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Last week’s entry reviewed the anatomy and function of the pelvic floor muscles and the means of using pelvic floor muscle exercises to improve pelvic health. Today’s entry segues to the use of biofeedback and electrical stimulation done under the guidance of a skilled and experienced personal pelvic trainer to optimally hone one’s ability to identify and isolate the pelvic floor muscles and increase their strength and endurance.
The goal is to improve urinary, bowel and sexual function and to gain control and confidence in everyday activities. This can benefit both females and males and can specifically help stress urinary incontinence, overactive bladder and urge incontinence, bowel urgency and incontinence, pelvic prolapse, and sexual dysfunction. Furthermore, the training can help decrease pelvic floor muscle tension and spasm and normalize pelvic floor muscle function in those suffering with pelvic pain syndromes due to tight pelvic floor muscles.
It is one thing to pursue pelvic floor muscle training independently, but another dimension entirely when you have the advantage of an experienced pelvic coach to provide one-on-one guidance to help the process and teach you how to become a master of your pelvic domain. The pelvic training is done by our superb personal pelvic trainer, Yosaira Brioso, who runs our centralized urodynamic laboratory and does the percutaneous tibial nerve stimulation for overactive bladder and with whom I have worked with since 2009. She has done an amazing job and our office has received a flood of compliments from patients about how positive and effective their experience was.
The system used is the Laborie Urostym (Stimulation and Biofeedback) equipment. The training is highly individualized and nuanced to address the specific problem and clinical scenario that the patient is experiencing.
The training involves a 30–45-minute session that is done weekly for 6 weeks. The first part of the session is biofeedback, an adjunct to pelvic floor muscle training in which special sensors (EMG patches and leads on the abdomen), a vaginal probe sensor in females, and a short anal probe sensor in males are used to relay auditory and visual feedback information about the quality and magnitude of one’s pelvic muscle contraction and relaxation. The intent of biofeedback is to enhance awareness of the pelvic floor muscles, ensure focus on and contraction of the proper muscles, and to optimize control over pelvic muscle function. The biofeedback helps evaluate the contraction strength, endurance, and relaxation of the pelvic muscles during the cycles of contraction and relaxation. This promotes using the proper muscles and decreases the use of accessory muscles including the abdominal muscles, gluteals, and thigh muscles. Ultimately, biofeedback facilitates patients in the process of strengthening, relaxing, and controlling the proper muscle groups. The biofeedback allows patients to objectively monitor their improvement over the course of the six sessions.
The second part of the session is electrical stimulation. Electrical stimulation of the pudendal nerve via the vaginal probe in females and short anal probe sensor in males produces a reflex contraction of the pelvic floor muscles. This helps increase awareness, identification, isolation, and strengthening of the proper muscles.
E-stimulation guided contraction of the pelvic muscles reflexively inhibits involuntary bladder contractions, helping to improve bladder function, decrease pelvic floor muscle spasms and normalize pelvic floor relaxation.
Bottom Line: Pelvic floor muscle one-on-one training, biofeedback, and electrical stimulation are a safe and conservative first-line approach to many pelvic floor issues. I have been delighted with the excellent outcomes that many of my patients have experienced after completing this program. One of my practice principles has always been to try simple solutions before complex and aggressive ones– “Simple is good”–and this program embodies that philosophy.
