Biofeedback Therapy for Incontinence

Biofeedback is a scientifically-validated therapy that uses instruments to increase your awareness and control over your mind and body. Nurses, occupational therapists, physical therapists, physicians, physicians’ assistants, and psychologists provide personal biofeedback training to restore control of pelvic floor muscles. Pelvic muscle biofeedback is effective in treating fecal incontinence and urinary incontinence in men and women.

What is fecal incontinence?

Fecal incontinence involves the involuntary release of wastes due to impaired control of the rectal sphincters. The rectum contains two rings of muscle called rectal sphincters that control the elimination of stools. The internal rectal sphincter opens to admit feces when pressure builds inside the rectum. Normally, you can postpone a bowel movement by intentionally constricting the external rectal sphincter. In fecal incontinence, patients lose control over this sphincter and cannot prevent voiding.

What causes fecal incontinence?

Fecal elimination disorders have diverse causes, including:

• rectal sphincter damage due to vaginal delivery and surgery
• congenital abnormalities that damage the spinal cord
• inflammatory conditions
• medical conditions like diabetes mellitus, stroke, spinal cord trauma, and neurodegenerative disorders

Who is affected?

The prevalence of fecal incontinence is 2.2%. Fecal incontinence is eight times more common in women than men since childbirth is its most frequent cause.

What is biofeedback therapy?

Biofeedback is information about your body’s performance that is detected and displayed back to you by biofeedback equipment. Biofeedback instruments monitor the contraction of muscles in your bladder, pelvic floor, rectum, and stomach that control elimination using biofeedback electrodes.

How does biofeedback treat this disorder?

After medical evaluation to determine the cause of your fecal incontinence, a biofeedback practitioner can teach you to control elimination by using muscle and pressure sensors to help you:

• increase external rectal sphincter strength to prevent the unwanted loss of feces
• develop internal cues so that signals from stretch receptors in the rectal wall will contract the external rectal sphincter to prevent leakage
• increase the strength of pelvic floor muscles  

How effective is biofeedback therapy for the treatment of fecal incontinence?

Biofeedback instructions can teach a majority of patients to regain bowel control. A recent review of biofeedback clinical trials found that biofeedback achieved a 67-74% success rate. The Association for Applied Psychophysiology and Biofeedback’s (AAPB) Evidence-Based Practice in Biofeedback and Neurofeedback, authored by Carolyn Yucha, PhD, and Christopher Gilbert, PhD, awarded biofeedback therapy for fecal incontinence the third-highest rating of probably efficacious.

What is urinary incontinence?

Urinary incontinence involves the involuntary loss of urine.

Who is mainly affected?

Urinary incontinence affects approximately 13 million Americans. Twice as many men are affected by urinary incontinence than women. This problem is more frequently found in older than younger men.

What is the role of muscles in urination?

Your bladder is a balloon-like organ that expands to store urine and contracts when you urinate. In men and women, a tube called the urethra extends from the bottom of the bladder to the outside of the body. The detrusor muscle in the wall of your bladder relaxes to fill your bladder with urine and contracts when you urinate. The muscles of the pelvic floor support the bladder and keep the urethra closed. When patients suffer urinary incontinence, an overactive detrusor muscle and weak pelvic floor muscles can produce the accidental loss of urine from the bladder.

How does biofeedback treat this disorder?

After a medical evaluation to determine the cause of your urinary incontinence, a biofeedback clinician can help you control urination by using muscle and pressure sensors to teach you to:

• reduce overactive detrusor muscle activity
• increase pelvic floor muscle strength
• reduce the contraction of the abdomen

Biofeedback techniques can help most patients regain control of urination. In one study, training using biofeedback devices reduced incontinence episodes 75.9-82% in about 5 sessions.

How effective is biofeedback therapy for urinary incontinence?

Evidence-Based Practice in Biofeedback and Neurofeedback awarded biofeedback training methods for urinary incontinence the highest rating of efficacious and specific when treating women and the second-highest rating of efficacious when treating men.

Who should treat these disorders?

Biofeedback providers who are experienced in treating urinary and fecal incontinence and certified by the Biofeedback Certification Institute of America (BCIA) in Pelvic Muscle Dysfunction Biofeedback are qualified to treat this disorder using biofeedback.

Is there insurance coverage for biofeedback?

Reimbursement for continence training varies across insurance providers and geographic locations.