**4. To show the bladder neck mobility**

Figures below show transvaginal ultrasound from bladder neck during rest and effort phases, before and after treatment with EMG BF. Figures 1 and 2 : ultrasound before treatment. Figures 3 and 4: ultrasuond post- treatment.

Fig. 1. Rest Fig. 2. Effort Fig. 3. Rest Fig. 4. Effort

HDUVJ: Horizontal Distance from Urethrovesical Junction; PUD: Pubo-Urethral Distance; UVJ: Urethrovesical Junction; VDUVJ: Vertical Distance from Urethrovesical Junction.

The EMG test presented a statistically significant difference (p= 0.0068) between the groups; Gbio (15.28 ±8.52 µV) presented higher levels of PF motor activity than Gc (9.40 ±5.99 µV).

Effects of Pelvic Floor Muscle Training with

inversion, with Gbio (8%) exceeding Gc (0%).

that BF can restore PF neuromuscular function.

groups.

**5. Discussion** 

women treated.

both studies was different.

statistically relevant improvement.

(28%), "moderate" (56%) and "severe" (16%) intensities for Gc.

Biofeedback in Women with Stress Urinary Incontinence 65

Regarding urinary frequency (p = 0.0337\*), Gbio presented lower percentages in the "low" (32%) and "moderate" (24%) categories, versus 56% "low" and 36% "moderate" for Gc. However, the "severe" category presented an inversion, with Gbio (8%) exceeding Gc (0%). Nocturia was statistically significantly different (p = 0.0261) between the groups, Gbio presented lower percentages in the "low" (40%) and "moderate" (8%) categories, versus 52% "low" and 32% "moderate" for Gc. However, the "severe" category presented an

When we analyze SUI results, we observe a statistically significant improvement (p<0.0001) in the "low" (52%) and "moderate" (4%) and "severe" (0%) intensities in Gbio, versus "low"

The other symptoms did not present any statistically significant difference between the

The results of this study indicate that the training of pelvic floor muscles through EMG BF can lead to changes in the anatomic and functional structures of PF, since there were statistically significant differences in all the assessed characteristics of the incontinent

When compared to healthy women, decrease of surface electromyographic activity in women with SUI, urgency incontinence and mixed incontinence has been found, which suggests a deterioration of the neuromuscular function in these women24. In this study, we observed that the quantification of muscular activity carried out through the EMG test showed statistically significant increase (p = 0.0068) after treatment in Gbio, which suggests

In this study, compared to Gc, PFM strength presented a statistically significant change (p = 0.0009) after BF treatment. However, we did not objectively quantify the SUI reduction. In a study of 52 women, aged from 24 to 64 (mean 45.4 years) suffering from SUI, a positive correlation between the increase in PFM maximum strength and the reduction in urine loss during stress was demonstrated 25, and in another study by Rett at al26, who included a sample of 26 women with SUI a significant improvement in pelvic floor muscular strength, from 0 (zero) or 1 (one) to 2 (two) or 3 (three) was seen. Yet, the profile of the patients in

Regarding the thickness of the levator ani muscle, Bernstein27 demonstrated through transabdominal ultrasonography a significant reduction in the thickness of the levator ani muscle in women over 60 compared to that of younger women. According to this author, the levator ani muscle was significantly thicker in healthier women than in those with urinary incontinence and this problem can be eliminated through physical therapy, as corroborated by this study, which showed a statistically significant increase in the thickness of the levator ani muscle in Gbio (p = 0.0044), but not in Gc, which did not have any

The investigation of the effectiveness of ultrasound in assessing bladder neck descent in the SUI diagnosis still presents contradictory results and unclear responses. Urethral

The assessment of pelvic floor muscular strength showed a statistically significant difference (p = 0.0009): Gbio (mean = 4) was higher than Gc (mean = 3).

In Gbio the levator ani muscle thickness (13.27 ±2.12 mm) was statistically significant bigger compared to Gc (11.66 ±1.65 mm) (p= 0.0044).

Bladder neck mobility was statistically significant less in the Gbio group (9.26 ±3.01 mm) than in Gc (17.67 ±4.53 mm) (p = 0.0044\*).

The intergroup KHQ analysis showed significant differences in 5 domains. In the impact on life domain (p = 0.0305), Gbio (mean = 33.3%) presented lower levels compared to Gc (mean = 50%); in the role limitations domain, there was a significant improvement (p = 0.0099) in Gbio (mean = 0.0%), but not in Gc (mean = 33.3%); in the physical limitations domain, the result was statistically significant (p = 0.0010), since Gbio (mean = 0.0%) showed fewer limitations than Gc (mean 33.33%); in the personal relationships domain (p = 0.0426), the mean for both groups was the same (0.0%), but no Gbio individual had scores higher than 50%; and in the severity (coping) measures, there was also a significant difference (p = 0.0021), with a mean of 6.6% in Gbio, versus a mean of 26.7% in Gc.

On the other hand, general health, social limitations, emotions and sleep/energy did not show a statistically significant difference between groups after treatment.


Comparison between groups of KHQ urinary scale symptoms (Table 3) shows that urinary frequency, nocturia and SUI were statistically significantly different after intervention

\*Chi-square

NRA: omitted response

Table 3. Urinary symptoms in Gc (n=25) and Gbio (n=25) after intervention.

Regarding urinary frequency (p = 0.0337\*), Gbio presented lower percentages in the "low" (32%) and "moderate" (24%) categories, versus 56% "low" and 36% "moderate" for Gc. However, the "severe" category presented an inversion, with Gbio (8%) exceeding Gc (0%).

Nocturia was statistically significantly different (p = 0.0261) between the groups, Gbio presented lower percentages in the "low" (40%) and "moderate" (8%) categories, versus 52% "low" and 32% "moderate" for Gc. However, the "severe" category presented an inversion, with Gbio (8%) exceeding Gc (0%).

When we analyze SUI results, we observe a statistically significant improvement (p<0.0001) in the "low" (52%) and "moderate" (4%) and "severe" (0%) intensities in Gbio, versus "low" (28%), "moderate" (56%) and "severe" (16%) intensities for Gc.

The other symptoms did not present any statistically significant difference between the groups.
