Biofeedback is a technique that teaches people how to control certain functions of the body that affect their health, such as blood pressure, heart rate, muscle contractions, and skin temperature. Urologists may use this treatment to help patients with urinary problems learn how to contract and relax the muscles that control urination.
How Biofeedback Works
During a biofeedback session, electrodes (sensors) are attached to the skin. The location depends upon the condition being treated. In the case of urological conditions, sensors may be placed inside the vagina or anus, and on the belly, in order to detect the electrical activity of the muscles that control urination.
The sensors transmit the signals from the body to a monitoring box or computer that translates the information into a tone that changes in pitch, a screen that varies in brightness, or an animation on a computer screen. This allows the patient to track minute-by-minute activities of the body that normally go unnoticed.
The biofeedback therapist guides the patient through several exercises. For urinary problems, this may involve contracting and relaxing the muscles of the pelvis, with the activity of the pelvic and abdomen muscles shown on the monitor or computer screen.
Learning to control the body’s processes—and what is displayed on the monitoring box or computer screen—is a matter of trial and error. It takes concentration, and weekly sessions are usually required, along with exercises done at home. With help from a biofeedback therapist, patients can learn how to contract and relax their bladder muscles and, over time, they can manage their condition without the use electrodes or a monitor.
Types of Biofeedback
The main types of biofeedback are:
- Electromyography (EMG): measures the tension in muscles and is used to help people learn how to properly contract specific muscles
- Thermal biofeedback: measures the temperature of the skin
- Neurofeedback or electroencephalography (EEG): measures brain wave activity
Urological Conditions Treated with Biofeedback
There are several urological conditions that can be treated with biofeedback, including:
Urinary incontinence
Urinary incontinence is the unexpected loss of bladder control. This condition happens when the muscles that support the urethra or bladder are too weak or too active, or when there is a malfunction of the urethral sphincter. Incontinence can occur as a result of childbirth, injury to the area around the urethra, or surgery in the pelvic area. Biofeedback training helps patients learn how to contract the proper muscles needed to retain the urine properly.
Voiding dysfunction in children
Leakage of urine, increased urinary frequency or urgency, dribbling or broken stream of urine, and infrequent urination are all voiding complications that can occur in children. While these urinary problems may develop as a result of a non-neurogenic voiding dysfunction caused by a disruption in the signals the bladder sends to the brain, or behavioral and developmental issues, it may too arise if there is a brain, spinal cord, or nerve condition. In such cases, biofeedback training helps reduce resistance during urination. Children under the age of five, however, are often unable to do biofeedback on a regular basis.
Neurogenic bladder
Neurogenic bladder control problem can occur at any age and is caused by a condition that involves the brain, spinal cord, or nerves. In some cases, biofeedback therapy may be useful alongside other treatments, and can help patients contract the correct muscles needed to control the flow of urination.
Shy bladder syndrome (paruresis)
Paruresis is a social anxiety disorder that involves being fearful of urinating while other people are nearby. When psychological counseling doesn’t work, patients may benefit from biofeedback treatments that help them de-stress and learn to relax the muscles of the pelvic floor in order to urinate.
Biofeedback Outcomes
The success of biofeedback depends on the condition being treated and the drive of the patient. While the number of sessions needed to produce results vary, it can take at least 10 weekly sessions, along with follow up sessions, to see improvements. Biofeedback alone may only render moderate results. It is most effective when combined with medication and behavioral modifications like Kegel exercises and bladder retraining.
Biofeedback programs that use animation and computer graphics are particularly helpful in motivating children who wet the bed. Though these types of programs have similar success rates as traditional biofeedback methods, some studies have found that children require fewer sessions when animation is involved.
References
Bernier F, Sims TW. (2009). Management of clients with urinary disorders. Medical-surgical nursing: Clinical management for positive outcomes, 8th ed.
Franco I. (2007). Overactive bladder in children. Part 2: Management. J Urol. 178(3 Pt 1):769-74; discussion 774.
Kajbafzadeh AM, Sharifi-Rad L, Ghahestani SM, et al. (2011). Animated biofeedback: an ideal treatment for children with dysfunctional elimination syndrome. J Urol. 186(6):2379-84.
Kaye JD, Palmer LS. (2008). Animated biofeedback yields more rapid results than nonanimated biofeedback in the treatment of dysfunctional voiding in girls. J Urol. 180(1):300-5.
McKenna PH, Herndon CD, Connery S, et al. (1999). Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol. 162(3 Pt 2):1056-62; discussion 1062-3.
