Biofeedback in Medicine

This post was written by H&W instructor 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!