueppel, C., Kreder, K., & See, W. (2001). Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Urologic Nursing, 21, 201–210.

    PubMed  Google Scholar 

  • Sung, M. S., Hong, J. Y., Choi, Y. H., Baik, S. H., & Yoon, H. (2000). FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. Journal of Korean Medical Science, 15, 303–308.

    PubMed  Google Scholar 

  • Van Kampen, M., De Weerdt, W., Van Poppel, H., De Ridder, D., Feys, H., & Baert, L. (2000). Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial. The Lancet, 355, 98–102.

    Article  Google Scholar 

  • Wang, A. C., Wang, Y. Y., & Chen, M. C. (2004). Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology, 63, 61–66.

    Article  PubMed  Google Scholar 

  • Wille, S., Sobottka, A., Heidenreich, A., & Hofmann, R. (2003). Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: Results of a prospective randomized trial. The Journal of Urology, 170, 490–493.

    Article  PubMed  Google Scholar 

  • Wyman, J. F., Fantl, J. A., McClish, D. K., & Bump, R. C. (1988). Comparative efficacy of behavioural interventions in the management of female urinary incontinence. American Journal of Obstetrics and Gynecology, 179, 999–1007.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joan and Sanford Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA

    Howard I. Glazer

  2. Saybrook Graduate School and Research Center, San Francisco, CA, USA

    Carolyn D. Laine

Authors
  1. Howard I. Glazer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolyn D. Laine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Howard I. Glazer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glazer, H., Laine, C. Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence: A Literature Review. Appl Psychophysiol Biofeedback 31, 187–201 (2006). https://doi.org/10.1007/s10484-006-9010-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-006-9010-x

KEY WORDS

Search

Navigation