Biofeedback and other Therapies for the Treatment of Urinary ...

ReviewUrinary IncontinenceAlthough a systematic review concludedthere is no benefit to adding biofeedback to pelvicfloor muscle exercises, 33 a meta-analysis of the samedata noted a “trend” in favor of adding biofeedback toexercise; the pooled results almost reached statisticalsignificance. 34Biofeedback has been evaluated as a treatmentfor patients who develop post-surgical SI. Studiesadding biofeedback to pelvic floor muscle exerciseshave reached different conclusions as to whether biofeedbackconfers an additional advantage. 1,35-43 In oneinvestigation, 50 post-prostatectomy subjects (meanage 65) were randomized to receive biofeedback-assistedpelvic floor muscle exercises and educationfor three months or to a control group who receivedno post-surgical intervention. 35 Biofeedback-trainedsubjects experienced a 26-percent greater continencerate at three months and 14 percent at one year. 35In two studies, individuals who utilized biofeedbackregained continence sooner after prostatectomy,although the overall rate of continence wasunchanged. 36,37 Biofeedback yielded continence ratesof close to 80 percent in two other uncontrolled trialsafter prostatectomy. 38,39 Two investigations, however,did not find added benefit to the use of biofeedbackafter prostate surgery. 40,41 Differences in biofeedbacktraining techniques, devices, and subject populationsmight have accounted for the variation in results.Overall, two comprehensive reviews concludedthe preponderance of evidence suggests theremight be benefit to the addition of biofeedback to pelvicfloor muscle exercises for SI. 2,44 In one, the combinedrelative risk of SI in biofeedback-assisted exercisewas 0.74 (95% confidence interval 0.60-0.93)compared to no treatment. 44Biofeedback for Mixed UIBiofeedback has been utilized for individualswho exhibit features of both SI and UR – termedmixed UI. In several small, uncontrolled trials, lastingfrom six weeks to 26 months and involving primarilymiddle-aged or elderly women, improvementin symptom scores of episodes of incontinence andurgency ranged from 36-75 percent. 45-49One investigation added biofeedback to othertreatments to reduce urge or mixed incontinence ina primarily elderly population. One hundred ninetysevenpatients (ages 55-92) were randomly assignedto utilize biofeedback-assisted pelvic floor muscleexercises, medication, or a placebo. 50,51 Subjects whoperformed the pelvic floor muscle exercises had twosessions to learn how to perform them. Biofeedbackwas added to the protocol for those subjects who exhibitedless than 50-percent reduction in frequencyof incontinence with exercise alone. Those subjectstrained in combination exercise and biofeedback reducedepisodes of incontinence from 15 to two episodesa week, medication-treated subjects decreasedincontinent episodes from 15 to three episodes aweek, and placebo recipients lowered episodes from15 to 10 episodes a week after two months. 50 Biofeedback-treatedsubjects also reduced episodes ofnocturia from 1.9 to 1.4 episodes a night, which wasstatistically significant and not matched in the othergroups. 51Biofeedback ConclusionsA number of problems exist in the quality ofthe evidence on the use of biofeedback as a treatmentfor incontinence: (1) there is no standardization ofbiofeedback devices or subject training used in differentinvestigations; (2) the nature of the treatmentmakes blinding difficult, if not impossible; (3) manyof the studies include a small number of subjects; (4)varying inclusion criteria are used to define incontinence;and (5) different instruments are used to assessthe efficacy of treatment on outcomes.Other important issues must be considered ina feasibility assessment of biofeedback for the elderly.Although many studies include older subjects, fewtrials have been performed exclusively on the elderly.It is not clear how easily elderly patients, many whomight have sensory or cognitive impairment, can betrained to use a biofeedback device. Other concernsinclude determining the optimal biofeedback deviceor training method and assessing the cost of such adevice.Miscellaneous Therapies: Hypnosis,Acupuncture, and Botanical MedicineHypnosis was the subject of one uncontrolledtrial to treat UR. 52 The subjects had 12 sessions overone month, followed by audio-taped sessions at homefor six months. Fifty-eight percent of 50 subjects whoreceived hypnosis experienced symptom improve-Alternative Medicine Review u Volume 11, Number 3 u 2006 Page 227Copyright © 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission. Alternative Medicine Review Volume 10, Number 4 December 2005