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Biofeedback: A Practitioner's Guide

By Mark S. Schwartz; Frank Andrasik | Go to book overview

CHAPTER 28
The Use of Biofeedback
for Pelvic Floor Disorders
Associated with a Failure
to Relax

JEANNETTE TRIES

EUGENE EISMAN

To a considerable degree, the pelvic floor muscles (PFMs) mediate bowel, bladder, and sexual activity. In Chapters 26 and 27, we have discussed the role of the PFMs in preserving continence. The biofeedback techniques described in those chapters improve continence mainly by improving PFM coordination and strength. However, disruption of PFM function can lead to symptoms other than incontinence, which is narrowly defined as the unwanted loss of urine or stool. This chapter is intended to outline some biofeedback applications for PFM dysfunction other than those directed toward improving strength. However, the reader should understand that more often than not, disorders of PFM function overlap. Undoubtedly, techniques discussed in this chapter will be used with those outlined in Chapters 26 and 27, when therapists treat incontinent patients. Conversely, therapists treating disorders discussed in this chapter will also use the PFM strengthening techniques outlined in the previous chapters.


A REVIEW OF PELVIC FLOOR ANATOMY

We begin with a brief review of pelvic floor anatomy (largely in women, since the great majority of patients treated for the disorders described in this chapter are female). In the earlier chapters, we have defined the PFMs as a group of muscles that span the inferior, or underlying, surface of the bony pelvis. The PFMs include the deeper muscular body of the levator ani, which is pierced by the urethra, the anal canal, and the vagina, and gives off fibers that interdigitate with the muscular and fascial fibers surrounding each orifice and its associated organ structure (i.e., the bladder neck and distal portion of the rectum). Peripheral to the levator ani is the diamond-shaped perineum, which can be divided into two triangular parts by a line between the ischial tuberosities. The divisions of the perineum are called the urogenital diaphragm, located anteriorly, and the anal triangle, which is posterior to the ischial tuberosi

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