Applied Psychophysiology and Biofeedback

, Volume 31, Issue 3, pp 187–201

Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence: A Literature Review


Biofeedback is efficacious in the training of the pelvic floor musculature in order to enhance continence. This article reviews the anatomy and physiology of micturition as the underlying rationale for pelvic floor muscle biofeedback in the treatment of urinary incontinence. It critically reviews 28 studies published in peer reviewed journals from 1975 to 2005 that were prospective, randomized studies with parametric statistical analyses, operationally defined patient selection criteria, treatment protocols and outcome measures. The overall mean treatment improvement for patients undergoing biofeedback for urinary incontinence was 72.61%. In 21 of 35 (60%) paired comparisons, biofeedback demonstrated superior symptomatic outcome to control or alternate treatment groups. Larger studies and a standardization of technology and methodology are required for more conclusive determinations.


biofeedback urinary incontinence pelvic floor muscle 


  1. Abrams, P., Blaivas, J. G., Stanton, S. L., & Andersen, J. T. (1988). International Continence Society committee on standardization of terminology of lower urinary tract function. Neurourology and Urodynamics, 7, 403–417.Google Scholar
  2. Aksac, B., Aki, S., Karan, A., Yalcin, O., Isikoglu, M., & Eskiyurt, N. (2003). Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Gynecologic and Obstetric Investigation, 56, 23–27.PubMedCrossRefGoogle Scholar
  3. Andersson, K. E., & Wein, A. J. (2004). Pharmacology of the lower urinary tract: Basis for current and future treatments of urinary incontinence. Pharmacological Reviews, 56, 581–631.PubMedCrossRefGoogle Scholar
  4. Aukee, P., Immonen, P., Laaksonen, D. E., Laippala, P., Penttinen, J., & Airaksinen, O. (2004). The effect of home biofeedback training on stress incontinence. Acta Obstetricia et Gynecologica Scandinavica, 83, 1–6.CrossRefGoogle Scholar
  5. Aukee, P., Immonen, P., Penttinen, J., Laippala, P., & Airaksinen, O. (2002). Increase in pelvic floor muscle activity after 12 weeks’ training: A randomized prospective pilot study. Urology, 60, 1020–1023.PubMedCrossRefGoogle Scholar
  6. Bales, G. T., Gerber, G. S., Minor, T. X., Mhoon, D. A., McFarland, J. M., Kim, H. L., & Brendler, C. B. (2000). Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology, 56, 627–630.PubMedCrossRefGoogle Scholar
  7. Berghmans, L. C. M., Frederiks, C. M. A., de Bie, R. A., Weil, E. H. J., Smeets, L. W. H., van Waalwijk van Doorn, E. S. C., & Janknegt, R. A. (1996). Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence. Neurourology and Urodynamics, 15, 37–52.PubMedCrossRefGoogle Scholar
  8. Blaivas, J. G. (1985). Pathophysiology of lower urinary tract dysfunction. Clinics in Obstetrics and Gynaecology, 12, 295–309.PubMedGoogle Scholar
  9. Brown, C. (2001). Pelvic floor reeducation: A practical approach. In J. Corcos & E. Schick (Eds.), The Urinary Sphincter (pp. 459–473). New York: Marcel Dekker.Google Scholar
  10. Brown, J. S., Grady, D., Ouslander, J. G., Herzog, A. R., Varner, R. E., & Posner, S. F. (1999). Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Obstetrics & Gynecology, 94, 66–77.CrossRefGoogle Scholar
  11. Burgio, K. L., Goode, P. S., Locher, J. L., Umlauf, M. G., Roth, D. L., Richter, H. E., Varner, R. E., & Lloyd, L. K. (2002). Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: A randomized controlled trial. The Journal of the American Medical Association, 288, 2293–2299.CrossRefGoogle Scholar
  12. Burgio, K. L., Locher, J. L., Goode, P. S., Hardin, J. M., McDowell, B. J., Dombrowski, M., & Candib, D. (1998). Behavioral vs. drug treatment for urge urinary incontinence in older women. Journal of the American Medical Association, 280, 1995–2000.PubMedCrossRefGoogle Scholar
