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Biofeedback Therapy in Pelvic Organ Rehabilitation

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WHAT IS BIOFEEDBACK THERAPY?

Biofeedback or BFB-therapy is a modern non-pharmacological treatment and rehabilitation method based on the principle that a patient can be trained to voluntarily change physiological parameters (for example, EEG, EMG or ECG) with biofeedback.

In other words, the essence of the biofeedback method is to «feed back» to the patient the current values of her physiological indicators, defined by the clinical protocol, on a computer display or in audio format. (A protocol is the combination of all the requirements for performing a biofeedback procedure).

At a clinic in Moscow, Dr. Maryana Abritsova conducts training sessions using the Callibri BeFit PRO biofeedback system manufactured by Neurotech, a medical research company. The system has proven to be reliable, high-quality equipment that meets all the technological and functional requirements of a specialist.

WHAT IS THE PELVIC FLOOR AND WHY IS IT IMPORTANT TO TRAIN PELVIC FLOOR MUSCLES?

This article reviews an EMG (electromyogram, electrical activity of muscles) study because the organs of the lesser pelvis include a group of muscles that are located between the pubic symphysis and the sacrum and that support the pelvic organs, such as the bladder, intestines and uterus.

The muscles help control the function of urinary continence, empty the intestines, and also contract and relax the vaginal wall during sexual intercourse.

If the pelvic floor muscles are tensed or, alternatively, relaxed, this can became a cause of pelvic pain and other disorders related to the functions of the pelvic organs:

  • Urinary dysfunction. Women and men can suffer from urinary incontinence while coughing, sneezing or laughing, or during physical exertion. Some feel an unbearable urge to urinate even when the bladder is empty. In contrast, others have difficulty urinating.
  • Fecal incontinence. Many women cannot control the passing of gas or fecal matter during the postpartum period.
  • Perineal pain. Women frequently experience this condition after childbirth, especially if they had lacerations or an episiotomy (a surgical incision of the perineum). Tightness of the pelvic floor muscles can be a cause of constant perineal pain even after the lacerations are healed.
  • Pelvic pain. Some women continue to experience pain during sexual intercourse for a long time after childbirth. Frequently, the pain becomes chronic, accompanied by an itching or burning sensation in the vulva, the tissue surrounding the vagina. These symptoms can make it impossible to wear tight clothing or underwear. Some experience pain while emptying their bowels. These symptoms are usually triggered by tense pelvic floor muscles, which can ultimately lead to inflammation of the tissue and nerve endings.
  • Vaginal wall prolapse, genital prolapse. When the pelvic floor muscles weaken due to pregnancy or childbirth, one of several organs supported by these muscles can drop into the vagina. Rehabilitation of the pelvic floor muscles can prevent or significantly improve this condition.
  • Constipation or the inability to fully empty the bowels during a prolonged period of time without an apparent medical reason. This problem can lead to awkwardness, embarrassment and reduced social interaction. It has many possible causes, including an inability to relax the muscles that control intestinal motility. Frequently, biofeedback therapy is recommended to demonstrate how to properly coordinate and use these muscles.
  • Biofeedback training of the pelvic floor muscles has a positive effect on the sphincter muscles, which gradually strengthen.
  • This pathology is characterized by the total or partial absence of orgasmic sensations during sexual intercourse. The main reason for the lack of sexual satisfaction is the decreased muscle tone of the vagina. Using the biofeedback method to train the muscles can resolve this problem after only 10–15 sessions.

Using biofeedback therapy to train the pelvic floor muscles is effective for postpartum rehabilitation and post-surgical reconditioning.

REHABILITATION OF LOWER PELVIC MUSCLES

Any treatment begins with a diagnosis of the problem: the condition and strength of the pelvic floor muscles are evaluated, and it is determined whether there are any symptoms and whether they are related to pelvic floor dysfunction. If a connection is found, a treatment program is developed that is aimed at reconditioning the muscles and ligaments. The case may call for a physiotherapy approach, specifically electrostimulation and biofeedback therapy.

Biofeedback therapy is administered by a special device. Prior to the start of the treatment, the pelvic floor muscles are tested for diagnostic purposes. Biofeedback therapy is recommended for treating all types of urinary incontinence, fecal incontinence, vaginal wall prolapse, chronic pelvic pain and sexual dysfunctions.

Biofeedback therapy is performed in a medical facility setting by specially trained medical staff and is coupled with mandatory training at home.

To train the intimate muscles at home, one of two training device options can be used:

  1. The Callibri BeFit PRO biofeedback system enables training at home under the remote supervision of a physician.
  2. The Callibri BeFit personal biofeedback trainer is controlled by a mobile phone application without leaving one's home. The trainer is very simple and does not cause any discomfort while used. Callibri BeFit is ideally suited for women of all ages with sexual dysfunction and for strengthening (conditioning) relevant muscles to enhance one’s sex life and attain new sensations.

HOW IS TRAINING CONDUCTED IN A DOCTOR'S OFFICE?

During biofeedback therapy, a special sensing electrode is placed in the vagina or rectum, while epidermal sensors are attached to the external surface of the abdominal wall. These electrodes amplify electrical signals from the muscles. The patient then contracts and relaxes the muscles according to the physician’s instructions. Electrical signals are displayed on a computer screen and are rendered in a game format. With the help of this software, the patient becomes aware of the specific muscles that must be contracted. 

