Use of Biofeedback Technologies in Female Pelvic Floor Muscle Rehabilitation: Clinical Outcomes and Neurophysiological Effects
DOI:
https://doi.org/10.61726/2495.2025.19.89.001Keywords:
biofeedback, pelvic floor muscles, electromyography, physiotherapy, female rehabilitation, stress urinary incontinence, psychophysiological regulation, telemedicine technologiesAbstract
The relevance of this research lies in the need to introduce evidence-based, non-invasive, and individualised methods for correcting urogenital dysfunctions in women. Despite the wide application of physical exercise and pharmacological treatments, their effectiveness remains limited due to the lack of objective control over pelvic floor muscle (PFM) activity. The use of biofeedback (BFB) and electromyographic (EMG) technologies overcomes this limitation by providing visualisation of muscular activity and enabling the development of correct motor patterns. The novelty of this study consists in its comprehensive approach, combining biophysiological, psycho-emotional, and functional correction. Unlike conventional techniques, the author’s protocol integrates personalised EMG parameters, adaptive feedback, and telemetric monitoring, thereby ensuring a sustained therapeutic effect and improving patients’ bodily self-perception. The object of the study is the functional state of the PFM in women exhibiting signs of hypotonia, stress urinary incontinence, and postpartum alterations. The subject of the study is the impact of biofeedback and EMG monitoring technologies on the restoration of pelvic muscle strength, endurance, and coordination. The aim is to assess the clinical and functional effectiveness of biofeedback-based rehabilitation in women with PFM dysfunctions and to identify the mechanisms by which it influences neuromuscular regulation and psycho-emotional wellbeing. Methods involved EMG analysis of pelvic muscle activity, training sessions using biofeedback devices, physiotherapeutic procedures, and structured patient questionnaires assessing subjective wellbeing and satisfaction with therapy. The study employed comparative and statistical analyses alongside real-time visual feedback monitoring. The results demonstrated a statistically significant increase in PFM strength and tone, improved voluntary control, and reduction of urinary incontinence symptoms after several weeks of therapy. EMG data revealed a rise in signal amplitude during voluntary contractions, confirming restoration of neuromuscular connectivity. Furthermore, participants reported higher self-esteem, reduced anxiety, and enhanced sexual wellbeing, underscoring the multidimensional therapeutic benefits of BFB training. The author concludes that biofeedback therapy is an effective tool not only for physical but also for psycho-emotional rehabilitation in women. This method activates intrinsic physiological resources, fostering conscious control over muscular responses. When combined with electromyostimulation and telemetric technologies, it opens new prospects for the prevention and treatment of urogenital dysfunctions. The findings confirm that BFB therapy provides long-term stabilisation of PFM function, improves quality of life, and can be regarded as a foundational technology in women’s health programmes, sports physiotherapy, and postnatal rehabilitation. The proposed model successfully integrates medical precision, neurophysiological validity, and a humanistic approach centred on patients’ active participation in their recovery process.
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Abreu, D. L. de, Rodriguez, P. T. V., Amaral Corrêa, L., Lacombe, A. D. C., Andreotti, D., & Nogueira, L. A. C. (2019). The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain. European Journal of Physiotherapy, 21, 2–7.
Al-Shukri, S. Kh., Ananiy, I. A., Amdiy, R. E., & Kuzmindr, I. V. (2016). Electrical stimulation of pelvic floor muscles in the treatment of patients with urinary incontinence after radical prostatectomy. Urological Bulletin, 4, 10–13. (In Russ.). [Аль-Шукри С. Х., Ананий И. А., Амдий Р. Э., Кузьминдр И. В. Электростимуляция мышц тазового дна в лечении больных с недержанием мочи после радикальной простатэктомии // Урологические ведомости. — 2016. — № 4. — С. 10–13.]. https://doi.org/10.17816/uroved6410-13
Alzahrani, A., & Ullah, A. (2024). Advanced biomechanical analytics: Wearable technologies for precision health monitoring in sports performance. Sensors, 10, 20552076241256745. https://doi.org/10.1177/20552076241256745
Barba, M. M., Cola, A., De Vicari, D., Costa, C., La Greca, G., Vigna, A., Volontè, S., Frigerio, M., Terzoni, S., & Maruccia, S. (2024). Changes in pelvic floor ultrasonographic features after flat magnetic stimulation in women with chronic pelvic pain and levator ani muscle hypertonicity. Medicina, 60(3), 374. https://doi.org/10.3390/medicina60030374
Basmajian, J. V., & De Luca, C. J. (1985). Muscles alive: Their functions revealed by electromyography. Baltimore: Williams & Wilkins.
