Urinary incontinence in women: biofeedback as an innovative treatment method

Marta Kopańska, Silvia Torices, Joanna Czech, Wiktoria Koziara, Michal Toborek, Łukasz Dobrek, Marta Kopańska, Silvia Torices, Joanna Czech, Wiktoria Koziara, Michal Toborek, Łukasz Dobrek

Abstract

Urinary incontinence is an involuntary urination (leakage of urine). About 200 million people suffer from this condition, and 60% of cases are concealed and untreated because of shame. It is estimated that an increasing number of young women and women of menopausal age will suffer from urinary incontinence. This disease occurs during the perinatal, perimenopausal period, as a result of brain damage or an unhealthy lifestyle. There are four main types of urinary incontinence: stress, urge, overflow and mixed form. Treatment is adapted to the severity of disease, its type and includes physiotherapeutic treatment (kinesiotherapy, physiotherapy, massage), pharmacological, psychological and surgical treatment. In recent years, growing interest has been observed in the noninvasive biofeedback method. The patient learns to contract the weakened pelvic floor muscles, constantly monitoring progress in treatment. She is also motivated by visual and auditory stimuli. Growing evidence confirms the effectiveness of this method, which to a large extent eliminates urinary incontinence. Nevertheless, attention should also be paid to prevention, which reduces the risk of involuntary leakage of urine.

Keywords: biofeedback; physiotherapeutic methods; urinary incontinence.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
The most commonly used types of biofeedback.
Figure 2.
Figure 2.
EMG biofeedback scheme of urinary incontinence treatment.
Figure 3.
Figure 3.
Specialized management of urinary incontinence in women.
Figure 4.
Figure 4.
Diagram showing the problems of women with urinary incontinence.

