How sEMG Biofeedback Restores Coordinated Defecation

In a recent article entitled “Physiotherapy Approaches in Individuals with Functional Defecation Disorders: Literature Review,” published in the Journal of Health Sciences in August of 2025, the use of surface EMG biofeedback (sEMG) was recommended as a first-step treatment for functional defecation disorders. It was concluded that biofeedback applications were superior to standard treatment and effective in improving patients’ quality of life. Both the American Neurogastroenterology and Motility Society and the American College of Gastroenterology recommend biofeedback as first-line therapy for dyssynergic defecation.

Surface electromyography (sEMG) biofeedback has emerged as one of the most effective conservative interventions for treating dyssynergic defecation, also known as pelvic floor dyssynergia. This condition is characterized by the paradoxical contraction or inadequate relaxation of the pelvic floor muscles and external anal sphincter during attempted defecation, resulting in functional outlet obstruction and chronic constipation. Dyssynergia affects many of our clients with chronic constipation and is a prevalent referral diagnosis in pelvic floor rehabilitation. For pelvic health therapists, sEMG biofeedback provides a valuable therapeutic tool that directly retrains neuromuscular coordination, corrects maladaptive defecation mechanics, and improves patient outcomes without the risks associated with pharmacologic or surgical interventions.

How Surface EMG Biofeedback Works
Biofeedback therapy addresses the underlying pathophysiology of dyssynergia by helping patients learn to modulate pelvic floor muscle activity during simulated defecation. Surface EMG biofeedback uses external perianal or intrarectal sensors to record muscle activation patterns, visually displaying motor unit firing in real time on a monitor. When patients attempt defecation, those with dyssynergia often engage in compensatory or dysfunctional mechanics such as breath-holding, strain maneuver without pelvic floor relaxation, or tightening of the external anal sphincter and puborectalis muscle. Biofeedback enables patients to see these abnormalities and receive immediate coaching to correct them. This learning model aligns with the principles of motor relearning and neuroplasticity and is particularly effective for reeducating muscles involved in autonomic and habitual reflex responses, including those of the pelvic floor.

A key benefit of surface EMG biofeedback is its ability to correct maladaptive motor patterns rather than merely provide symptomatic relief. Unlike laxatives, which simply soften stool or increase motility, biofeedback teaches coordinated defecation by training patients to relax the anal sphincter, lengthen the pelvic floor, and generate appropriate intra-abdominal pressure. Many patients demonstrate dyssynergic patterns such as Type I dyssynergia, where the pelvic floor contracts during attempted evacuation, or Type III, where inadequate abdominal force is generated. Biofeedback helps individualize treatment, as therapists can use EMG data to identify specific coordination deficits and modify training accordingly. In addition, EMG signals provide objective progress markers, reinforcing patient engagement and compliance.

Another important clinical advantage of biofeedback is that it is non-invasive, safe, and well-tolerated across patient populations. It is appropriate for adults, older adults, and even motivated pediatric patients. Side effects are minimal, especially with surface EMG sensors that eliminate the need for internal probes when preferred clinically. This makes EMG biofeedback a valuable option for patients who may not tolerate rectal balloon training or invasive anorectal procedures due to pain, anxiety, or trauma history.

Integrating Biofeedback into Pelvic Rehabilitation
Biofeedback therapy integrates well within holistic pelvic rehabilitation programs. Treatment typically includes coordination training, diaphragmatic breathing, colonic massage instruction, toileting posture education, bowel mechanics retraining, and behavioral strategies to restore normal recto-anal sensory reflexes. Surface EMG enhances the effectiveness of behavioral training by improving patients’ proprioceptive awareness of their pelvic floor, a region in which neuromuscular awareness is typically poor. Additionally, EMG biofeedback can incorporate downtraining techniques to reduce high resting pelvic floor tone.

Despite its proven benefits, access to biofeedback therapy can be inconsistent due to limited awareness among healthcare providers and insufficient training opportunities for therapists. However, pelvic health therapists are uniquely positioned to deliver this intervention effectively due to their expertise in neuromuscular reeducation, movement analysis, and behavioral coaching. Incorporating sEMG biofeedback into a pelvic rehabilitation practice not only aligns with evidence-based care but also enhances clinical credibility and expands therapeutic capabilities, especially for patients with chronic functional bowel disorders.

