Overview & Efficacy: Several comparative and controlled studies and numerous clinical studies have shown that muscle tension and pneumatic biofeedback can be highly effective for the treatment of the two most common types of urinary incontinence (physical stress and urge) as long as the muscle attachments are intact, most types of fecal incontinence (as long as the nerve paths are intact), and constipation due to malfunctioning anal muscles (as opposed to dehydration).

This therapy is rated as efficacious for males (level 4 on a scale of 1 - 5 with 5 being the best) and efficacious and specific for females (level 5 on a scale of 1 - 5 with 5 being the best).

For more information on how efficacy is rated click here.

Why biofeedback would help this problem: The muscles of the pelvic floor (including those controlling the anus and urinary sphincters) can become weakened due to overall loss of conditioning with age, stretching during delivery, etc. These muscle may be in fine shape but they may have to resist more pressure than they can handle during a cough or jump. Many people do not have a good sense of when the actually have to urinate or defecate and are either fooled by sensations which are just warnings or miss the warnings entirely. Most people tense the wrong muscles when they are trying to avoid leaking. Biofeedback sensors inserted into the vaginal canal or anus or taped to the pelvic floor can easily pick-up these signals so people can learn to recognize them by watching the biofeedback display and relating the changes in the display to sensations in their bodies. Pressure sensors (which look like tiny balloons) can both pick up the signals and simulate them so the signals can be produced on demand. Muscle tension biofeedback used in combination with Kegal exercises and other forms of home practice help the person strengthen the muscles and contract only the correct muscles when they should be contracted. This same methodology can be used to help patients recognize when they need to have a bowel movement and to relax the appropriate muscles in the appropriate sequence when ready.

Brief summary of evidence supporting the efficacy of biofeedback for elimination disorders:

Numerous studies demonstrate levels 4 and 5 efficacy of biofeedback for urinary incontinence in females. It is better than no treatment (i.e., control) (Burgio et al., 1998; Burns et al., 1993; Dougherty et al., 2002; McDowell et al., 1999), better than or equal to other behavioral treatments (e.g., pelvic floor exercises) (Burns et al., 1993; Glavind, Nohr, Walter, 1996; Sherman, Davis, Wong, 1997; Sung, Hong, Choi Baik, Yoon, 2000; Weatherall, 1999; Wyman, Fantl, McClish, Bump, 1998) and better than drug (i.e., oxybutynin chloride) treatment (Burgio et al., 1998) in both young and old females. Combining drug and behavioral therapy in a stepped program can produce added benefit for those not satisfied with the outcome of single treatment (Burgio, Locher, Goode, 2000). Palsson et al (2004) have reviewed the evidence showing that biofeedback is efficacious for constipation, fecal incontinence, anal pain, and other functional anorectal disorders. They found that the average probability of successful treatment outcome for patients treated with biofeedback was 67% for functional fecal incontinence and 62% for constipation.

Detailed information on biofeedback augmented treatment of elimination disorders:

A. Citations to the papers summarized in the "brief summary":

Burgio, K.L., Locher, J.L., & Goode, P.S. (2000). Combines behavioral and drug therapy for urge incontinence in older women. Journal of the American Geriatric Society, 48(4), 370-374.

Burgio, K.L., Locher, J.L., Goode, P.S., Hardin, J.M., McDowell, B.J., Dombrowski, M., et al. (1998). Behavioral vs drug treatment for urge urinary incontinence in older women: A randomized controlled trial. Journal of the American Medical Association, 280(23), 1995-2000.

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(4), M167-174.

Dougherty, M.C., Dwyer, J.W., Pendergast, J.F., Boyington, A.R., Tomlinson, B.U., Coward, et al. (2002). A randomized trial of behavioral management for continence with older rural women. Research in Nursing and Health, 25(1), 3-13.

Glavind, K., Nohr, S.B., & Walter, S. (1996) Biofeedback and physiotherapy versus physiotherapy alone in the treatment of genuine stress urinary incontinence. International Urogynecologic Journal of Pelvic Floor Dysfunction, 7(6), 339-343.

McDowell, B.J., Engberg, S., Sereika, S., Donovan, N., Jubeck, M.E., Weber, E., et al. (1999). Effectiveness of behavioral therapy to treat incontinence in homebound older adults. Journal of the American Geriatric Society, 47(3), 309-318.

Palsson O., Heymen S., &Whitehead W. (2004). Biofeedback Treatment for Functional Anorectal Disorders: A Comprehensive Efficacy Review. Applied Psychophysiology and Biofeedback 29: 153 – 174.

Sherman, R.A., Davis, G.D., & Wong, M.F. (1997). Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Military Medicine, 162(10), 690-704.

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(3), 303-08.

Weatherall, M. (1999). Biofeedback or pelvic floor muscles exercise for female genuine stress incontinence: A meta-analysis of trials identified in a systematic review. British Journal of Urology, International 83(9), 1015-1016.

Wyman, J.F., Fantl, J.A., McClish, D.K., & Bump, R.C. (1998). Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. American Journal of Obstetrics and Gynecology, 179(4), 999-1007.