The effect of home biofeedback training on stress incontinence.

BACKGROUND: To compare the effectiveness of pelvic floor training (PFT) with the aid of a home biofeedback device to PFT alone for urodynamic stress urinary incontinence (SUI) in women after a 1-year follow-up. METHODS: A randomized study comparing two conservative interventions was conducted in an outpatient clinic of a university hospital. Thirty-five consecutive women were randomized to either the PFT with home biofeedback group or the PFT alone group. The intensive training period lasted 12 weeks. After 1 year, 33 women could be evaluated according to the protocol. At the 1-year visit pelvic floor muscle activity was measured and the need for surgical intervention was evaluated. Logistic multivariate analysis was used to predict response to the PFT. RESULTS: In the home biofeedback training group 11/16 (68.8%) avoided surgery vs. 10/19 (52.6%) in the PFT alone group. The difference was not statistically significant. In the nonoperated home biofeedback group the increase in pelvic floor muscle activity (p = 0.005 in supine, p = 0.005 in standing) and the decrease in leakage index (p = 0.05) was significant after 12 weeks and pelvic floor activity remained constant. By contrast, in the nonoperated PFT group the increase in pelvic floor muscle activity after 12 weeks predicted a good result for conservative treatment. CONCLUSIONS: This randomized controlled trial suggests that the home biofeedback method in PFT has a good success rate of 68.8%. The change achieved in leakage index after 12 weeks of training predicted an effective outcome for conservative treatment.

Increase in pelvic floor muscle activity after 12 weeks' training: a randomized prospective pilot study.

OBJECTIVES: To compare electromyography-assisted biofeedback training to pelvic floor muscle training (PFMT) alone in patients with female stress urinary incontinence. METHODS: A prospective randomized pilot study was conducted between March 1998 and February 2000 at the university hospital for outpatient care. Participants were women with urodynamically tested stress incontinence aged 31 to 69 years without previous incontinence operations, 30 volunteers altogether. The biofeedback group received an electromyography-guided biofeedback device for home training and the PFMT-alone group trained without any device at home. All patients were advised to practice for 20 minutes per day five times a week for 12 weeks. RESULTS: According to the data analysis, muscle forces increased significantly in both supine (P <0.001) and standing (P <0.001) positions. In the supine position, the increase was significantly higher in the biofeedback group (P = 0.024). The results showed close to a significant decrease in the leakage index in the biofeedback group (P = 0.068), but in the PFMT-alone group, no change occurred. With respect to the pad test, the decrease was significant, but it was the same for both groups (P = 0.907). CONCLUSIONS: The findings of this study show that pelvic floor muscle activity is increased and the amount of leaked urine is decreased after 3 months of PFMT. These preliminary results show a significant improvement compared with the PFMT-alone group in PFMT outcome measures in patients using electromyography-assisted biofeedback training.