Beneficial Factors of Biofeedback Therapy in Incontinent Adults

1.0 Background

1.1 Description of the Problem

Urinary incontinence refers to the involuntary leakage of urine by individuals. It is simply referred to as the loss of bladder control, and the severity of the problem varies as some people can pass urine when they cough or sneeze or have sudden incidences of the urge to urinate that they do not get to the toilet. According to Nordqvist (2016), the problem is more common among women than among men. Nordqvist (2016) specifically points to the findings of the American Urological Association, which established that at least 30% of women aged 30 to 60 years tend to suffer from urinary incontinence compared to 1.5 to 5% of men. Some of the key risk factors that effectively explain the etiology of the condition among the individuals include smoking habits, gender where women have a higher chance of suffering from it, and obesity where obese people tend to be at more risk of the condition. Other vital risk factors that characterize the condition include prostate disease, old age, and some other diseases among the individuals, including diabetes and neurologic diseases.

Among the leading causes of urinary incontinence, the Mayo Clinic Staff (2017) identifies several causes, including pregnancy, menopause, the labor experienced during childbirth, age, obesity, some surgical procedures, and hysterectomy. The key symptom that is attributed to urinary incontinence is the involuntary leakage of urine, but the condition tends to manifest itself in different forms. One of the forms that it manifests itself includes stress incontinence where actions, such as sneezing and laughing, could trigger the leakage of urine. Additionally, the problem manifests itself in the form of overflow incontinence, urge incontinence, functional incontinence, and gross total incontinence. All these situations are characterized by the involuntary leakage of urine. With the prevalence of the condition, some of the key approaches to treatment that have been adopted in ensuring that urinary incontinency is handled effectively include bladder training, use of medications, such as anticholinergics, use of medical devices, such as urethral inserts, as well as surgery involving such elements as sling procedures.

1.2 Impact on Health

The impact of urinary incontinency on the health of adults is undesirable. The undesirable physical consequences that come with the condition include increased incidences of frailty among older adults. Because of the ease of passing urine, the skin tends to easily get in touch with the urine, hence aggravating the risk of other additional conditions, including dermatitis, itching, fungus, and even pressure ulcers (Chughtai, Lee, Sandhu, Te, & Kaplan, 2013). This is a reflection of the overall decline in the health wellbeing of the individuals. It leads to other additional diseases that negatively affect the overall health of older adults, hence increasing incidences of hospitalizations.

However, the biggest impact on health is seen in terms of the depression that it puts patients in. Among incontinent patients, the incidences of depression and anxiety are high because of the embarrassment that they face and the tendency of the rest of the population to isolate them. Dealing with the challenges of involuntary urine leakage ensures that those suffering from the disease have a negative view of their overall health status and a feeling of isolation besides the loss of interest in any other activity within the community (Ghaderi & Oskouei, 2014). Depression is negative to the health of these individuals because it weighs them down to the extent where they choose to stay away from other people because of the feelings of rejection.

1.3 Relevance to Nursing

The relevance of the problem of urinary incontinence to nurses begins at the assessment level. The relevance here is that nurses have to take into consideration the history of the patient to determine the underlying causes, including aspects, such as the sex of the patient, habits such as smoking, age, and even pregnancy history. It is only through reliable and effective assessments that nurses are able to get the correct way of ensuring that the problem is addressed in the best ways possible while aiming at improving the quality of life of the individual (Padilla-Fernandez, et al., 2013). It is significant that nurses get the correct picture of the condition for proper administration of the perceived care and potential treatments for the patients.

More so, the problem is of relevance to nursing in respect to its management. Nurses are in charge of ensuring that the patients suffering from urinal incontinency are managed in the most appropriate way possible that would ultimately boost outcomes (Dass, Lo, Khanuengkitkong, & Tan, 2013). One of the key aspects of the management includes behavioral interventions, such as toileting assistance for the patients with the inclusion of practices, such as timed voiding. More so, the significance to nursing is seen in terms of the nurses directly being involved in practices, such as bladder training of the patients for the improvement of their health and realization of the set outcomes.

