Biofeedback assisted behavioral training reduces incontinence by teaching patients to control the responses of the bladder and pelvic muscles that control continence. Patients who undergo this behavioral training are taught skills and strategies for preventing incontinence which include: 1.) elimination foods that stimulate the bladder such as: caffeine, soda, alcohol, spicy and highly acidic foods. 2.) building strategies to control the urge to urinate, for example when you feel the urge to urinate instead of rushing to the toilet, which increases intra‐abdominal pressure, patients are encouraged to sit, relax and contract the pelvic muscles repeatedly to diminish urgency. When the urge has subsided, then they can proceed to the toilet at a normal pace. 3.) keeping a diary of urinary activity: the time you urinate; the time of urine loss episodes; type of activity associated with urine loss (i.e. cough, sneeze, laughter or urgency) and volume of loss. That data can be reviewed by a nurse trained in biofeedback who will make suggestions regarding the use dietary strategies, various urge control strategies, timed‐voids and fluid management.
Biofeedback is a proven treatment for urinary incontinence and is accomplished through the use of a vaginal probe attached to a computer. The pelvic floor muscles are gently stimulated through the vaginal probe and then a biofeedback nurse coaches the patient to learn to alternately contract and relax the pelvic floor muscles while keeping the abdominal muscles relaxed. The intensity and duration of the patient’s contractions around the vaginal probe are displayed on the computer screen providing visual feedback on the patient’s performance. Biofeedback sessions usually last about ½ hour per week for 6‐8 consecutive weeks. A personalized exercise schedule is established to be performed at home usually 2‐3 times per day and progress is monitored in the weekly session.
Patients are typically highly satisfied with the results of this behavioral intervention which has the advantage of significantly reducing incontinence without the adverse side‐effects of drug therapy. In a controlled study 74% of patients rated themselves much better and 26%, better following biofeedback and behavioral treatment. In the same study only 50% were much better and 30% better on drug therapy. In addition there is evidence of even better improvement when drug therapy is used in combination with biofeedback. As with many interventions the success and durability of behavioral treatment depends on the active participation of a motivated patient.