Cacciari, L. P., Pássaro, A. C., Amorim, A. C., Geuder, M., & Sacco, I. C. N. (2017). Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal. Journal of Biomechanics, 58, 139–146. https://doi.org/10.1016/j.jbiomech.2017.04.035
Carvalho, N., & Reis, M. (2022). El papel de la fisioterapia deportiva en atletas de edad avanzada: Una revisión de la literatura. Revista Científica Multidisciplinar Núcleo do Conhecimento, 5(2), 113–126. https://doi.org/10.32749/nucleodoconhecimento.com.br/salud/fisioterapia-deportiva
Chemidronov, S. N., Suvorova, G. N., & Kolsanov, A. V. (2023). The effect of physical exercise on the pelvic floor and perineal muscles: Basic hypotheses and statements. Man and His Health, 26(3), 44–57. (In Russ.). [Чемидронов С. Н., Суворова Г. Н., Колсанов А. В. Влияние физических упражнений на мышцы тазового дна и промежности. Основные гипотезы и утверждения.] https://doi.org/10.21626/vestnik/2023-3/06
Constantinou, C. E., & Omata, S. (2007a). Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions. Neurourology and Urodynamics, 26, 386–391. https://doi.org/10.1002/nau.20263
Constantinou, C. E., Omata, S., Yoshimura, Y., & Peng, Q. (2007b). Evaluation of the dynamic responses of female pelvic floor using a novel vaginal probe. Annals of the New York Academy of Sciences, 1101, 297–315. https://doi.org/10.1196/annals.1389.020
Curillo-Aguirre, C. A., & Gea-Izquierdo, E. (2023). Effectiveness of pelvic floor muscle training on quality of life in women with urinary incontinence: A systematic review and meta-analysis. Medicina, 59(6), 1004. https://doi.org/10.3390/medicina59061004
Djivoh, Y. S., & De Jaeger, D. (2023). Intra-abdominal and perineal pressures during abdominal exercises: A cross-sectional study in postpartum women. Neurourology and Urodynamics, 42, 205–212. https://doi.org/10.1002/nau.25069
Dornowski, M., Sawicki, P., Vereshchaka, I., Piernicka, M., Błudnicka, M., Worska, A., & Szumilewicz, A. (2018). Training-related changes of EMG activity of the pelvic floor muscles in women with urinary incontinence problems. Neurophysiology, 50, 215–221. https://doi.org/10.1007/s11062-018-9740-4
El-Hamamsy, D., Watson, A., Corden, J., Smith, A. R. B., & Reidet, F. M. (2021). An assessment of techniques and practices used to elevate intra-abdominal pressure when assessing pelvic floor dysfunction. Neurourology and Urodynamics, 40, 783–790. https://doi.org/10.1002/nau.24617
Fukuda, F. S., Arbieto, E. R. M., Da Roza, T., & da Luz, S. C. T. (2023). Pelvic floor muscle training in women practicing high-impact sports: A systematic review. International Journal of Sports Medicine, 44(6), 397–405. https://doi.org/10.1055/a-1939-4798
Grimes, W. R., & Stratton, M. (2025). Pelvic floor dysfunction. Treasure Island: StatPearls Publishing.
Hao, J., Yao, Z., Remis, A., Huang, B., Li, Y., & Yu, X. (2024). Pelvic floor muscle training in telerehabilitation: A systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 309(5), 1753–1764. https://doi.org/10.1007/s00404-024-07380-x
Hay-Smith, E., Starzec-Proserpio, M., Moller, B., Aldabe, D., Pazzoto Cacciari, L., Pitangui, A., Vesentini, G., Woodley, S., Dumoulin, C., Frawley, H., Jorge, C., Morin, M., Wallace, S., & Weatherall, M. (2024). Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 12, CD009508. https://doi.org/10.1002/14651858.CD009508.pub2
Hay-Smith, E. J., Bø, K., Berghmans, B., Hendriks, E., de Bie, R., & van Waalwijk van Doorn, E. (2008). Pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 3, CD001407. https://doi.org/10.1002/14651858.CD001407
Horng, H.-C., Chao, W.-T., Chen, J.-F., Chang, C.-P., Wang, P.-H., & Chang, P.-L. (2022). Home-based noninvasive pelvic floor muscle training device to assist women in performing Kegel exercise in the management of stress urinary incontinence. Journal of the Chinese Medical Association, 85, 484–490. https://doi.org/10.1097/JCMA.0000000000000660
Hsu, Y., Hitchcock, R., Niederauer, S., Nygaard, I. E., Shaw, J. M., & Sheng, X. (2018). Variables affecting intra-abdominal pressure during lifting in the early postpartum period. Female Pelvic Medicine & Reconstructive Surgery, 24, 287–291. https://doi.org/10.1097/SPV.0000000000000462
Huber, J., Hochleitner, M., Kowarik, M. C., Sutter, S., Goecke, T. W., & Friese, K. (2020). Biofeedback devices for training pelvic floor muscles in the treatment of urinary incontinence in women. Medicina, 56(10), 477. https://doi.org/10.3390/medicina61030477
Jozwik, M., Jóźwik, M., Adamkiewicz, M., & Szymanowski, P. (2013). An updated overview on the anatomy and function of the female pelvic floor, with emphasis on the effect of vaginal delivery. Medycyna Wieku Rozwojowego, 17, 18–30.