2.0 Aim and Purpose of the Review and PICO Question

2.1 Aim

The aim of the review is to efficiently address the problem of urinal incontinency, which has become more prevalent among adults, especially women, hence impacting the quality of their living. This means that the project is aimed at evaluating the effectiveness of biofeedback therapy in boosting the treatment of urinary incontinence, hence improving the quality of life for these individuals (Starr, Drobnis, & Cornelius, 2016). The aim stems from the understanding that biofeedback has been confirmed to be effective in ensuring that the condition is treated in the best ways possible. It is of great significance because it plays an assistive role in boosting the ability of women to learn how to regulate and strengthen the pelvic floor muscles. It is critical to note that the pelvic floor muscles comprise muscles that are critical in facilitating the control of the bladder, and biofeedback ensures that they are strengthened to avoid the instances of involuntary urine leakage (Nordqvist, 2016). Thus, the aim is to ensure that the approach is employed in ensuring that the frequency of urine leakage is mitigated and the quality of life is improved.

2.2 Purpose

With the above aim, the review is purposed at achieving three key outcomes. First, the review is purposed at stress reduction among the patients suffering from urinary incontinency. As aforementioned, the patients who suffer from urinary incontinency face the incidences of low self-esteem because of the embarrassing situations that they have to deal with while handling the regular and involuntary leakage of urine (Hersh & Salzman, 2013). The review is purposed at employing the use of biofeedback to ensure that these patients do not suffer from the extreme stress levels that have made most of them lead isolated lives because of the feeling of being undesirable in the societal context (Dass, Lo, Khanuengkitkong, & Tan, 2013). In the overall sense, this purpose will be critical in returning some confidence to the patients and ensuring that they have more stable thoughts about their conditions and value as other people in the society.
More so, the review is purposed at further disease prevention. More so, it was identified that frequent urine leakage can lead to other additional diseases, including dermatitis and skin diseases because of the frequent urine leakages to the skin. Since additional diseases mean increased costs of treatment on the part of the patient, this problem should be addressed appropriately (Ghaderi & Oskouei, 2014). The purpose is to ensure that biofeedback is employed and the regularity of urine leakage is addressed for the attainment of better results. It is important to help the patients avoid situations where they have to deal with more than one disease. The occurrence of other diseases must be carefully handled because they have the capacity to have more negative impacts on the esteem of the patients, which could be detrimental.

Last but not least, the project is purposed at enhancing the wellbeing of the individuals, as well as allowing them to get back to their healthy state of homeostasis. Patients suffering from urinary incontinency face an overall decline in their wellbeing and unstable performance of normal functions within their physical processes (Ghaderi & Oskouei, 2014). The review is purposed at suggesting the appropriate strategy that would ensure the condition is effectively treated, hence boosting better healthy and improved body functioning among the patients. It is important that patients return to their normal living conditions as compared to the health impacts that they pose to the individuals, including stress and anxiety. This would go a long way into ensuring that patients live a more fulfilling life after the therapy and that they are in a better position to mingle with the rest of the society without having the feeling of being unwanted by others.

2.3 PICO Question

The PICO question that has been developed for this review is, For adults with urinary incontinence (P). Is the use of biofeedback therapy (I). Compared to no biofeedback therapy (C). Effective in decreasing the frequency of urinary incontinence improving the quality of life and decreasing depressive symptoms associated with urinary incontinence? (O). This question is vital in understanding the outcomes that would come to the individuals with the understanding of the application of biofeedback therapy as opposed to not using it in the treatment of adults suffering from urinary incontinency.

3.0 Methods

3.1 Selection Criteria

In the selection criteria, the most significant types of studies that were considered in the selection process included specifically peer-reviewed journal articles. The peer-reviewed journal articles must have focused on the specific intervention being explicated in the course of this study for them to be applied. The studies that were considered for this research ranged from peer-reviewed evidence-based journal articles explicating diverse aspects, including the diagnosis of the disease and clinical management. This would go a long way into ensuring that appropriate information is applied into the review.