Biofeedback therapy for treating urinary incontinence is effective in 54–87% of cases. A multitude of medical studies have demonstrated a significant improvement in the function of urinary retention in patients with neurological disorders as well as in elderly patients. 

ELECTROSTIMULATION

Electrostimulation (for the professional version) is the most sophisticated type of feedback therapy aimed at rehabilitating the pelvic floor muscles. This type of physiotherapy is directed at stimulating the muscles that support the anus. When the muscles are stimulated with electric impulses, the levator ani and bladder sphincter contract, while bladder contraction is suppressed. Electrostimulation can be administered together with feedback therapy.

Electrostimulation is an effective treatment method for stress, urge and mixed urinary incontinence, and for weakened pelvic floor muscles. Electrostimulation can help women suffering from urge urinary incontinence relax the bladder and reduce the degree of uncontrollable contraction of the detrusor (bladder muscle).

Electrostimulation is also highly effective in treating patients with neurogenic urinary dysfunction. The greatest effect is achieved by combining electrostimulation and feedback therapy treatments. The percentage of patients experiencing recovery or improvement in symptoms after a course of electrostimulation treatment fluctuates between 54 and 77%; however, a significant change is felt after a minimum of four weeks with mandatory continuous training at home.

In addition to electrostimulation’s direct effect on the muscular system, it also expands local blood vessels and improves microcirculation of tissue and nourishment of cells.

Myostimulation makes it possible to:

  • Increase vaginal muscle tone;
  • Condition the birth canal for childbirth;
  • Complete postpartum recovery;
  • Increase sexual sensitivity;
  • Strengthen the vaginal wall in the presence of pelvic prolapse symptoms;
  • Solve incontinence problems.

The operating principle of the device is based on the forced stimulation of the pelvic floor muscles using microcurrents. Electric impulses elicit muscle contraction, thereby training the muscles and increasing their tone.

The Callibri BeFit HOME biofeedback system offers training with additional electrostimulation for weakened muscles.

BIOFEEDBACK THERAPY AND QUALITY OF SEX LIFE

Well-developed pelvic floor muscles are key to sexual pleasure: their size and tone affect the degree of the pudendal cleft closure and, correspondingly, the intensity of arousal and orgasm. After pregnancy and childbirth, these muscles often become weaker and lose their tone.

During childbirth, when the birth canal is stretched, these «lazy» muscles stretch faster and undergo trauma. This can lead to the «loose vagina syndrome» or vaginal relaxation. It is easier for infections to enter a wide-open pudendal cleft, increasing the likelihood of thrush and vaginitis. In addition, close contact between the mucosal tissue of the vagina and underwear can lead to drying and partial atrophy of the vagina.

It comes as no surprise that the sensitivity of the mucosal tissue, as an erogenous zone, decreases. Moreover, during any sexual intercourse, the partner’s sex organ does not fit closely inside the vagina’s internal walls. As a result, it is not just the woman who stops feeling pleasure on contact; the man is also affected because the intensity of the erection largely depends on the degree of tightness.

An effective way to revive a harmonious sex life is biofeedback therapy, which allows women to perform exercises that are specially developed for intimate muscle training. Of course, these exercises can be performed at home as well; however, it is very important to learn the proper technique under the guidance of a specialist because women sometimes confuse muscle groups and exercise the wrong ones.

As a result of these exercises, the size, strength and endurance of the intimate muscles are increased, as well as their ability to relax and stretch. There is nothing mysterious or surprising about this: the same way we build our biceps working out at the gym, the size of the muscles around the base of the vagina (levator muscles) can be increased twofold (as proven by ultrasound imaging). The pudendal cleft closes and tightens; sensitivity of the erogenous zones is restored.

TREATMENT OF ERECTILE AND EJACULATORY DYSFUNCTION

Erection is controlled by the autonomic nervous system. During sexual arousal, veins are compressed, restricting the egress of venous blood, which in turn fills the cavernous tissue, causing an erection.

Due to a number of reasons, a spontaneous opening of veins occurs during sex, blood flows from the cavernous tissue back into the vessels, and the erection subsides.

Biofeedback therapy restores erectile function by substantially increasing the tone of the bulbospongiosus muscle. In this way, the man can significantly increase his ability to delay the egress of blood from the cavernous tissue and maintain a longer erection during sexual intercourse.

The ejaculatory function is normalized by restoring the brain’s inhibitory mechanism of reflexive ejaculation of semen.

PELVIC FLOOR MUSCLE REHABILITATION IN CHILDREN

In pediatric urology: as a first-choice treatment for all types of functional urinary incontinence, stress incontinence and nocturnal enuresis (bedwetting).

In pediatric proctology: for restoration of sphincter function after surgery (for a damaged sphincter), natural fecal incontinence, functional fecal incontinence and anal neuralgia.

In pediatric gynecology: for the development and guided reconditioning of pelvic floor muscle function after surgical correction of defects or congenital pathologies of genital development.

The recommended course of treatment consists of 15–20 half-hour sessions.

For pediatric rehabilitation with the Callibri BeFit HOME biofeedback system, epidermal EMG leads are used.

The pelvic floor muscles play a significant role in a person’s physiological and social life. One's health and mood depend on the well-being of these muscles. Therefore, examining and, if necessary, training the pelvic floor muscles is as important as taking care of one’s health and having a satisfactory love life.

Timely consultation with a specialist and selection of reliable, high-quality medical equipment for home use will help achieve the desired results.

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