Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis

Abstract

Biofeedback (BF) has been widely used in the treatment of pelvic floor dysfunctions, mainly by promoting patient learning about muscle contraction with no side effects. However, its effectiveness remains poorly understood with some studies suggesting that BF offers no advantage over the isolated pelvic floor muscle training (PFMT). The main objective of this study was to systematically review available randomized controlled trials assessing the effectiveness of BF in female pelvic floor dysfunction treatment. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). Randomized controlled trials assessing the training of pelvic floor muscle (PFM) using BF in women with PFM dysfunction were selected. Outcomes were converted to a scale ranging from 0 to 100. Trials were pooled with software used to prepare and update Cochrane reviews. Results are presented as weighted mean differences with 95 % confidence intervals (CI). Twenty-two trials with 1,469 patients that analyzed BF in the treatment of urinary, anorectal, and/or sexual dysfunctions were included. PFMT alone led to a superior but not significant difference in the function of PFM when compared to PFMT with BF, by using vaginal measurement in the short and intermediate term: 9.89 (95 % CI -5.05 to 24.83) and 15.03 (95 % CI -9.71 to 39.78), respectively. We found a few and nonhomogeneous studies addressing anorectal and sexual function, which do not provide the cure rate calculations. Limitations of this review are the low quality and heterogeneity of the studies, involving the usage of distinct protocols of interventions, and various and different outcome measures. The results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction.

Pelvic floor muscle training for overactive bladder symptoms – A prospective study

“…The increase in vaginal contraction pressure was 105% in the BF group; 78.9% in the PFMT group; and only 12.6% in the electrostimulation group. 21 BF is an adjuvant to PFMT and allows patients to observe PFM contractions during exercise, thereby improving exercise performance and treatment motivation, [22][23][24] which may justify a significant improvement in PFM function.…”

Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study

“…1 PFM training should be recommended as a first-line conservative management in the treatment of urinary incontinence, 2,3 as demonstrated by numerous randomized controlled trials. [4][5][6][7] The success of treatment with exercises is dependent on the achievement of strength and endurance, which consequently leads to improvement of the PFM function.…”

MicroRNA-29 facilitates transplantation of bone marrow-derived mesenchymal stem cells to alleviate pelvic floor dysfunction by repressing elastin

“…Approximately half of parous women suffer from SUI and/or POP to various extents, both of which are closely linked to birth-related injury to the pelvic floor [1]. These disorders occur with increasing rate particularly in adult women of older age [2, 3]. Current clinical treatment and management of these conditions are mainly symptom-based and conservative, and surgeries are only considered for women who fail or decline conservative treatments.…”

“…Current clinical treatment and management of these conditions are mainly symptom-based and conservative, and surgeries are only considered for women who fail or decline conservative treatments. Eleven percent of PFD patients above the age of 80 undergo surgery, which often involves partial (anterior or posterior) or total vaginal repair with concurrent hysterectomy [2, 3]. However, as many as 20–30 % of the patients require repeated surgery due to relapse [4, 5].…”