Since urinary incontinency is more widely spread among women, the types of participants that were available in the studies were basically women. In most of these studies, the participants were divided into two key groups. The first group entailed those suffering from urinary incontinence and treated using biofeedback therapy, whereas the second one made up women suffering from urinary incontinence but not treated using the biofeedback approach. This was aimed at ensuring that the health outcomes of the two groups of participants were effectively compared. However, men were also considered in these studies.

From the selected studies, the key intervention that was utilized was primarily biofeedback therapy that was done within different time intervals during the week. The time intervals were those involving once a week therapy. Apart from biofeedback therapy, some of the key interventions that were featured in the studies selected for this review included behavior modification, pelvic muscle training, pharmacotherapy, and electromyography. The interventions play a critical role in ensuring that the embarrassment and stress that come with urinary incontinence is handled properly.

The primary result coming out of the interventions was the understanding that such approaches as biofeedback therapy played a vital role in boosting the strength of pelvic muscles, hence helping patients to be in a better position to deal with the incidences of urine pressure. However, secondary results indicated that the interventions should be used in combination in some instances where it was determined that biofeedback therapy would work better together with approaches, such as behavioral therapy or Kegel exercises.

In the selection criteria, the exclusion criteria entailed leaving out single case reports because of the understanding that they would not give a proper reflection of the effectiveness of diverse therapies that could be applied in the treatment of the patients with urinary incontinency. More so, the articles that did not effectively cover the biofeedback intervention in regard to its importance in treating the patients with urinary incontinency were excluded. This is because they did not match the study’s purpose of the application of biofeedback incontinency and the lack of its application to compare patients’ outcomes.

3.2 Search Strategy

The search strategy was clear from the beginning of the study. The strategy involved the review of various databases to ensure that more effective peer-reviewed journal articles were identified for the application into the study. PubMed was one of the key databases searched . The database was effective in terms of availing relevant articles with literature detailing urinary incontinency and the interventions that are available for its treatment. The preference of the database was based on the availability of many articles. Science Direct was the second database used for this research.

The richness of the database also played an instrumental role in ensuring that it was selected for use in this review. The other key databases used included Google Scholar, Medline, and CINAHL. The databases proved significant in ensuring that peer-reviewed journals with adequate data were acquired for the application into the study. They provided a good place to begin the research process and collect the desirable data that were used in the following study. In the course of the search, the language that was used included such keywords as biofeedback therapy, urinary incontinency, adults with urinary incontinency, and management of urinary incontinency. These keywords were vital in leading to the establishment of the key articles that were of great significance for this study. Each of these words gave a direction to the location of the articles that were subsequently utilized in the study. The English words were perceived critical to the location of the original peer-reviewed articles that were subsequently applied into the study. In the overall sense, the search strategy was quite vital in ensuring that the most recent articles were selected to be used in the study. Particularly, the aim was to use articles that were written from 2012 onwards with the view of keeping the review as recent as possible.

3.3 Study Selection

The studies were selected based on their thorough approach to the topic and the year of publication. This means that all the studies were selected based on their depth of research and the approach to research. This ensured that only studies that used a particular form of experimentation and the testing of the interventions were chosen to be used in the research. More so, the studies were selected based on their publication year, as mentioned earlier with the most current ones written from 2012 being the priority. I selected the articles myself because I needed the ones that I would feel comfortable using in the course of the study to attain the desired goals.

3.4 Methodological Quality Assessment

Studies become more relevant and reliable to any particular research in instances where they have a strong and relevant methodological appeal that is approved by reputable institutions. Medical studies need effective approval by reputable institutions in the field for them to be more applicable and reliable in informing the study. The Society of Urologic Nurses and Associates (SUNA) is one of the key institutions that reviewed the studies. The organization plays a critical role in the understanding of the urological conditions and effective treatment of conditions, such as urinary incontinence.

