Biofeedback in the treatment of urinary incontinence in adults.

OBJECTIVE For patients with the most common types of urinary incontinence, first line therapy consists of behavioral treatments, such as bladder training and pelvic floor muscle exercises (PME). The patient learns to strengthen the pelvic floor musculature and to better control bladder emptying. Biofeedback itself is not a treatment for urinary incontinence, but can be used as an adjunct to pelvic floor muscle exercises. By providing patients with concurrent feedback on muscle tone, biofeedback is intended to improve the patients' ability to perform pelvic muscle exercises. If patients can learn to exercise more effectively with biofeedback, greater improvement in self-control of incontinence may result. The objective of this technology assessment is to determine whether adding biofeedback as an aid to performing pelvic floor muscle exercise results in a greater improvement in urinary incontinence, as compared to pelvic floor muscle exercises alone. Stress incontinence and urge incontinence are the most common types of urinary incontinence treated with behavioral techniques and are the main focus of this assessment. The use of biofeedback in treatment of post-prostatectomy incontinence is also addressed in this assessment, as this is a common cause of incontinence in the Medicare population. The treatment of urinary incontinence that is due to neurologic injury or disease is not addressed as part of this assessment.