Accessing Hard to Reach Places: Biofeedback for the Pelvic Floor Muscles

One of the most common things I hear from clients as a pelvic health physical therapist is “I had no idea I had muscles down there!” If you have been keeping up with our blog, you will already know that the pelvis is full of muscles and other tissues that helps us with our daily functioning. And, better yet, you can control the muscles of the pelvic floor just like you can control any other muscle group. However, sometimes people need help in being able to establish awareness and control in the pelvic floor muscles. Because these muscles are located inside the pelvis, we call upon a special tool called ‘biofeedback’ to help bring awareness to these muscles.

In short, biofeedback is a tool that provides information on what’s going on inside the body in order to help someone facilitate a change in their behavior to positively affect the tissue or bodily function being measured. Biofeedback for muscles is specifically the measurement of how much muscle is firing either during a contraction or a resting period (ie, is the muscle on or off?). One thing Biofeedback is not: a measure of muscle strength. The pelvic floor muscles are a unique set of muscles because they are located inside the pelvis. Biofeedback is helpful in order to access these muscles, usually with the use of a biofeedback machine. This small handheld device is connected to wires that are connected to the patient either by external electrodes placed on the skin of perineum or by an internal sensor placed into the vaginal or rectal canal. These electrodes and sensors then pick up the activity (or lack thereof) within the pelvic floor muscles, both when the patient is at rest as well as when the patient is cued by the therapist to engage or relax their muscles. The information is read by the handheld unit so the patient can see the activity of the muscle and then be able to change their muscular activation as needed. Biofeedback units range from being small, handheld devices all the way to very expensive computer systems. No matter the size or cost of the unit, generally speaking, biofeedback can be used for both strengthening weak pelvic floor muscles (referred to as ‘up training’) as well as training painful, tight, and overactive pelvic floor muscles to relax (called ‘down training’).

While the use of technology is helpful for biofeedback, especially when it allows patients to use home units between PT sessions, there’s another type of biofeedback that is considered the gold standard approach: the therapist! The physical therapist is an excellent resource to help a patient gather information about her body to help facilitate a positive change in muscle behavior. Pelvic health PTs are specialized in using their own palpation and manual therapy techniques (ie, their hands) combined with their clinical expertise (ie, their verbal cues and patient education) during internal pelvic floor muscle assessments in order to guide patients into proper muscle contractions and/or muscular relaxation. As we all know, computers (this includes biofeedback units) are not fool proof. They, too, can sometimes facilitate altered muscle habits that are less than ideal. This is why seeing a pelvic health PT to specifically get to know your own pelvic floor muscles is important in order to access those hard to reach places. Getting in touch with your own pelvic floor muscles with the help of a pelvic health PT will eventually translate into reduced pelvic floor dysfunction during daily life, keeping you pain free and leak free when you need it the most.