Therapeutic efficacy of biofeedback pelvic floor muscle exercise in women with dysfunctional voiding

Ching-Hsiang Chiang, Yuan-Hong Jiang, Hann-Chorng Kuo, Ching-Hsiang Chiang, Yuan-Hong Jiang, Hann-Chorng Kuo

Abstract

Dysfunctional voiding (DV), a voiding dysfunction due to hyperactivity of the external urethral sphincter or pelvic floor muscles leading involuntary intermittent contractions during voiding, is not uncommon in neurologically normal women with lower urinary tract symptoms (LUTS). We aimed to investigate the therapeutic efficacy of biofeedback pelvic floor muscle training (PFMT) in female patients with DV and to identify the therapeutic efficacy. Thirty-one patients diagnosed with DV. All participates completed the 3-month biofeedback PFMT program, which was conducted by one experienced physiotherapist. At 3 months after treatment, the assessment of treatment outcomes included global response assessment (GRA), and the changes of clinical symptoms, quality of life index, and uroflowmetry parameters. 25 (80.6%) patients had successful outcomes (GRA ≥ 2), and clinical symptoms and quality of life index significantly improved after PFMT. Additionally, uroflowmetry parameters including maximum flow rate, voided volume, voiding efficiency, total bladder capacity, voiding time, and time to maximum flow rate significantly improved after PFMT treatment. Patients with the history of recurrent urinary tract infection in recent 1 year were found to have unsatisfied therapeutic outcomes. In conclusion, biofeedback PFMT is effective in female patients with DV with significant improvements in clinical symptoms, quality of life, and uroflowmetry parameters. The history of urinary tract infection in recent 1 year is a negative predictor of successful outcome.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Videourodynamic characteristics of (a) Normal, (b) DV and (c) severe DV appearance.
Figure 2
Figure 2
The application of surface 2-channel electromyography (EMG) electrodes over (a) abdominal rectus muscles and (b) perineum.
Figure 3
Figure 3
The example of electromyography on (a) inadequate PFM isolation, contraction and poor relaxation at the first time of office visiting; (b) An adequate picture of EMG which indicated well PFM isolation and relaxation after biofeedback PFMT at the 6th time of office visiting.