Another organization that reviewed the methodological aspect of the studies is the U.S. National Library of Medicine National Institute of Health. This organization is also critical in the evaluation of the effectiveness of studies and was vital for the ones used for this study. The third organization identified to have reviewed the articles selected is the American Academy of Family Physicians. The input of these organizations is quite vital in improving confidence in the available sources and weighing their significance in the study. The assessment checklists used for the studies selected included the use of focused questions that were answered through the experimentation approach. The other relevant checklists used included the assessment of heterogeneity among the studies applied to the literature review, the appreciation of internal validity, and the eligibility criteria for the study.

3.5 Data Extraction

Across most of the studies applied in this research, questionnaires were the primary form of data extraction from the participants in the studies. The studies began by conducting the therapies, including the biofeedback therapy on participants before employing questionnaires as a data collection instrument. The questionnaires were primarily used because they play a critical role in leading to the collection of larger samples of data. More so, the minimal time involved in the collection of data using questionnaires gave them an edge over other approaches to the collection of data across these articles. Apart from the questionnaires, a systematic review was also utilized to collect the data that was applied to the study. For the questionnaires, reliability was guaranteed by giving all the participants the standard questions that they needed to complete based on their conditions and outcomes from the therapies that they participated in. Answering similar questions was vital in promoting reliability as the researchers kept track of the outcomes in the course of the study. The questionnaires had to be validated before being applied to the collection of the desirable results, hence guaranteeing their effectiveness in the study.

3.6 Data Synthesis

Heterogeneity is concerned about the key differences that stand out in the studies that are used in the review. In regard to this research, the included studies were categorized based on the therapies used and the findings that were established by the respective researchers. For instance, they were categorized based on the use of the therapies such as the biofeedback therapy, bladder training, physiotherapy, pelvic floor muscle, and the functional electric stimulation. The categorization was critical in boosting the understanding of the different approaches that could be applied into the study and the explication of the selected intervention. Ultimately, the studies were assessed for clinical and methodological heterogeneity based on the findings that they presented. For the methodology, heterogeneity was identified at the point where different approaches were taken in the studies in terms of identification of the effective approach to the management of urinary incontinency. On clinical heterogeneity, the research compared and contrasted the structure of the interventions that were used in the studies and the manner in which they led to the realization of the set research goals.

4.0 Results

4.1 Search Results

As aforementioned, it is imperative to adopt a strategic and clear approach to the identification of the articles to be used in the study. The study retrieval and selection is demonstrated in the figure given below.

Biofeedback Therapy in Incontinent Adults

Figure 2 below demonstrates the history of searches in the study.

4.2 Methodological Quality

This section demonstrates the evaluation table given below in Table 1. The evaluation table presented the studies included and the respective authors, the conceptual framework used in the studies, the methodology, the sample, the key variables, measurement, data analysis, and the findings of these studies.

The synthesis table is demonstrated below. It indicates the level and quality of the evidence and the significance of the research. Table 2 below is the evidence table.

5.0 Types of Interventions

Biofeedback therapy is one of the key types of interventions that has been clearly brought out in the studies.. According to Dikstra-Eshuis et.al (2015) and Starr, Drobnis, and Cornelius (2016), biofeedback therapy is a vital intervention that alleviates pressure on the pelvic floor muscles by increasing the level of control and strength on them. Through biofeedback intervention, it is easier to exercise control on the muscles and ensure that the adults are not exposed to situations where they have to involuntarily pass the urine. In the views of Padilla-Fernandez (2013), biofeedback therapy accompanied by electromyography is utilized as the primary treatment for urinary incontinency. Biofeedback as a therapy is always successful in the instances where one instructor is left in the position of controlling and managing participants in all sessions. The instructor must also be friendly to the patients and the commitment of the participants is also a significant contributor to the success of the treatment process.