Surface EMG biofeedback offers substantial therapeutic benefits for the treatment of pelvic floor dyssynergia. It is superior to standard medical therapy, targets the root cause of dyssynergia through neuromuscular retraining, promotes long-term bowel function normalization, and empowers patients to take an active role in their recovery. With growing clinical validation and patient demand for non-pharmacologic treatments, sEMG biofeedback should be considered an essential component of pelvic floor therapy practice. For pelvic health therapists seeking to deliver advanced, evidence-based care, biofeedback represents a powerful and effective intervention with lasting results.

Conclusion
A long history of scientific evidence supports the use of sEMG biofeedback for managing incontinence or pain symptoms. As a noninvasive, cost-effective, and powerful treatment modality, healthcare providers should consider this tool when managing pelvic floor dysfunction. Providers should be adequately educated in this valuable modality to make the most of the skills and knowledge gained through this intervention. For more information regarding courses and certification, please visit www.pelvicfloorbiofeedback.com.

Biofeedback for Pelvic Muscle Dysfunction is available in satellite and self-hosted formats.
Biofeedback for Pelvic Muscle Dysfunction, scheduled for December 13, 2025, is led by board-certified Instructors Jane Kaufman and Tiffany Lee, who introduce participants to the use of biofeedback in the treatment of bladder, bowel, and pelvic floor disorders. In this course, participants learn about surface EMG biofeedback by using the equipment on themselves to experience dynamic muscle assessment in supine, sitting, and standing positions. This dynamic course also includes behavioral strategies to relearn proper muscle control and improve pelvic floor function.

If you attend this course at a scheduled hosted location (NOT self-hosted), then the equipment will be supplied by our biofeedback vendor, Current Medical Technologies. Satellite Locations for December 13th are:

• New Bern, NC
• Goodyear, AZ

Self-hosted participants do not need partners and can treat themselves using the equipment. Equipment used in this course, and required for all self-hosted registrants, is as follows (all items can be purchased on www.cmtmedical.com):

• A 2-channel sEMG biofeedback hand-held unit with software on a laptop or computer is required. The instructors will teach biofeedback with the Prometheus Telesis software. Participants can use MR-20, MR-25, EMYO, CTS 1500, or CTS 2000.
• The participants who are self-hosting will need a vaginal or rectal sensor and abdominal leads. Alternatively, participants can use external perianal electrodes.
• To use the disposable external electrodes, participants will need a Pathway Velcro adapter (PG-3660), 1 Pathway External Adapter (PG-7100), and Vermed sEMG disposable lead wire set (VM-A10057-S).
• Another option for external electrodes are the Pre-gelled sEMG Biofeedback Electrodes (DE-301) with a 24-inch external lead wire set (PG-5328).

 

References:

1. Büyüktaş, N., & Bakar, Y. (2025). Physiotherapy Approaches in Individuals with Functional Defecation Disorders: Literature Review. Fenerbahçe University Journal of Health Sciences, 5(2), 281-291.
2. Kaufman, J., Stanton, K., & Lee, T. E. (2021). Pelvic Floor Biofeedback for the Treatment of Urinary Incontinence and Fecal Incontinence. Biofeedback, 49(3), 71-76.
3. Rao, S. S., Benninga, M. A., Bharucha, A. E., Chiarioni, G., Di Lorenzo, C., & Whitehead, W. E. (2015). ANMS‐ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders.Neurogastroenterology & Motility, 27(5), 594-609.
4. Shelly, Beth & Kaufman, Jane (2023). Foundations of Pelvic Floor Muscle Assessment Using Surface Electromyography. APTA Academy of Pelvic Health Physical Therapy.

 

AUTHOR BIO
Tiffany Lee, OTR, OTD, MA, BCB-PMD, PRPC

Tiffany Lee holds a BS in OT from UTMB Galveston (1996), an MA in Health Services Management, and a post-professional OTD from Texas Tech University Health Sciences Center. In 2004, she received her board certification in Pelvic Muscle Dysfunction from the Biofeedback Certification International Alliance. She is a Herman and Wallace Pelvic Rehab Institute faculty member and teaches biofeedback courses. She has been treating pelvic health patients for 25 out of her 30-year career. Her private practice in San Marcos, Texas, is exclusively dedicated to treating urinary and fecal incontinence and pelvic floor disorders. Her continuing education company, Biofeedback Training & Incontinence Solutions, offers clinical consultation and training workshops. She also enjoys mentoring healthcare professionals working toward their BCIA certification.