Date of Award

Spring 2020

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Fox, Robert

Second Advisor

Taft, Thomas

Third Advisor

Czech, Donald


Urinary and fecal incontinence are problems which can significantly reduce the quality of life of many people and place a considerable burden on health care resources. Millions of people experience incontinence but a larger proportion are women. Incontinence is often caused by partial pelvic floor muscle (PFM) denervation that occurs with childbirth and/or chronic straining with stool. Therefore, many women have complaints of both urinary and fecal incontinence. Biofeedback treatment is a conservative therapy that is recommended for the treatment of incontinence before more invasive procedures are used. However, the mechanism by which biofeedback reduces incontinence remains ambiguous because physiological outcomes measures are generally not reported. Because biofeedback protocols are not based upon empirical findings, there are no standards for biofeedback procedures that are used clinically. The goals of this study were to determine: (a) how biofeedback measures of PFM function differ between incontinent and asymptomatic women; (b) to what degree do electromyographic (EMG) measures of PFM and abdominal muscle change as a result of a single biofeedback session; (c) to what degree are surface measures, of EMG in the proximal and distal regions of the anal canal, valid indices of pressure as measured in the same regions of the canal, respectively; and (d) to what degree is the surface measure of abdominal EMG a valid index of intra-abdominal pressure as measured by a rectal balloon. This study compared EMG measures from abdominal muscle and three PFM sites, obtained from 30 asymptomatic and 19 incontinent women, before and after a biofeedback procedure. Biofeedback was found to be effective in teaching the women to decrease counterproductive abdominal muscle activity during PFM contraction. However, PFM activity was also found to decrease. This study also demonstrated support for the validity of the EMG measures as indices of PFM function when compared to criterial measures of pressure. Moreover, the EMG measures were found to be reliable in a test-retest evaluation. All measures of PFM function were found to differ in asymptomatic women compared to incontinent women. These findings have implications for further research and clinical work.



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