  13. Burgio, K. L., Robinson, J. C., & Engel, B. T. (1986). The role of biofeedback in Kegel exercise training for stress urinary incontinence. American Journal of Obstetrics and Gynecology, 154, 58–64.PubMedGoogle Scholar
  14. 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, M167.PubMedGoogle Scholar
  15. Burton, J. R., Pearce, K. L., Burgio, K. L., Engel, B. T., & Whitehead, W. E. (1988). Behavioral training for urinary incontinence in elderly ambulatory patients. Journal of the American Geriatrics Society, 36, 693–698.PubMedGoogle Scholar
  16. Chung, A. K., Peters, K. M., & Diokno, A. C. (2001). In J. Corcos & E. Schick (Eds.), The Urinary Sphincter (pp. 183–191). New York: Marcel Dekker.Google Scholar
  17. Critchley, H. O., Dixon, J. S., & Gosling, J. A. (1980). Comparative study of the periurethral and perianal parts of the levator ani muscle. Urologia Internationalis, 35, 226–232.PubMedCrossRefGoogle Scholar
  18. DeLancey, J. O. (2001). Anatomy. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 111–124). London: Isis Medical Media.Google Scholar
  19. Dorey, G., Speakman, M., Feneley, R., Swinkels, A., Dunn, C., & Ewings, P. (2002). Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction: A randomized controlled trial. Urologic Nursing, 24, 490–512.Google Scholar
  20. Dougherty, M. C., Dwyer, J. W., Pendergast, J. F., Boyington, A. R., Tomlinson, B. U., Coward, R. T., Duncan, R. P., Vogel, B., & Rooks, L. G. (2002). A randomized trial of behavioral management for continence with older rural women. Research in Nursing & Health, 25, 3–13.CrossRefGoogle Scholar
  21. Fantl, J. A., Newman, D. K., Colling, J., DeLancey, J. O., Keeys, C., Loughery, R., et al. (1996). Urinary Incontinence in Adults: Acute and Chronic Management: Clinical Practice Guideline No. 2, 1996 Update. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 96-0682.Google Scholar
  22. Floratos, D. L., Sonke, G. S., Rapidou, C. A., Alivizatos, G. J., Deliveliotis, C., Constantinides, C. A., & Theodorou, C. (2002). Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostectomy. BJU International, 89, 714–719.PubMedCrossRefGoogle Scholar
  23. Franke, J. J., Gilbert, W. B., Grier, J., Koch, M. O., Shyr, Y., & Smith, J. A. (2000). Early post-prostatectomy pelvic floor biofeedback. The Journal of Urology, 163, 191–193.PubMedCrossRefGoogle Scholar
  24. Glazer, H. I., Romanzi, L., & Polaneczky, M. (1999). Pelvis floor muscle surface electromyography: Reliability and clinical predictive validity. The Journal of Reproductive Medicine, 44, 779–782.PubMedGoogle Scholar
  25. Goode, P. S. (2004). Behavioral and drug therapy for urinary incontinence. Urology, 63(3 Suppl. 1), 58–64.PubMedCrossRefGoogle Scholar
  26. Haab, E., Sebe, P., Mondet, F., & Ciofu, C. (2001). Functional anatomy of the bladder and urethra in females. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 15–24). New York: Marcel Dekker.Google Scholar
  27. Hald, T., & Bradley, W. E. (1982). The urinary bladder: Neuology and dynamics. Baltimore: Williams & Wilkins.Google Scholar
  28. Harrison, G. L., & Memel, D. S. (1994). Urinary incontinence in women: Its prevalence and its management in a health promotion clinic. The British Journal of General Practice, 44, 149–152.PubMedGoogle Scholar
  29. Johnson, T. M., Burgio, K. L., Redden, D. T., Wright, D. C., & Goode, P. S. (2005). Effects of behavioral and drug therapy on nocturia in older incontinent women. Journal of the American Geriatrics Society, 53, 846–850.PubMedCrossRefGoogle Scholar
  30. Kegel, A. H. (1948). Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology, 56, 238–249.PubMedGoogle Scholar
  31. Khullar, V., & Cardozo, L. (2001). History and examination. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 153–166). London: Isis Medical Media.Google Scholar
  32. Laycock, J., Brown, J., Cusack, C., Green, S., Jerwood, D., Mann, K., McLachlan, Z., & Schofield, A. (2001). Pelvic floor reeducation for stress incontinence: Comparing three methods. British Journal of Community Nursing, 6, 230–237.PubMedGoogle Scholar
