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Biofeedback or no biofeedback?

Short answer: I do not have biofeedback currently.

Long answer: (Remember that this pertains to the pelvic floor, not any other bodily region)

What is biofeedback? Biofeedback is a machine (could be a hand-held device or a computer) that attaches to censors or, in this case, a vaginal probe which reads the muscle action potential/ contractions (again in this case - kegels). If using the censors for children or for adults who cannot tolerate the vaginal or rectal probe, the censors are attached (sticky side) to the insides of the butt cheeks. The screen then shows the patient how much he/she is contracting and/or relaxing. When using biofeedback, the practitioner can set goals for the patient to achieve. These can be for the patient to try to achieve a stronger pelvic floor contraction over a certain level or to try to more fully relax the pelvic floor below a certain level specified. For some programs, these screens present the muscle contraction on a graph, a rose contracting/ relaxing, etc. For children, a dolphin jumping out of water, a pole vaulter clearing the bar, etc. This can be extremely helpful for those patients who have lost awareness of their pelvic floor after childbirth, surgery, or in children who may be having bladder and/ or bowel dysfunction.

When practicing pelvic floor physical therapy, I used biofeedback all of the time. It was all the rage. Patients gained awareness and improved. I, because I'm curious and, well, known as 'Vagina Jill', ran my patients to the bathroom for fun, put censors on their 'area' and tested their pelvic floor resting baseline in various different toileting positions to find which positions truly relaxed and allowed better emptying. I am never one to believe or practice something just because someone told me to or because I read it. I like to test things out before I believe it. More results on this another post... Aren't you curious:)

However, for me and some other pelvic floor therapists that I admire, I started realizing that biofeedback may actually not be as beneficial as the knowledge gained through my own hands. While biofeedback can be paired with a other censors to ensure a patient is truly isolating the pelvic floor muscles during a kegel and not their abdominal, inner thighs, etc, I realized that only my hands (and other skilled practitioner's hands) can tell if a specific portion of the internal pelvic floor muscles are contracting or not. Biofeedback reads the overall muscle activity of the region, but does not (that I know of at this time) read whether, for example, the right pelvic floor is contracting stronger than the left, or if 7 o'clock in the pelvic floor is weaker than all the rest of the clock. There are internal electrical stimulation units that can provide input to 'wake up' a muscle or even force more of a contraction, but I prefer to at least try myself before recommending one of these. Again, this would be overall and not specific to one muscle itself. These are recommended for extremely weak pelvic floors. I am more of a hands-on girl with not many gadgets in my practice. I like to be internal with a patient and provide neurological re-education if she is lacking contractile ability in one particular part of her pelvic floor. There are several ways in which a PT can do this. No two patients are the same, and I try to keep learning so that I have many tools to offer for each patient who learns differently.

However, I do see the benefits of biofeedback in down-training the pelvic floor. This is when a patient walks in with a pelvic floor that has a lot of tension and needs to be taught to let go and relax. This is where I, personally, see that biofeedback could be a definite asset to internal manual treatments to release the tension. At this point, my patient outcomes have not caused me to strongly consider purchasing biofeedback, as they improve with tactile and verbal cues, breathing, and positioning well enough, but it is in the back of my head.

Also, if one is treating pediatric pelvic floor dysfunction, biofeedback could be extremely beneficial since internal examination and treatment would not be performed. This could help little ones and teenagers to increase their overall awareness of their pelvic floor, which can be unbelievably helpful their whole life long. At times, when treating pediatrics, the patient and parents (if not with the child due to school/work) cannot provide accurate accounts of bladder/ bowel habits. Therefore, trying to bladder/ bowel train, not having biofeedback, and expecting progress can be like finding a needle in a haystack. If I started getting a ton of pediatric patients, I would definitely consider purchasing. Then, the benefits would outweigh the cost. For the few that I have, they seem to be improving and happy with what we have done so far with education, working on awareness using props, dietary changes, and strengthening.

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