Kolgaeva, D. I. (2020). Development and justification of a comprehensive programme of conservative treatment of stress urinary incontinence in women using electrical stimulation and biofeedback [Doctoral dissertation, Central State Medical Academy]. (In Russ.). [Колгаева Д. И. Разработка и обоснование комплексной программы консервативного лечения стрессового недержания мочи у женщин с использованием электростимуляции и биологической обратной связи.]. https://www.sechenov.ru/upload/iblock/586/Dissertatsiya-Kolgaevoy-D.I..pdf
Krutova, V. A., Shefer, V. V., & Nadtochiy, A. V. (2017). Topical issues of urogynecology: Pelvic floor muscle rehabilitation system. A teaching manual for residents and practitioners. Kuban State Medical University. (In Russ.). [Крутова В. А., Шефер В. В., Надточийи А. В. Актуальные вопросы урогинекологии. Система реабилитации мышц тазового дна: учебно-методическое пособие для ординаторов и практических врачей.]. https://bagk-med.ru/personal/pdf/Posobiya/UROSTYM.pdf
Kuroda, Y., Young, M., Shoman, H., Punnoose, A., Norrish, A. R., & Khanduja, V. (2021). Advanced rehabilitation technology in orthopaedics: A narrative review. International Orthopaedics (SICOT), 45, 1933–1940. https://doi.org/10.1007/s00264-020-04814-4
Lee, H. N., Lee, S. Y., Lee, Y.-S., Han, J.-Y., Choo, M.-S., & Lee, K.-S. (2013). Pelvic floor muscle training using an extracorporeal biofeedback device for female stress urinary incontinence. International Urogynecology Journal, 24, 831–838. https://doi.org/10.1007/s00192-012-1943-4
Leonov, S. V. (2012). Experiencing sports injury. National Psychological Journal, 2, 136–143. (In Russ.). [Леонов С. В. Переживание спортивной травмы // Национальный психологический журнал. — 2012. — № 2. — С. 136-143.]. https://msupsyj.ru/articles/detail.php?article=2676
Madokoro, S., & Miaki, H. (2019). Relationship between transversus abdominis muscle thickness and urinary incontinence in females at 2 months postpartum. Journal of Physical Therapy Science, 31(1), 108–111. https://doi.org/10.1589/jpts.31.108
Marchenko, N. V., Demyanenko, S. A., & Kirichenko, V. N. (2016). Comparative analysis of physiotherapeutic methods for preoperative prevention of early complications of dental implantation. Russian Dental Journal, 4, 14–17. (In Russ.). [Марченко Н. В., Демьяненко С. А., Кириченко В. Н. Сравнительный анализ физиотерапевтических методов дооперационной профилактики ранних осложнений зубной имплантации.]. https://rucont.ru/efd/428042
New discoveries in sports massage and physiotherapy. (2024). Runway Auto. (In Russ.). [Новые открытия в спортивном массаже и физиотерапии // Runway Auto. — 2024.]. https://runway-auto.ru/trenirovki-i-zdorove/vosstanovlenie-posle-nagruzo k-novye-otkrytija-v-sportivnom-massazhe-i-fizioterapii/
Omata, S., Yamaguchi, O., Yoshimura, Y., & Constantinou, C. E. (2003). Novel directionally sensitive sensor probe for the clinical evaluation of the pelvic floor biomechanics. Proceedings of IEEE EMBS Asian-Pacific Conference of Biomedical Engineering, 278–279. https://doi.org/10.1109/APBME.2003.1302692
Parkinson, L. A., Rosamilia, A., Mukherjee, S., Papageorgiou, A. W., Melendez-Munoz, J., Werkmeister, J. A., Gargett, C. E., & Arkwright, J. W. (2019). A fiber-optic sensor-based device for the measurement of vaginal integrity in women. Neurourology and Urodynamics, 38, 2264–2272. https://doi.org/10.1002/nau.24130
Peng, Q., Jones, R., Shishido, K., Omata, S., & Constantinou, C. E. (2007). Spatial distribution of vaginal closure pressures of continent and stress urinary incontinent women. Physiological Measurement, 28, 1429–1450. https://doi.org/10.1088/0967-3334/28/11/009
