What exactly is biofeedback?

Why do I find it so difficult to work out if I am doing pelvic floor exercises properly even when I’m practising these exercises on a regular basis? How can I tell if my muscles are becoming any stronger?

The answer to these questions is very simple. It’s called  ‘biofeedback’.

To begin with it’s helpful to have a basic understanding of what biofeedback is exactly.

There are many different definitions but the best way to describe it is by looking at an example of your body’s own ‘natural’ biofeedback mechanisms.

If you had a weak leg muscle and were trying to strengthen it you would be able to watch it as you tried to exercise. You could also put your fingers over the muscle to feel the increase in its tone.

These actions of watching and feeling are a way of feeding information back to your brain to tell you that you’re on the right track. Most gyms have lots of mirrors, not to make you feel bad about yourself, but to help you improve the quality of your movement.

Physiotherapists use biofeedback techniques when helping patients to strengthen and re-educate weak muscles and develop an effective pattern of movement.

Why is biofeedback so useful for pelvic floor muscle training?

Some women find it really difficult to work out if they are practising pelvic floor exercises correctly. It’s understandable as these muscles are hidden inside so you can’t see if they are contracting properly.

A weak muscle produces very little movement as it tightens and this increase in tension often fades out quickly. The combination of limited movement and poor endurance in an internal muscle makes it very hard to work out what is actually happening! Biofeedback helps to give you re-assurance and positive feedback about your technique.

As muscles become slightly stronger it’s important to progress exercise routines to get the maximum benefit out of the effort you’re putting in.

So biofeedback helps you to:

• check that your technique is effective
• progress your exercises
• stay motivated as you monitor any improvement

You may like to assess your own pelvic floor muscles before looking at the different treatment options that are available. Read the blog or watch the video to learn how to do this. Pelvic floor muscles that are very weak often benefit from electrical stimulation before using biofeedback.

How can my pelvic floor muscle movement be detected?

We are all familiar with the heart monitors that are seen in TV documentaries and dramas. We probably all know what the pattern of an ECG (electrocardiograph) trace looks like. These monitors show the pattern of heartbeats.

In the same way, an EMG (electromyograph) trace shows on a screen the pattern of electrical activity that’s occurring in your muscle.

A vaginal sensor is needed to pick up any change in electrical activity as your pelvic floor muscle contracts. The periform does this job well as once in position it lies very close to this muscle group. So as you tighten your pelvic floor you can see a change in the pattern on a screen.

This form of biofeedback is a great way of checking out your ‘internal muscles’

Once you have a baseline trace you can start to progress your exercises and then review any improvement by repeating the biofeedback over a number of weeks and months.

Is biofeedback only available in a clinic?

Women’s health physios have used biofeedback in clinic settings for many years. It’s a great way of motivating people to stay focused and obtain the maximum benefit from the programme they have been given. It helps us to set and progress exercise routines and tailor make them for each individual.

The good news is there are now hand held biofeedback devices such as the NeuroTrac Simplex available for you to use yourself at home. These units have a small screen with an LED light to display your muscle activity.

Women rarely experience bladder leaks when lying down but we all tend to do pelvic floor exercises in bed often just before we go to sleep. Our muscles get used to doing gentle tightening movements without the pressure of body weight or gravity bearing down upon them.

In the real world pelvic floor muscles need to be reactive and strong. We need them to work with the rest of our core muscles to support our bladder and pelvic organs when we are;

• Coughing and sneezing
• Standing and walking around
• Going to the gym or participating in higher impact exercise

Lots of women say they can ‘feel’ their pelvic floor tightening when lying down but lose that awareness when they stand up. We need to be educating these muscles to work in different positions and during different types of activity.

Biofeedback is great because once the periform is in place, pelvic floor activity can be seen and measured in lying, sitting, standing and even when we cough. You may like to watch the video tutorial to find out more about the Simplex unit and how to use biofeedback at home.

Are there any other types of biofeedback?

There are some simple techniques to check out your ability to tighten pelvic floor muscles:

• ask for feedback from your sexual partner during intercourse.
• use a mirror to check your muscle contraction by looking from the outside. Although you cannot see your pelvic floor muscles you will be able to watch the effect they have as they tighten. You should see the area around the vagina lift away from the mirror.
• monitor the sensation of tightening against your finger. Gently insert a finger or thumb into your vagina and feel to your right or left side. As you squeeze your pelvic floor there should be an increase in tension under your finger.
• sophisticated techniques are available in some more specialist continence or women’s health clinics. Real time ultrasound scanners enable you to actually see your pelvic floor muscle contracting. This works in the same way we use ultrasound to show an expectant mum an image of her baby.

It’s recommended that any form of biofeedback is used under the supervision of a physiotherapist or continence nurse advisor specialising in pelvic floor assessment.