Pelvic floor biofeedback therapy is a type of physical therapy that can help men and women to learn how to contract and relax the pelvic floor muscles. It can be useful for patients who have bladder or bowel incontinence, slow urination caused by abnormal pelvic muscle contraction, and patients with interstitial cystitis and pelvic floor dysfunction. Patients usually spend one hour per week for 6-8 weeks with a therapist who is specially trained in pelvic floor therapy.
The pelvic floor is a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone). Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum. These muscles also wrap around your urethra, vagina (in women), and rectum. Contracting and relaxing these muscles helps to control bowel and bladder functions. These muscles must relax to allow for urination and bowel movements, and women must be able to relax these muscles during sexual intercourse. Weakness in these muscles is one of the causes of urinary incontinence, and abnormal tension or spasm of these muscles can cause pelvic pain or slow stream or other urinary symptoms.
Pelvic floor biofeedback therapy works by training the brain and pelvic muscles to work together to tighten and relax the pelvic floor muscles. Sensors in the vagina or rectum measure the contraction and relaxation of the muscles and patients get visual cues on a computer monitor so that they can learn to better use these muscles. In many cases women have tried “Kegel” exercises to strengthen the pelvic muscles without success, but they have not been contracting the proper muscles or they have been contracting them in an improper manner. Many of these women will have more improvement following pelvic floor biofeedback therapy.
During a pelvic floor therapy session you will discuss your symptoms and your progress with the clinician. She will place a sensor in your vagina which can measure the strength of the contraction of your pelvic muscles. The strength of your muscle contractions will be displayed on a computer monitor. You will also experience light electrical stimulation of your pelvic muscles, which will cause them to contract. This helps to strengthen the muscles and teaches your brain and your pelvic muscles to work together properly. Some patients with pelvic pain may undergo massage of specific places in the pelvic muscles, called "trigger points", to help diminish the pelvic pain.
Pelvic floor biofeedback therapy is covered by many insurance plans, including Medicare. In many cases insurance plans will initially deny coverage for pelvic floor therapy and we are required to submit paperwork documenting the need for therapy in order to obtain coverage. In some cases the insurance plans will refuse to cover pelvic floor therapy, or it is not a covered benefit, and patients will need to pay for the therapy themselves. A letter to the insurance plan from the patient will often times be very helpful, because the patient is their customer and can choose a different insurance plan if their needs are not being met.