(646) 355-8777

Herman & Wallace Blog

Biofeedback in Medicine

This post was written by H&W instructor Jennafer Vande Vegte.

Jennafer Vande Vegte

Biofeedback is a truly wonderful tool for a pelvic floor physical therapist. Using surface EMG can really help a patient learn how to control a muscle (typically the pelvic floor) that has been under improper voluntary or involuntary control, sometimes for many years. A recent article on biofeedback in medicine looked at the effectiveness of using biofeedback to treat a number of medical conditions (not just for pelvic floor function) and reviewed pertinent research. Using biofeedback for the treatment of urinary incontinence got the best rating (Level 5) as efficacious and specific. Treatment for constipation met Level 4 criteria for effectiveness while treating urinary incontinence in men, vulvar vestibulitis and fecal incontinence received a Level 3 rating as probably efficacious. (Frank et al., 2010)

It is wonderful when we have evidence that what we do as therapist works. But another question we might have is "HOW does it work?" Emmanuel and Kamm (2001) saw that biofeedback for constipation was effective in retraining faulty pelvic floor function but also noted that many patients undergoing treatment for elimination disorders also saw their transit time and bowel movement frequency improve. They theorized that this may be a response of the extrinsic autonomic nerves sending signals from the brain to the gut. They used mucosal laser Doppler flowmetry to show whether treatment changed extrinsic innervations, if autonomic changes were gut specific (or if there were cardiovascular changes as well) and whether gut transit was affected.

Forty-nine patients with idiopathic constipation had about five biofeedback sessions. Twenty-nine reported improvements in symptoms. Thirteen of twenty-two people with slow transit developed normal transit. There was a significant increase in rectal mucosal blood flow in patients who had subjective improvement compared to those who did not.

The authors concluded that biofeedback treatment to the pelvic floor can affect more than just the muscles and in some people did in fact improve the activity of the direct cerebral innervations to the gut while also improving transit time. This effect did not carry over to the cardiovascular system and is thought to be gut-specific.

As a pelvic rehabilitation provider who is always asking questions, this article makes me wonder if the same principles can apply for other visceral/pelvic floor conditions. For example, does biofeedback to the pelvic floor help with autonomic regulation of over active bladder? How about with interstitial cystitis or endometriosis? Could we show that improving pelvic floor function helps down-train the body's global autonomic stress response? It is exciting to see our body of research growing and adding new dimensions of understanding to the rewarding work that we are privileged to perform.

To learn more about pelvic pain, biofeedback, and relaxation principles, our Level 2A and 2B continuing courses cover topics such as constipation and pelvic pain. Check out the 2A series by clicking here, or the 2B series by clicking here. Remember that these courses sell out many months in advance, so if you see a location that is near you (or that you want to visit!) sign up early!

Menopause and Risk of Long-term Hot Flashes
Debra Goldman - Featured Certified Pelvic Rehabili...

Upcoming Continuing Education Courses

Pelvic Floor Level 2A - Grand Rapids, MI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 1- Kansas City, MO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Centerpoint Medical Center

Oncology of the Pelvic Floor Level 1 - Grand Junction, CO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Urological Associates of Western Colorado

Mobilization of Visceral Fascia: The Gastrointestinal System - Arlington, VA (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Virginia Hospital Center

Pelvic Floor Level 2B - East Greenwich, RI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: New England Institute of Technology

Pilates for the Pelvic Floor - Livingston, NJ (Rescheduled)

Apr 18, 2020 - Apr 19, 2020
Location: Ambulatory Care Center- RWJ Barnabas Health

Genital Lymphedema

Apr 24, 2020

Pelvic Floor Level 1- Canton, OH (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Aultman Hospital

Pelvic Floor Level 1 - Rochester, NY (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Unity Health System

Pediatric Functional Gastrointestinal Disorders - Ann Arbor, MI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Michigan Medicine

Lumbar Nerve Manual Assessment and Treatment - Madison, WI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: University of Wisconsin Hospital

Pelvic Floor Level 2A - Winfield, IL (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Robert Wood Johnson Medical Associates

Athletes & Pelvic Rehabilitation - Minneapolis, MN (Rescheduled)

Apr 25, 2020 - Apr 26, 2020
Location: Viverant

Sacral Nerve Manual Assessment and Treatment - Fairlawn, NJ (Rescheduled)

May 1, 2020 - May 3, 2020
Location: Bella Physical Therapy

Pelvic Floor Level 1 - Fayetteville, AR

May 1, 2020 - May 3, 2020
Location: Washington Regional Medical Center

Pelvic Floor Level 1 - Boise, ID

May 1, 2020 - May 3, 2020
Location: St Luke's Rehab Hospital

Pediatric Incontinence - Duluth, MN

May 1, 2020 - May 3, 2020
Location: Polinsky Medical Rehabilitation Center

Yoga for Pelvic Pain - Online Course

May 2, 2020 - May 3, 2020

Pregnancy Rehabilitation - Corvallis, OR

May 2, 2020 - May 3, 2020
Location: Albany Sport & Spine Physical Therapy

Coccydynia and Painful Sitting - Boston, MA

May 2, 2020 - May 3, 2020
Location: Marathon Physical Therapy

Pelvic Floor Level 1 - Bay Shore, NY (SOLD OUT)

May 11, 2020 - May 13, 2020
Location: Touro College: Bayshore

Pelvic Floor Level 2A - Crown Point, IN

May 15, 2020 - May 17, 2020
Location: Franciscan Health System

Mobilization of Visceral Fascia: The Urinary System - Medford, OR

May 15, 2020 - May 17, 2020
Location: Asante Rogue Valley Medical Center