Raalte, H. van, & Egorov, V. (2015). Tactile imaging markers to characterize female pelvic floor conditions. Obstetrics and Gynecology, 5, 505–515. https://doi.org/10.4236/ojog.2015.59073
Rachin, S. A., Sharov, M. N., Zaitsev, A. V., Tynterova, A. M., Nuvakhova, M. B., Prokofieva, Yu. S., Parsamyan, R. R., Maksimova, M. Yu., & Rachin, A. P. (2020). Chronic pelvic pain: From accurate diagnosis to adequate therapy. Neurology, Neuropsychiatry, Psychosomatics, 12(2), 12–16. (In Russ.). [Рачин С.А., Шаров М.Н., Зайцев А.В., Тынтерова А. М., Нувахова М. Б., Прокофьева Ю. С., Парсамян Р. Р., Максимова М. Ю., Рачин А. П. Хроническая тазовая боль: от правильной диагностики к адекватной терапии.]. https://nnp.ima-press.net/nnp/article/download/1298/1019
Rosenbluth, E. M., Johnson, P. J., Hitchcock, R. W., & Nygaard, I. E. (2010). Development and testing of a vaginal pressure sensor to measure intra-abdominal pressure in women. Neurourology and Urodynamics, 29, 532–535. https://doi.org/10.1002/nau.20794
Samsonova, I., Gaifulin, R., Toktar, L., Orazov, M., Kamarova, Z., Li, K., & Pak, V. (2023). Pelvic floor muscle training as a method of prevention and treatment of pelvic floor dysfunction and genital prolapse. RUDN Journal of Medicine, 27, 39–45. https://doi.org/10.22363/2313-0245-2023-27-1-39-45
Serov, V. N., Apolikhina, I. A., Kubitskaya, Yu. V., & Zheleznyakova, A. I. (2022). Electrical stimulation of pelvic floor muscles in the treatment of urinary incontinence in women. Current Research in Gynaecology, 7(2), 51–55. (In Russ.). [Серов В. Н., Аполихина И. А., Кубицкая Ю. В., Железнякова А. И. Электростимуляция мышц тазового дна в лечении недержания мочи у женщин.]. https://aig-journal.ru/articles/Elektrostimulyaciya-myshc-tazovogo-dna-v-lechenii-nederjaniya-mochi-u-jenshin.html
Shashkova, T. S., & Batueva, A. E. (2021). The effect of strength loads on the pelvic floor muscles of female weightlifters: A literature review. Human. Sport. Medicine, 21(S2), 14–20. (In Russ.). [Шашкова Т. С., Батуева, А. Э. Влияние силовых нагрузок на мышцы тазового дна женщин-тяжелоатлеток (обзор литературы).]. https://doi.org/10.14529/hsm21s202
Tan-Kim, J., Weinstein, J. M., & Nager, C. (2010). Urethral sleeve sensor: A non-withdrawal method to measure maximum urethral pressure. International Urogynecology Journal, 21(6), 685–691. https://doi.org/10.1007/s00192-009-1084-6
Tian, T., Budgett, S., Smalldridge, J., Hayward, L., Stinear, J., & Kruger, J. (2018). Assessing exercises recommended for women at risk of pelvic floor disorders using multivariate statistical techniques. International Urogynecology Journal, 29, 1447–1454. https://doi.org/10.1007/s00192-017-3473-6
Tibaek, S., & Dehlendorff, C. (2013). Pelvic floor muscle function in women with pelvic floor dysfunction. International Urogynecology Journal, 25, 663–669. https://doi.org/10.1007/s00192-013-2277-6
Unanyan, N. N., & Belov, A. A. (2019). Signal-based approach to EMG-sensor fault detection in upper limb prosthetics. Proceedings of the 20th International Carpathian Control Conference (ICCC), 1–6. https://doi.org/10.1109/CarpathianCC.2019.8765960
Zhu, M., Huang, F., Xu, J., Zhou, Q., Ding, B., & Shen, Y. (2024). Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome. Medicina, 19(1), 20240936. https://doi.org/10.1515/med-2024-0936
Zhumanova, Z. Yu. (2023). The effect of complex rehabilitation therapy using fractional microablative CO₂ laser and electromyostimulation on pelvic floor muscle function in women after surgery. Siberian Medical Journal. (In Russ.). [Жуманова З. Ю. Влияние комплексной реабилитационной терапии с использованием фракционной микроаблятивной терапии СО2 лазером и электромиостимуляции на функцию мышц тазового дна у женщин после операций.]
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