After childbirth or after the age of 50, it is strongly recommended by various health experts to have perineal rehabilitation sessions. Several methods of perineal re-education can be considered: by oneself, through sport, through the intervention of a midwife or a physiotherapist, etc. However, a technique called Biofeedback has been developed in the United States of America. It is used more and more these days and in this article we explain everything there is to know about this method of perineal rehabilitation.
What is Biofeedback ?
Originating in the 1960s in the United States of America, Biofeedback is a technology that uses alpha waves and was first used to examine the electroencephalogram. Although it is a technology that can now be applied to many areas in medicine, it is currently very popular as it is particularly involved in perineal rehabilitation.
Biofeedback in perineal rehabilitation is specialised in the treatment and assessment of anal incontinence but also constipation. Its use in this field consists in teaching the patient how to regulate the contractions of the perineal muscles.
It is therefore not a therapy as such but rather a learning technique. Biofeedback allows us to see the effectiveness or otherwise of the exercises performed, but it is not an electrostimulation technique. The latter allows the muscularization of the perineum by sending electrical impulses to it.
Biofeedback is indicated when there is terminal constipation secondary to anism, loss of exonerative urge, unstable anal hypertonia. In these conditions, it acts more as a behavioural therapy. An anorectal anomaly is then used to establish a helping relationship with the patient.
How does Biofeedback work ?
The way it works is explained first of all by its name. Biofeedback means "biofeedback" or "biological feedback". It is a set of techniques that are mainly related to bioelectricity technology.
With these techniques, it is possible to measure organic functions of the body by visualising the physiological signals of a conscious patient. All this is done with the help of a set of electrical devices.
Feedback is said to occur when the patient who benefits from the technology can control the measured organ functions. The control can be voluntary (e.g. to correct a state of stress or to perform contractions) or involuntary (e.g. after a change in psychological state such as the occurrence of stress).
A feedback device is typically composed of an instrumentation amplifier that amplifies versatile physiological signals. A link circuit called a coupler allows the signals to be fed into a computer sound card.
The entire treatment is performed by a program and then transmitted to the screen. The receiver can be the computer of the practitioner who performs the examination and/or simply the patient's smartphone thanks to a dedicated application.
How does Rehabilitation work ?
In a practical way for rehabilitation, an electronic device connected to a probe equipped with sensors is placed in the patient's vagina or anus. It will record all contraction movements and translate them into a sound and/or visual signal.
The patient will be able to see or hear if he has done his contraction exercises properly. Depending on the result, he can adapt his efforts. To motivate the patient, some devices even allow the creation of objectives from one session to the next.
There are also manual devices with an air probe called perinometers. They are less and less used.
Why use Biofeedback for perineal rehabilitation ?
The weight of the uterus during pregnancy and the enlargement of the vagina during childbirth cause the tissues that make up the perineum to become slack. This slackening thus leads to small urinary leaks in the event of effort, however small (laughing, coughing, etc.). It is therefore important to re-educate the perineum. This can be done using the so-called manual method, the electrostimulation method or the biofeedback method.
The high failure rate in the first moments and the random results of the manual method are often sources of frustration. As for electrostimulation, it seems to be effective but according to health experts, there is a risk of relapse because electrostimulation is a passive re-education technique. The patient concerned does not really learn how to contract the perineum by himself.
Biofeedback re-education allows the patient to become aware of his or her contractions and to learn to control them voluntarily. It is therefore a complementary method to the other two seen above. It provides an objective measure of the patient's progress.
Although so interesting, one might be tempted to ask whether this is a method only for women.
Who can benefit from perineal rehabilitation ?
Biofeedback perineal reeducation is aimed at all people who need to learn to control their perineum, whether after childbirth or in the event of urinary incontinence (which often happens after a certain age). It is therefore equally suitable for men and women. The Biofeedback technique makes it possible to measure the effectiveness of the exercises performed and is independent of the sexual gender of the patient concerned.
What are the benefits ?
The benefits of Biofeedback rehabilitation are numerous :
1 - Duration
Unlike electro-stimulation sessions which last a long time, Biofeedback sessions last on average 5 to 15 minutes depending on the effectiveness of the patient's voluntary control of their perineal muscle contractions.
2 - Motivation
On average, 6 to 12 sessions of perineal rehabilitation are needed to observe the first results. For more complex clinical situations, the number of sessions may be higher. Thanks to Biofeedback, the patient can objectively follow his or her progress and therefore remain motivated throughout the process because he or she can visualise his or her progress. This is not the case with other techniques.
3 - Improvement of incontinence
Biofeedback can improve anal incontinence secondary to sphincter incompetence by strengthening the contraction of the striated perineal muscles. Biofeedback can be equally effective whether or not there is a sphincter injury, especially if the anal incontinence is not too severe. It can also complement surgical treatment of incontinence or have a role in its prevention.