Biofeedback for community-dwelling individuals with urinary incontinence

Objectives. To review the role of biofeedback in the management of community-dwelling individuals with urge urinary incontinence (UUI), and to present a practical approach to patient evaluation and treatment selection. Methods. In view of a lack of objective published information, perspectives on the use of biofeedback in UUI are derived from extrapolation of studies in patients with stress incontinence as well as from the author's personal experience. Results. Through the use of careful baseline evaluations, appropriate exercise and biofeedback treatment for UUI can be selected for specific patients. Office-based biofeedback is preferred for patients who have no or minimal ability to isolate and contract the levator muscles at baseline. Such individuals cannot be expected to exercise effectively without instruction but can be converted to home-based treatment once responses have been achieved. Patients with weak contractions but appropriate muscle isolation are appropriate candidates for Kegel exercises; biofeedback has not been conclusively demonstrated to be superior to exercise therapy alone in this group. Vaginal cones or simple home biofeedback units may be useful adjuncts in these cases. Patients who have good muscle isolation and strong pelvic contractions at baseline generally have more severe bladder dysfunction and require aggressive treatment aimed at the detrusor. Instruction in "quick flicks" may assist in inhibiting urgency, and motivated patients may be offered vaginal cones. Conclusions. Pelvic floor muscle dysfunction is an important but often-overlooked component of UUI. The algorithm presented here can assist in tailoring exercise and biofeedback therapy to the individual patient. However, more research is needed to help stratify patients according to the degree of detrusor dysfunction and status of pelvic floor muscles before intervention. (C) 1998, Elsevier Science Inc. All rights reserved.