References

    1. Abrams P, Andersson KE, Birder L, et al.; Members of Committees, Fourth International Consultation on Incontinence. Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010; 29: 213–240.
    1. Borowicz AM, Wieczorowska-Tobis K. Physiotherapy treatment in urinary incontinence. Gerontol Pol 2010; 18: 114–119.
    1. Derewiecki T, Mroczek M, Majcher P, et al. Importance of urinary incontinence problem among women over 40 years of age. Hygeia Publ Health 2015; 50: 219–225.
    1. Fiodorenko-Dumas Z, Paprocka-Borowicz M. Physiotherapy in urinary incontinence. Med Og Nauk Zdr 2014; 20: 12–16.
    1. Hrycyna M, Strupińska-Thor E. Exercises strenghtening muscles of the true pelvis fundus in women with stress urinary incontinence. Zeszyty Naukowe WSKFiT 2016; 11: 21–28.
    1. Opara J, Socha T, Prajsner A, et al. Physiotherapy in stress urinary incontinence in females Part I. Contemporary recommendations for Kegel exercises (PFME). Physiotherapy 2011; 19: 41–49.
    1. Chmielewska DD, Piecha M. Urinary incontinence: a problem of the modern woman. Menopause Rev 2013; 5: 378–384.
    1. Wlazlak E, Surkont G, Stetkiewicz T, et al. Influence of selected non-operative treatment methods of urinary stress incontinence on patients’ life quality. Menopause Rev 2005; 2: 53–60.
    1. Klimaszewska K. The social aspects of urinary incontinence of women. Pielęg XXI w 2017; 16: 57–61.
    1. Radziszewski P, Dobrobski P, Borkowski A. Chirurgiczne leczenie wysiłkowego nietrzymania moczu ukobiet. Terapia 2002; 4: 15–19.
    1. Zygmunt R, Koziol S, Hladki W, et al. The influence of physiotherapy on incontinence in women. Emergency Duty 2017; 10: 77–83.
    1. Berghmans LCM, Hendriks HJM, De Bie RA, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int 2000; 85: 254–263.
    1. Klisowska I, Dabek A, Zborowska I, et al. Urinary incontinence – task for the physiotherapist. Part II. Piel Zdr Publ 2012; 2: 145–152.
    1. Opara JA, Socha T, Poswiata A. Pelvic floor muscle exercise as the best stress urinary incontinence prevention method in women practising competitive sport. Physiotherapy 2013; 21: 57–63.
    1. Opara J, Socha T, Prajsner A. Physioherapy in stress urinary incontinence in females Part III. Electrical stimulation in stress urinary incontinence. Physiotherapy 2012; 20: 79–86.
    1. Purc D, Rasala A. Method of treating urinary incontinence. Eur J Med Technol 2015; 3: 29–38.
    1. Nowara A, Witek A, Wilk K. Diagnostic and treatment of over active bladder. Ginekol Pol 2007; 78: 549–553.
    1. Ptak M. The impact of pelvic floor muscle exercises with and without synergistic muscles on the quality of life of women with stress urinary incontinence. Pomeranian J Life Sci 2017; 63: 49–55.
    1. Surkont G, Wlazlak E. Urinary incontinence in women – social, medical and scientific problem. Menopause Rev 2003; 1: 59–65.
    1. Dutkiewicz S, Kapusta K. Risk factors and quality of life in urinary incontinence females in the care and medical centre in Kielce. Menopause Rev 2011; 6: 493–499.
    1. Kubik A, Kubik P. Influence of the neurofeedback therapy on EEG pattern in children with ADHD syndrome. Przegl Lek 2011; 68: 1092–1097.
    1. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89: 501–506.
    1. Wierzbicka M, Urban K, Murawski M, et al. Prevalence and risk factors of urinary incontinence in women. Physiotherapy 2009; 17: 38–44.
    1. Garcia-Sanchez E, Rubio-Arias JA, Avila-Gandia V, et al. Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: a current review. Actas Urol Esp 2016; 40: 271–278.
    1. Townsend MK, Danforth KN, Rosner B, et al. Physical activity and incident urinary incontinence in middle-aged women. J Urol 2008; 179: 1012–1016; discussion 1016–1017.
    1. Cardoso AMB, Lima C, Ferreira CWS. Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction. Eur J Sport Sci 2018; 18: 1405–1412.
    1. Carvalhais A, Natal Jorge R, Bo K. Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med 2018; 52: 1586–1590.
    1. Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. Phys Sportsmed 2017; 45: 399–407.
    1. Dos Santos KM, Da Roza T, Tonon da, Luz SC, et al. Quantification of urinary loss in nulliparous athletes during 1 hour of sports training. PM R 2019; 11: 495–502.
    1. Hagovska M, Svihra J, Bukova A, et al. The impact of physical activity measured by the international physical activity questionnaire on the prevalence of stress urinary incontinence in young women. Eur J Obstet Gynecol Reprod Biol 2018; 228: 308–312.
    1. Poswiata A, Socha T, Opara J. Prevalence of stress urinary incontinence in elite female endurance athletes. J Hum Kinet 2014; 44: 91–96.
    1. Da Roza T, Brandao S, Mascarenhas T, et al. Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists. Clin J Sport Med 2015; 25: 270–275.
    1. Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 2004; 34: 451–464.
    1. Kruger JA, Murphy BA, Heap SW. Alterations in levator ani morphology in elite nulliparous athletes: a pilot study. Aust N Z J Obstet Gynaecol 2005; 45: 42–47.
    1. Louis-Charles K, Biggie K, Wolfinbarger A, et al. Pelvic floor dysfunction in the female athlete. Curr Sports Med Rep 2019; 18: 49–52.
    1. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, et al. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J 2018; 29: 1757–1763.
    1. Teixeira RV, Colla C, Sbruzzi G, et al. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J 2018; 29: 1717–1725.
    1. Fozzatti C, Riccetto C, Herrmann V, et al. Prevalence study of stress urinary incontinence in women who perform high-impact exercises. Int Urogynecol J 2012; 23: 1687–1691.
    1. Moser H, Leitner M, Eichelberger P, et al. Pelvic floor muscle activity during jumps in continent and incontinent women: an exploratory study. Arch Gynecol Obstet 2018; 297: 1455–1463.