  33. McDowell, B. J., Engberg, S., Sereika, S., Donovan, N., Jubeck, M. E., Weber, E., & Engberg, R. (1999). Effectiveness of behavioral therapy to treat incontinence in homebound older adults. Journal of the American Geriatrics Society, 47, 309–318.PubMedGoogle Scholar
  34. Morkved, S., Bo, K., & Fjortoft, T. (2002). Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstetrics and Gynecology, 100, 730–739.PubMedCrossRefGoogle Scholar
  35. Myers, R. P. (2001). The male striated urethral sphincter. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 25–42). New York: Marcel Dekker.Google Scholar
  36. Pages, I.-H., Jahr, S., Schaufele, M. K., & Conradi, E. (2001). Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. American Journal of Physical Medicine & Rehabilitation, 80, 494–502.CrossRefGoogle Scholar
  37. Parekh, A. R., Feng, M. I., Kirages, D., Bremner, H., Kaswick, J., & Aboseif, S. (2003). The role of pelvic floor exercises on post-prostatectomy incontinence. The Journal of Urology, 170, 130–133.PubMedCrossRefGoogle Scholar
  38. Resnick, N. M., & Yalla, S. V. (1987). Detrusor hyperactivity with impaired contractile function: An unrecognized but common cause of incontinence in elderly patients. The Journal of the American Medical Association, 257, 3076–3081.CrossRefGoogle Scholar
  39. Romanzi, L. J., Polaneczky, M., & Glazer, H. I. (1999). Simple test of pelvic muscle contraction during pelvic examination: Correlation to surface electromyography. Neurourology and Urodynamics, 18, 603–612.PubMedCrossRefGoogle Scholar
  40. Schick, E. (2001). Physical examination. In J. Corcos & E. Schick (Eds.), The urinary sphincter (pp. 251–260). New York: Marcel Dekker.Google Scholar
  41. Schmidt, R. A. (2001). Pelvic floor: Lessons from our past. In L. Cardozo & D. Staskin (Eds.), Textbook of female urology and urogynaecology (pp. 101–110). London: Isis Medical Media.Google Scholar
  42. Seo, J. T., & Kim, Y. H. (2004). A randomized prospective study comparing new vaginal cone and FES-biofeedback. Yonsei Medical Journal, 45, 879–884.PubMedGoogle Scholar
  43. Shafik, A., Ahmed, I., Shafik, A. A., El-Ghamrawy, T. A., & El-Sibai, O. (2005). Surgical anatomy of the perineal muscles and their role in perineal disorders. Anatomical Science International, 80, 167–171.PubMedCrossRefGoogle Scholar
  44. Sherman, R. A., Davis, G. D., & Wong, M. F. (1997). Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Military Medicine, 162, 690–694.PubMedGoogle Scholar
  45. Singh, K., Reid, W. M., & Berger, L. A. (2002). Magnetic resonance imaging of normal levator ani anatomy and function. Obstetrics and Gynecology, 99, 433–438.PubMedCrossRefGoogle Scholar
  46. Sueppel, C., Kreder, K., & See, W. (2001). Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Urologic Nursing, 21, 201–210.PubMedGoogle Scholar
  47. 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, 303–308.PubMedGoogle Scholar
  48. Van Kampen, M., De Weerdt, W., Van Poppel, H., De Ridder, D., Feys, H., & Baert, L. (2000). Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial. The Lancet, 355, 98–102.CrossRefGoogle Scholar
  49. Wang, A. C., Wang, Y. Y., & Chen, M. C. (2004). Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology, 63, 61–66.PubMedCrossRefGoogle Scholar
  50. Wille, S., Sobottka, A., Heidenreich, A., & Hofmann, R. (2003). Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: Results of a prospective randomized trial. The Journal of Urology, 170, 490–493.PubMedCrossRefGoogle Scholar
  51. Wyman, J. F., Fantl, J. A., McClish, D. K., & Bump, R. C. (1988). Comparative efficacy of behavioural interventions in the management of female urinary incontinence. American Journal of Obstetrics and Gynecology, 179, 999–1007.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Joan and Sanford Weill Medical College of Cornell UniversityNew York Presbyterian HospitalNew YorkUSA
  2. 2.Saybrook Graduate School and Research CenterSan FranciscoUSA

Personalised recommendations