The effect of EMG biofeedback assisted pelvic floor muscle therapy with the maple on symptoms of the overactive bladder syndrome in women after nine weeks of treatment: a randomised trial

Introduction: The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (1). The most commonly used approaches are behavioural therapy, pharmacotherapy and surgery. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest and many patients are intolerant of the side effects or do not experience sufficient relief (2). Literature indicates that pelvic floor physiotherapy is effective for incontinence, as well as urgency, frequency and nocturia (3). Objective: The aim of this study was to determine the efficacy and effectiveness of EMG biofeedback assisted pelvic muscle therapy on symptoms of overactive bladder (OAB) after 9 weeks of treatment. Methods: Women with urgency/frequency and/or urge urinary incontinence are randomly divided into an intervention group that will receive biofeedback assisted pelvic floor muscle therapy (BAPFMT) or into a control group (no treatment). Exclusion criteria were neurological disorders, a medical history with invasive perineal and/or rectal surgery or existing SUI. The Pelvic Floor Inventories (PeLFIs), the King's Health Questionnaire (KHQ), a voiding dairy, a 24‐h pad test and vaginal EMG registration of the pelvic floor with an EMG probe (MAPLe) are used to determine the effect of BAPFMT on complaints of OAB and Quality of Life (QoL). Patients assigned to the intervention group received nine 30‐min sessions of BAPFMT with the MAPLe using a standardized protocol. After 9 weeks, both groups are requested to fill in the KHQ and the 24‐h voiding diary again and to conduct a 24‐h pad test. In addition, the PeLFIs is administered and the EMG registration of the pelvic floor is repeated. Results: Fifty ‐eight patients were included in this study. Six patients discontinued their cooperation in the study before completion of the 9 weeks follow‐up. Mean age was 56.13 years (range 16.24‐72.96 years), Mean Body Mass Index (BMI) was 26.5 (range 16.7‐44.14). The groups were homogeneous for analysis. Twenty four % of the women had a history of negative sexual experiences. The PeLFIs showed significant improvement in the intervention group with respect to the control group in complaints of OAB in the domains micturition pattern (p=0.001), obstructive micturition (p=0.02) and urinary incontinence (p=0.02). For the KHQ the domains social and sleep/energy improved significantly (p <0.05) in the intervention group, compared to the control group. The 24‐h voiding diary also showed significant improvement in the invention group in urgency, 24 h padtest (gram) and the daily use of pads (p<0.05). EMG registration of the pelvic floor showed significant improvement in pelvic floor muscle function between the intervention group with respect to the control group (p<0.05). Conclusions: EMG biofeedback assisted pelvic floor muscle therapy with the MAPLe is effective in the OAB syndrome in women after 9 weeks of treatment. It significantly reduces symptoms and complaints of OAB and increases Quality of Life for patients. Therefore this treatment should be considered as an alternative and non‐invasive therapy for OAB. Long term efficacy with a 1 year follow‐up is conducted at this moment.