Elsevier

Urology

Volume 56, Issue 6, December 2000, Pages 951-955
Urology

Adult urology: CME article
Biofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome

https://doi.org/10.1016/S0090-4295(00)00796-2Get rights and content

Abstract

Objectives. Pelvic floor tension myalgia may contribute to the symptoms of male patients with chronic pelvic pain syndrome (CPPS). Therefore, measures that diminish pelvic floor muscle spasm may improve these symptoms. Based on this hypothesis, we enrolled 19 patients with CPPS in a 12-week program of biofeedback-directed pelvic floor re-education and bladder training.

Methods. Pre-treatment and post-treatment symptom assessments included daily voiding logs, American Urological Association (AUA) symptom score, and 10-point visual analog pain and urgency scores. Pressure-flow studies were obtained before treatment in most patients. Instruction in pelvic floor muscle contraction and relaxation was achieved using a noninvasive form of biofeedback at biweekly sessions. Home exercises were combined with a progressive increase in timed-voiding intervals.

Results. Mean age of the 19 patients was 36 years (range 18 to 67). Four patients completed less than three treatment sessions, 5 patients completed three to five sessions, and 10 attended all six sessions. Mean follow-up was 5.8 months. Median AUA symptom scores improved from 15.0 to 7.5 (P = 0.001), and median bother scores decreased from 5.0 to 2.0 (P = 0.001). Median pain scores decreased from 5.0 to 1.0 (P = 0.001), and median urgency scores decreased from 5.0 to 2.0 (P = 0.002). Median voiding interval increased from 0.88 hours to 3.0 hours (P = 0.003). Presence of detrusor instability, hypersensitivity to filling, or bladder-sphincter pseudodyssynergia on pretreatment urodynamic studies was not predictive of treatment results.

Conclusions. This preliminary study confirms that a formalized program of neuromuscular re-education of the pelvic floor muscles together with interval bladder training can provide significant and durable improvement in objective measures of pain, urgency, and frequency in patients with CPPS.

Section snippets

Material and methods

Between July 1995 and July 1998, 19 patients were treated with the biofeedback regimen described below. Mean age was 38 years (range 18 to 67). All patients were diagnosed with nonbacterial CPPS based on the presence of symptoms with a negative expressed prostatic fluid (EPF) or VB3 urine culture. Symptoms included pain (perineal, testicular, suprapubic, scrotal, ejaculatory, abdominal) and voiding complaints (frequency, urgency, nocturia, decreased force of stream, hesitancy, sense of

Results

Fourteen of the 19 patients underwent pretreatment urodynamics in our laboratory. Five exhibited detrusor instability (DI) and an additional 4 had diminished bladder capacity. No patients were obstructed based on Abrams-Griffiths criteria,8 but 6 patients demonstrated dysfunctional voiding as evidenced by incomplete relaxation of the external urethral sphincter with voiding (pseudodyssynergia). Despite these findings, no postvoid residual urine volume was more than 60 mL. Three patients had a

Comment

The connection between pelvic pain and voiding dysfunction is poorly understood. In a recent study of 103 men with pelvic pain, Zermann et al.9 found pathologic tenderness of the pelvic floor muscles associated with the inability to contract and relax the pelvic floor muscles in 88%. Urodynamic testing on 84 of these men demonstrated abnormal pelvic floor function, including increased urethral sensitivity and tonicity, and pseudodyssynergia during attempted voiding. They hypothesized that

Conclusions

At 6 months’ follow-up, a structured program of biofeedback-assisted pelvic floor exercises and timed voiding resulted in significant improvement in voiding symptoms and pain in a group of men with CPPS refractory to other treatments. Measurable effects were seen following as few as two treatments. Our results suggest that this treatment approach may benefit CPPS patients with dysfunctional voiding, detrusor instability, and/or chronic pelvic pain. The long-term durability of these outcomes is

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