References

    1. Meier K, Padmanabhan P. Female bladder outlet obstruction: An update on diagnosis and management. Curr. Opin. Urol. 2016;26(4):334–341. doi: 10.1097/MOU.0000000000000303.
    1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 2010;29(1):4–20. doi: 10.1002/nau.20798.
    1. Carlson KV, Fiske J, Nitti VW. Value of routine evaluation of the voiding phase when performing urodynamic testing in women with lower urinary tract symptoms. J. Urol. 2000;164(5):1614–1618. doi: 10.1016/S0022-5347(05)67041-3.
    1. Peng C-H, Chen S-F, Kuo H-C. Videourodynamic analysis of the urethral sphincter overactivity and the poor relaxing pelvic floor muscles in women with voiding dysfunction. Neurourol. Urodyn. 2017;36(8):2169–2175. doi: 10.1002/nau.23263.
    1. Gunnarsson M, Mattiasson A. Female stress, urge, and mixed urinary incontinence are associated with a chronic and progressive pelvic floor/vaginal neuromuscular disorder: An investigation of 317 healthy and incontinent women using vaginal surface electromyography. Neurourol. Urodyn. 1999;18(6):613–621. doi: 10.1002/(SICI)1520-6777(1999)18:6<613::AID-NAU11>;2-B.
    1. Kuo H-C. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–1009. doi: 10.1016/j.urology.2005.05.047.
    1. Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J. Urol. 2011;27(4):437–447. doi: 10.4103/0970-1591.91429.
    1. Artibani W, Cerruto MA. Dysfunctional voiding. Curr. Opin. Urol. 2014;24(4):330–335. doi: 10.1097/MOU.0000000000000074.
    1. Bertotto A, Schvartzman R, Uchôa S, Wender MCO. Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: A randomized controlled trial. Neurourol. Urodyn. 2017;36(8):2142–2147. doi: 10.1002/nau.23258.
    1. Schreiner L, dos Santos TG, de Souza ABA, Nygaard CC, Silva Filho IG. Electrical stimulation for urinary incontinence in women: A systematic review. Int. Braz. J. Urol. 2013;39(4):454–464. doi: 10.1590/S1677-5538.IBJU.2013.04.02.
    1. Moroni RM, Magnani PS, Haddad JM, de Castro RA, Brito LGO. Conservative treatment of stress urinary incontinence: A systematic review with meta-analysis of randomized controlled trials. Rev. Bras. Ginecol. Obstet. 2016;38(2):97–111. doi: 10.1055/s-0035-1571252.
    1. Burns PA, Pranikoff K, Nochajski TH, Hadley EC, Levy KJ, Ory MG. A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. J. Gerontol. 1993;48(4):M167–M174. doi: 10.1093/geronj/48.4.M167.
    1. Wyndaele JJ, Hoekx L, Vermandel A. Bladder biofeedback for the treatment of refractory sensory urgency in adults. Eur. Urol. 1997;32(4):429–432. doi: 10.1159/000480802.
    1. Burgio KL, Locher JL, Goode PS, et al. Behavioral vs drug treatment for urge urinary incontinence in older women: A randomized controlled trial. JAMA. 1998;280(23):1995–2000. doi: 10.1001/jama.280.23.1995.
    1. Elser DM, Wyman JF, McClish DK, Robinson D, Fantl JA, Bump RC. The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence. Continence Program for Women Research Group. Neurourol. Urodyn. 1999;18(5):427–436. doi: 10.1002/(SICI)1520-6777(1999)18:5<427::AID-NAU3>;2-0.
    1. Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318(7182):487–493. doi: 10.1136/bmj.318.7182.487.
    1. Kulaksizoğlu H, Akand M, Çakmakçi E, Gül M, Seçkin B. Effectiveness of pelvic floor muscle training on symptoms and uroflowmetry parameters in female patients with overactive bladder. Turk. J. Med. Sci. 2015;45(2):449–453. doi: 10.3906/sag-1310-95.
    1. Voorham JC, et al. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial. Neurourol. Urodyn. 2017;36(7):1796–1803. doi: 10.1002/nau.23180.
    1. Hoebeke P, Vande Walle J, Theunis M, De Paepe H, Oosterlinck W, Renson C. Outpatient pelvic-floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology. 1996;48(6):923–927. doi: 10.1016/S0090-4295(96)00364-0.
    1. Liaw Y-M, Kuo H-C. Biofeedback pelvic floor muscle training for voiding dysfunction and overactive bladder. Incont. Pelvic Floor Dysfunct. 2007;1:13–15.
    1. Pedraza R, Nieto J, Ibarra S, Haas EM. Pelvic muscle rehabilitation: A standardized protocol for pelvic floor dysfunction. Adv. Urol. 2014;2014:487436. doi: 10.1155/2014/487436.
    1. Laycock J, Jerwood D. Pelvic floor muscle assessment: The PERFECT Scheme. Physiotherapy. 2001;87(12):631–642. doi: 10.1016/S0031-9406(05)61108-X.
    1. Okamura K, Nojiri Y, Osuga Y, Tange C. Psychometric analysis of international prostate symptom score for female lower urinary tract symptoms. Urology. 2009;73(6):1199–1202. doi: 10.1016/j.urology.2009.01.054.
    1. Coyne KS, Matza LS, Kopp Z, Abrams P. The validation of the patient perception of bladder condition (PPBC): A single-item global measure for patients with overactive bladder. Eur. Urol. 2006;49(6):1079–1086. doi: 10.1016/j.eururo.2006.01.007.
    1. Massey JA, Abrams PH. Obstructed voiding in the female. Br. J. Urol. 1988;61(1):36–39. doi: 10.1111/j.1464-410X.1988.tb09158.x.
    1. Costantini E, Mearini E, Pajoncini C, Biscotto S, Bini V, Porena M. Uroflowmetry in female voiding disturbances. Neurourol. Urodyn. 2003;22(6):569–573. doi: 10.1002/nau.10026.
    1. de Groat WC, Yoshimura N. Chapter 5—Anatomy and physiology of the lower urinary tract. In: Vodušek DB, Boller F, editors. Handbook of Clinical Neurology. Elsevier; 2015. pp. 61–108.
    1. Kuo TLC, Ng LG, Chapple CR. Pelvic floor spasm as a cause of voiding dysfunction. Curr. Opin. Urol. 2015;25(4):311–316. doi: 10.1097/MOU.0000000000000174.
    1. Groutz A, Blaivas JG, Pies C, Sassone AM. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol. Urodyn. 2001;20(3):259–268. doi: 10.1002/nau.1003.
    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49. doi: 10.1016/S0090-4295(02)02243-4.
    1. Carlson KV, Rome S, Nitti VW. Dysfunctional voiding in women. J. Urol. 2001;165(1):143–147. doi: 10.1097/00005392-200101000-00035.
    1. Chen Y-C, Kuo H-C. Clinical and video urodynamic characteristics of adult women with dysfunctional voiding. J. Formos Med. Assoc. 2014;113(3):161–165. doi: 10.1016/j.jfma.2012.04.008.
    1. Kahyaoglu Sut H, Balkanli KP. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol. Urodyn. 2016;35(3):417–422. doi: 10.1002/nau.22728.
    1. de Jong TPVM, Klijn AJ, Vijverberg MAW, de Kort LM, van Empelen R, Schoenmakers MAGC. Effect of biofeedback training on paradoxical pelvic floor movement in children with dysfunctional voiding. Urology. 2007;70(4):790–793. doi: 10.1016/j.urology.2007.05.005.
    1. Chai TC, Steers WD. Neurophysiology of micturition and continence in women. Int. Urogynecol. J. Pelvic Floor Dysfunct. 1997;8(2):85–97. doi: 10.1007/BF02764824.
    1. Shafik A, Shafik IA. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J. Urol. 2003;20(6):374–377. doi: 10.1007/s00345-002-0309-9.
    1. Greer JA, Smith AL, Arya LA. Pelvic floor muscle training for urgency urinary incontinence in women: A systematic review. Int. Urogynecol. J. 2012;23(6):687–697. doi: 10.1007/s00192-011-1651-5.
    1. Lee P-J, Kuo H-C. High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections. Low Urin. Tract Symptoms. 2020;12(1):33–40. doi: 10.1111/luts.12280.
    1. Guglietta A. Recurrent urinary tract infections in women: Risk factors, etiology, pathogenesis and prophylaxis. Future Microbiol. 2017;12:239–246. doi: 10.2217/fmb-2016-0145.
    1. Minardi D, d’Anzeo G, Parri G, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: A randomized controlled prospective study. Urology. 2010;75(6):1299–1304. doi: 10.1016/j.urology.2009.11.019.

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