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

Introduction: Overactive bladder syndrome (OAB) is defined by the International Continence Societyas urgency with or without urge urinary incontinence, usually with frequency and nocturia. Prevalence rates of OAB in in females 16.9%. It has profound effect on quality of life(QOL). Pelvic floor muscle training(PFMT) is one of the important modality in the treatment of OAB. The rationale of pelvic floor muscle exercise is to improve the timing of contractions, the strength of the pelvic floor muscles and the stiffness of the pelvic floor muscles. Thus, voluntary pelvic floor muscle contractions may be used to control urgency and urge incontinence. It is difficult for a women to identify correct pelvic floor muscle group, adding biofeedback helps women to identify correct group of pelvic floor muscles. This study is designed to compare the effectiveness of pelvic floor muscle training alone with biofeedback assisted pelvic floor muscle training(BAPFMT) in treatment of overactive bladder. Objectives: The objectives were to compare the strength of pelvic floor muscles and quality of life in women with OABbefore and after treatment with BAPFMT and PFMT. Methods: This prospective randomized study was conducted in department of Obstetrics and Gynaecology in collaboration with department of Urology & Physical and Medical Rehabilitation. Before the study permission was taken from ethical committee of hospital. Total of 100 patients fulfilling inclusion and exclusion criteria were selected. Women with current pregnancy or delivered within three months, diagnosed with active urinary tract infection, interstitial cystitis, history of tuberculosis, neurologic diseases (stroke/multiple sclerosis/spinal cord injury), medically complicated, uncontrolled diabetes mellitus, fecal motility disorder, chronic pelvic pain, gross cancers (bladder/colon/cervix/uterus cancer), pelvic radiation were excluded. Randomization of the patients was done into two groups. Both the groups had 50 patients with overactive bladder symptom, half of them were subjected to PFMT (group 1) and other half to BA PFMT. (group 2)After taking comprehensive history and performing examination ,an overactive bladder symptom score questionnaire(OABSS) and quality of life questionnaire was filled for all the participants.All patients were given dietary and behaviour modification and were given pelvic floor muscle therapy programme over 12 weeks. Result: Both groups had comparable demographic profile, pelvic floor muscle strength and symptoms There was improvement in both OABSS and maximum vaginal squeeze pressure at 12 weeks. in both groups. In BAPFMT group there was 44.64% improvement in maximum vaginal squeeze pressure as compared to only 18.78% in PFMT group at the end of 12 weeks. In PFMT group there was 17.66% improvement in OABSS as compard to 13.6% in BAPFMT group at the end of 12 weeks There was no significant difference in reduction of incontinence episodes at the end of 12 weeks. There was no statistically significant improvement in various variables of QOL when two groups were compared at the end of 12 weeks Conclusions: The present study demonstrated that pelvic floor muscle training could relieve OAB symptom and have a beneficial effect on health related quality of life measurements. Adding biofeedback to PFMT results in higher increase in pelvic floor muscle strength and decrease in severity of symptoms compared to PFMT. But overall no difference was found in QOL score.