In the studies, other relevant interventions for the treatment of urinary incontinency are also articulated. For instance, Ghaderi and Oskouei (2014) reveal that the pelvic floor psychotherapy is also a vital intervention in the treatment of urinary incontinency among adults. As an intervention, the approach entails the improvement of the pelvic organ. It hypothesizes the view that the compression of the urethra by contracting the pelvic floor muscle helps in the prevention of the leakage of urine involuntarily. This gives patients a better opportunity to deal with the challenges that they have to face in the course of their lives as a result of struggling with the condition. The intervention is quite similar to the biofeedback theory in the sense that it works toward the mitigation of urine leakage. The advantage, in this case, is to give patients a better chance of living quality life that is stress-free. All the interventions, including behavior training and the Kegel exercises, are critical in boosting the ability of patients to have control over their urine at all given moments for better and successful living with other people within the society.

6.0 Effects of Interventions

One of the key effects of the interventions, especially biofeedback therapy, is that it improves the pelvic floor muscles of the patients, thus leading to better outcomes and improved quality of life. For instance, Dass, Lo, Khanuengkitkong, and Tan (2013) bring out the view that biofeedback as part of the therapy enhances the quality of life for patients because of the understanding that the pelvic floor muscles are trained to be more stable and stronger, hence not passing urine involuntarily. The same case is also reported for other therapies, including pharmacotherapy and electrical simulation, which have been explicated as being vital in improving the ability of the patients to cope with the stress of involuntary urination. According to Hersh and Salzman (2013), such therapies as the pharmacological treatments play a critical role in strengthening the bladder, hence ensuring that there is resistance to the involuntary passage of urine among the patients. Thus, the overall effect is that the therapies are vital in strengthening the bladder, hence leading to the improvement in the quality of life of the patients. They do not have to deal with the stresses of suffering the negative impacts of having to pass urine involuntarily.

The second critical effect of the interventions is that they helped in the reduction of stress levels among the patients suffering from urinary incontinency. This is reflective of the key purpose that was outlined at the beginning of the review. According to Padilla-Fernandez (2013), the individuals suffering from urinary incontinency experience a great deal of stress and embarrassment in their lives because of the shame they have to handle while in the face of the society. The therapies have the effect of going a long way of alleviating the distress that patients have to suffer in the course of their lives. This is attained by strengthening the bladder and keeping the patients in a stable state of health that is without any form of doubt or embarrassment on their part. Confidence and self-acceptance are always restored as a result of the application of the therapies in the treatment process. The reduction of stress among the patients goes a long way into ensuring that they lead more quality lives free from any particular form of embarrassment.

7.0 Discussion

Faiena, Patel, Parihar, Calabrese, and Tunuguntla (2015) affirm the view that urinary incontinence is highly prevalent among women and has been one of the key contributors of the high levels of morbidity. Since it is not a progressive disease, the well-defined therapies play a vital role in treating patients suffering from it. Dass, Lo, Khanuengkitkong, and Tan (2013) add to this understanding by revealing the view that urinary incontinency affected an estimated 17-45% of women across the globe and that it can occur to the individuals at any given age. However, Dass, Lo, Khanuengkitkong, and Tan (2013) reiterate that the adults aged 50-65 years are at the highest risk of suffering from the condition because of the progression with age, which is one of the risk factors.. This has led to the perception of the problem as an occurrence of old age. However, the assumption has not been fully taken as a satisfactory cause of the condition because there are other risk factors, including sex, and habits, such as smoking. In the overall sense, it is agreeable from the conducted studies that urinary incontinency is an undesirable condition that leads to the weakening of the bladder, hence resulting to involuntary passage of urine without warning.