    1. Saeuberli PW, Schraknepper A, Eichelberger P, et al. Reflex activity of pelvic floor muscles during drop landings and mini-trampolining-exploratory study. Int Urogynecol J 2018; 29: 1833–1840.
    1. Bo K, Bratland-Sanda S, Sundgot-Borgen J. Urinary incontinence among group fitness instructors including yoga and pilates teachers. Neurourol Urodyn 2011; 30: 370–373.
    1. Dornowski M, Makar P, Sawicki P, et al. Effects of low- vs high-volume swimming training on pelvic floor muscle activity in women. Biol Sport 2019; 36: 95–99.
    1. Simeone C, Moroni A, Petteno A, et al. Occurrence rates and predictors of lower urinary tract symptoms and incontinence in female athletes. Urologia 2010; 77: 139–146.
    1. Gebska M, Wojciechowska A, Weber-Nowakowska K, et al. The use of biofeedback training in physiotherapy. Acta Balneol 2013; 55: 293–296.
    1. Kubik P. Types of biofeedback. Przegl Lek 2016; 73: 191–193.
    1. Szymanowski P, Wojcik A, Szepieniec WK, et al. Complex treatment of urogynecological conditions. The role of physiotherapy. Rehabilitacja w ginekologii 2014; 3: 15–18.
    1. Walkowiak H. EEG biofeedback: characteristics, application, opinions of specialists. Studia Edukacyjne 2015; 36: 307–325.
    1. Oleksy L, Mika A, Kielnar R, et al. The use of transabdominal ultrasound in pelvic floor muscles evaluation in physiotherapy. Acta Bio-Opt Inform Med Inż Biomed 2017; 23: 270–277.
    1. Jozwik M, Jozwik M. Impact of vaginal delivery on the function of the Lower urinary tract and pelvic floor innervation – an overview of current knowledge. Nowa Med 2000; 5: 44–48.
    1. Lochowska M, Szumilewicz A, Doronowski M, et al. Changes in the neuromuscular activity in pelvic-floormuscles in health nulliparas after supervised or unsupervised training – a randomized trial with two experimental groups. Rocznik Naukowy AWFiS w Gdańsk, 2015; 25: 52–58.
    1. Piernicka M, Szumilewicz A, Dornowski M, et al. Teaching the technique of pelvic-floor muscle exercises among sport university females tudents – a randomized controlled trail. Rocznik Naukowy AWFiS w Gdańsku 2015; 25: 45–51.
    1. Jarzebicka D, Sleczkowska J, Ryzko J, et al. Biofeedback therapy in the treatment of functional constipation. Stand Med Pediatr 2014; 11: 396–401.
    1. Terlikowski R, Dobrzycka B, Kinalski M, et al. Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial. Int Urogynecol J 2013; 24: 1631–1638.
    1. Weber-Rajek M, Bulatowicz I, Radziminska A, et al. Evaluation of the efficacy of physical methods in the treatment of urinary incontinence in women - a review of research. J Educ Health Sport 2015; 5: 11–34.
    1. Hagovska M, Takac P. EMG biofeedback as a diagnostic and therapeutic method in the treatment and prevention of women’s urinary incontinence. Prz Med Uniw Rzesz Inst Leków 2010; 4: 410–418.
    1. Rett MT, Simoes JA, Herrmann V, et al. Management of stress urinary incontinence with surface electromyography-assisted biofeedback in women of reproductive age. Phys Ther 2007; 87: 136–142.
    1. Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 2002; 288: 2293–2299.
    1. Herderschee R, Hay-Smith EJ, Herbison GP, et al. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011; CD009252.
    1. Burns PA, Pranikoff K, Nochajski T, et al. Treatment of stress incontinence with pelvic floor exercises and biofeedback. J Am Geriatr Soc 1990; 38: 341–344.
    1. Dannecker C, Wolf V, Raab R, et al. EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients. Arch Gynecol Obstet 2005; 273: 93–97.
    1. Capelini MV, Riccetto CL, Dambros M, et al. Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol 2006; 32: 462–468; discussion 469.
    1. Cendrowska A, Nalewczynska A, Kowalska J. Pelvic floor electricalstimulation (PFES) as a conservative method of urinary incontinence treatment in women. Ginekol Prakt 2010; 18: 34–38.
    1. Debinski P, Niezgoda T. Classification of urinary incontinence and methods of treatment. Przegl Urol 2014; 5: 1–6.
    1. Hojan K, Tyminska A, Kurnatowski J, et al. Physiotherapy in neurogenic bladder therapy. Prakt Fizjoter Rehabil 2016; 6–16.
    1. Wierzbicka M, Urban K, Murawski M, et al. The treatment of urinary stress incontinence with particular consideration of physiotherapeutic methods. Physiotherapy 2010; 18: 53–60.
    1. Dalewska M, Kasicka-Jonderko A, Jonderko K, et al. Physical exercise – a prescription-free remedy: physical activity in prophylaxis and treatment of female urinary stress incontinence (set of suggested exercises in appendix). Ann Acad Med Siles 2013; 67: 384–392.
    1. Elliott CS, Sokol ER. New methods of treatment of urinary incontinence. Contemporary OB/GYN 2011; 52: 12–23.
    1. Rechberge T, Kulik-Rechberger B. Dysfunctions of the lower urinary tract – evaluation and therapeutical approach in family practice. Forum Med Rodz 2010; 4: 397–407.
    1. Dadej R, Jedrzejczak-Dadej A. Urinary incontinence – treatment. Geriatria 2009; 3: 103–111.
    1. Stachowicz N, Maciejczyk-Pencula M, Morawska D, et al. Urgent Urinary Incontinence – preliminary diagnostics and pharmacological treatment. Wiad Lek 2012; 65: 162–166.
    1. Plocka-Molinska M, Jakobczak B, Plagens-Rotman K. The Influence of urinary incontinence on the quality of women’s live. Pol Prz Nauk Zdr 2017; 2: 161–167.
    1. Cichonska M, Maciag D, Zboina B, et al. The assessment of women’s knowledge concerning urinary incontinence. Zdrowie i Dobrostan 2013; 4: 45–64.
    1. Chmielewska DD, Kwasna K, Piecha M, et al. Selected methods of conservative treatment of stress urinary incontinence: current views. Part 1. Menopause Rev 2012; 11: 264–268.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi