Biofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome

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 dail y voiding logs, American Urological Association (AUA) symptom score, and 10 -point visual analog pain and urgency scores. Pressure-flow studies were ob tained before treatment in most patients. Instruction in pelvic floor muscl e contraction and relaxation was achieved using a noninvasive form of biofe edback at biweekly sessions. Home exercises were combined with a progressiv e increase in timed-voiding intervals. Results. Mean age of the 19 patients was 36 years (range 18 to 67). Four pa tients completed less than th ree treatment sessions, 5 patients completed three to five sessions, and 10 attended all six sessions. Mean follow-up wa s 5.8 months. Median AUA symptom scores improved from 15.0 to 7.5 (P = 0.00 1), 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 score s 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 pre treatment urodynamic studies was not predictive of treatment results. Conclusions. This preliminary study confirms that a formalized program of n euromuscular re-education of the pelvic floor muscles together with interva l bladder training can provide significant and durable improvement in objec tive measures of pain, urgency, and frequency in patients with CPPS. UROLOG Y 56: 951-955, 2000. (C) 2000, Elsevier Science Inc.