In regard to the therapies, it has been established from the studies explicated in this paper that biofeedback therapy is one of the most outstanding approaches to ensuring that the patients have the best possible outcomes. In outlining the biofeedback therapy, Dijkstra-Eshuis et al. (2013) reveal that biofeedback therapy needs to be approached in a systematic manner that is vital in leading to the best possible outcomes for the patients. This could be done across several weeks of the treatment process with a follow-up on the patients. Both patients and caregivers need to collaborate in the best way to ensure that they do work toward the attainment of the best outcomes. Starr, Drobnis, and Cornelius (2016) espouse the view that the biofeedback mechanism is critical in leading to the improvement of the strength of the pelvic floor muscles, which are responsible for the release of urine. With effective strength, these muscles do not allow the overflow of urine, hence leading to better and quality living. Ghaderi and Oskouei (2014) indicate that biofeedback therapy may not necessarily work on its own, as it may be complemented by other vital therapies, including electrical stimulation and pharmacotherapy. It is through the mixture of approaches that patients are put in the best position possible to enjoy the benefits of the therapies in the treatment process. Therefore, it is advisable that when dealing with patients, healthcare practitioners combine the different approaches and therapies that achieve the same purpose of strengthening the pelvic floor muscles. The aims should be to improve the quality of living and the stresses that the patients have to deal with in the course of their lives. This will ensure that both men and women at risk of urinary incontinency live more satisfying lives even in the old age.

8.0 Implications for Practice and Research

The most significant implication of this review for practice is that it will encourage the increased adoption and application of biofeedback therapy in the clinical setting. According to Starr, Drobnis, and Cornelius (2016), biofeedback could be a critical component of the behavior training approach for the patients suffering from urinary incontinency.

Therefore, the significant implication of this review for practice research is that it will set the pace for continued biofeedback application to the patients. This could be done through monitoring and conveying it back through acoustic signals with the view of improving their habits and their approach to the handling of weaker pelvic muscles. The implication here will be the improvement of the quality of living for the patients and the realization of normal life that has been a rare occurrence for most of the patients going through urinary incontinency. The clinical scenario of managing patients with clinical incontinency will be more predictable. There will also be more technological and skill application to the handling of the patients with the condition in the best ways possible. This will even boost the outcomes available for the patients.

The implication of the review on research is that it will ensure that the gaps in the research on the treatment of the patients with urinary incontinency are treated in the best ways possible. Currently, the research has been focusing on the effectiveness of biofeedback therapy in leading to the improved outcomes on the part of the patients. However, with this review, some light has been shed on the nature of biofeedback therapy and the outcomes that it is always likely to achieve for the patients suffering from urinary incontinency. The nature has been portrayed to be quite effective in terms of outcome improvement. With this in mind, the implication of the study on the research is that it will enhance the opportunities for the discovery of the compelling advantages of urinal incontinency. The existing gaps in it will be addressed for the development of an even stronger therapy that will ultimately satisfy the patients and minimize their stress levels, as well as improve their positivity while interacting with other people in society.

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9.0 Conclusions

One of the key conclusions that could be drawn from the study is that urinary incontinency is more prevalent among women than among men. As much as the effects of the disease come to more adults aged above 50 years, women always stand at the highest risk of suffering from the disease compared to their male counterparts. The weakening of the pelvic muscles is more pronounced in women because of the key causes, such as pregnancy and subsequent childbirth, as well as menopause. The criticality of the condition and the vulnerability of women should call for even a more elaborative approach to ensure that they are treated in the best way possible that will get the best outcomes for them.

The second notable conclusion from the review is that urinary incontinency comes with a lot of embarrassment and stress on the part of the patients. Stress emanates from the rejection that the patients face from other members of society and they do not have the opportunity to live well as required. On most occasions, patients prefer isolating themselves from the rest of society because of the shame they have to deal with because of urine leakage. It is imperative that the patients should be helped to overcome the stress that they face by putting in place various therapies that are satisfactory enough.

Another key conclusion that could be drawn from the review that the patients undergoing biofeedback therapy stand the best chance of recovering from the distress that is brought about by urinary incontinency as opposed to the patients who fail to undergo the therapy. This emanates from the fact that biofeedback therapy plays a helpful role in strengthening pelvic muscles and ensuring that patients are in a better position to resist urine leakage. The above-mentioned measures could ultimately improve their accommodation into the society and the ability to be part of the whole societal process.