Pelvic floor muscle training with and without biofeedback in treatment of overactive bladder

Preethi Badda, Achla Batra, Sheeba Marwah, Rupali Dewan


Background: Overactive bladder (OAB) is a commonly encountered problem in gynaecological practice. It has profound effect on quality of life (QOL), affecting simple daily activities as well. Prevalence rates of OAB in Asians are 53.1%. The first line management of OAB is behaviour modification and pelvic floor muscle training (PFMT). Objective of this study was to comparative assessment of biofeedback assisted PFMT (BAPFMT) versus PFMT alone in treatment of OAB using strength of pelvic floor muscle and QOL before and after treatment.

Methods: A prospective comparative randomized controlled trial was conducted to compare the effect of PFMT versus BAPFMT on OAB symptoms over period of 12 weeks. Total of 100 patients fulfilling inclusion and exclusion criteria were selected. Randomization of patients was done into two groups of 50 patients each; half of them were subjected to PFMT and other half to BAPFMT. Appropriate statistical test were applied.

Results: At the end of 12 weeks of intervention, there was a significant improvement in pelvic floor muscle strength and QOL in both groups (p<0.001). The improvement in pelvic floor muscle strength was more with BAPFMT; however there was no difference in improvement of QOL between the groups.

Conclusions: Addition of biofeedback to PFMT may be a useful adjunct in OAB patients.


King’s health questionnaire, Modified oxford scale, Overactive bladder symptom score

Full Text:



Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Managed Care. 2000;6(suppl):S580-90.

Wein AJ, Rovner ES. Definition and epidemiology of overactive bladder. Urolo. 2002;60(5 Suppl 1):7-12.

Brown JS, Subak LL, Gras J. Urge incontinence: the patient’s perspective. J Women’s Health. 1998;7:1263-9.

Samuelsson E, Victor A, Tibblin G. A population study of urinary incontinence and nocturia among women aged 20-59 years. Acta Obstet Gynecol Scand. 1997;76:74-80.

Gentili A, Weiner DK, Kuchi M, Edinger JD. Factors that disturb sleep in nursing home residents. Aging ClinExp Res. 1997;9:207-13.

Brown JS, McGhan WF, Chokroverty S. Comorbidities associated with overactive bladder. Am J Managed Care. 2000;6(suppl):S574-79.

Johansson C, Hellstrom L, Ekelund P, Milsom I. Association between urinary incontinence and urinary tract infections and fractures in postmenopausal women. Maturitas. 1996;23:265-71.

Brown JS, Vittinghoff E, Wyman J. Urinary incontinence: does it increase risk for fall and fracture? J Am Geriatr Soc. 2000;48:721-5.

Wagner TH, Hu TW. Economic costs of urinary incontinence in 1995. Urol. 1998;51:355-61.

Wilson PD, Herbison RM, Herbison JP. Obstetric practice, and the prevalence of urinary incontinence three months after delivery. BJOG. 1996;103:154-61.

Ellsworth PI, MD Professor of Urology, University of Massachusetts Medical School; Chief, Division of Pediatric Urology, Department of Urology, UMass Memorial Medical Center.

Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment,for urinary incontinence in women:a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34(4):300-8.

Hay-Smith EJ, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006;1:CD005654.

Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training. Ann Intern Med. 1985;103(4):507-15.

Wang AC, Wang YY, Chen MC. Single-blind, randomized trial of pelvic floor muscle training, biofeedback muscle training, and electrical stimulation in the management of overactive bladder. Urol. 2004;63:61-6.

Liaw MY, Kuo CH. Biofeedback pelvic floor muscle training for voiding dysfunction and overactive bladder. Incont Pelvic Floor Dysfunction. 2007;1:13-5.

Ferreira CHJ, Barbosa PB, de Oliveira Souza. Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer. Physiotherapy. 2011;97:132-8.

Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104:1374-9.

Ref-Lin Ting-Yi, Chou Lung-ChiehEric. Assessment of Overactive Bladder (OAB) Symptom Scores. Incont Pelvic Floor Dysfunction. 2009;3(Suppl):9-14.

Ng SC, Lin TL, Chang SJ, Tai HL, Hu SW, Chen GD. Nursing intervention to enhance efficacy of home practice of pelvic floor muscle exercises in treating mixed urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):637-42.

Ibrahim IK, Hameed MMA, Taher EM, Shaheen EM, GawdatElsawya MA. Efficacy of biofeedback-assisted pelvic floor muscle training in females with pelvic floor dysfunction. Alexandria J Med. 2015;51(12):137-42.

Mantle J. Physiotherapy for incontinence. Cardoza L, Staskin D, editors. Text- book of female urology and urogynaecology. London: Isis Medical Media Ltd;2001:351-358.

Haslem J. Therapeutic management of incontinence and pelvic pain. 2nd ed. London: Springer; 2007.

Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynaecol. 1948;56:238-49.

Miller JM, Perucchini D, Cardichi LT, Delancey JOL, Ashton-Miller J. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97:255-60.

Miller JM, Ashton-Miller JA, DeLancey JOL. A pelvic muscle pre contraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46:870-4.