Biofeedback: Indications and therapy

Biofeedback is defined by the German Society for Biofeedback as "a scientifically founded method of behavioural therapy and behavioural medicine, which allows usually unconscious psychophysiological processes to be made perceptible by feedback."

Processes such as blood pressure, heart rate or muscle activity are measured and notified to the patient via acoustic or visual signals. The aim is to enable patients to learn how to consciously influence these processes and thereby accelerate regeneration.1

Biofeedback has now established itself as a treatment method for a whole range of physical, mental and psychosomatic disorders. Although different measurement methods and values are used and a wide variety of physiological processes are monitored, the underlying principle remains the same.

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Biofeedback in incontinence therapy

With around 10 million patients affected, incontinence has become a major health problem which affects around 200 million people worldwide. Biofeedback therapy has been an established treatment method since the 1970s, allowing patients to directly address the cause of their incontinence. With incontinence, distinctions are made between urinary incontinence, faecal incontinence and a combination of the two. Depending on the cause, urinary incontinence is further subdivided into stress, reflex and overflow incontinence. Women are particularly affected by this condition: in Germany, around 25% of the female population is at least partly incontinent. Urinary incontinence is the most common chronic disease amongst women.2

The cause of many forms of urinary and faecal incontinence is often a weak pelvic floor musculature. The pelvic floor muscles surround the urethra, anus and other organs, and fulfil three important functions that significantly influence continence: tensing, relaxing and reflexive tensing, or in other words withstanding increased pressure.

The functioning of the pelvic floor muscles is largely unconscious. Biofeedback therapy in this case involves the use of vaginal and anal probes or electrodes on the skin, through which muscular activity is measured. This enables the patient to train the bladder and sphincter muscles in a targeted manner so that the cause of the incontinence can be counteracted. The ability to follow the success of the training directly via the biofeedback can lastingly increase motivation and in this way promote long-term therapeutic success. In addition, the muscles can also be electrically stimulated to assist the patient while exercising. With regularly repeated exercise, the chances of success are around 70–80%.3

Biofeedback therapy: indications and benefits

Direct feedback from the processes and functions in the body allows the patient to learn how to consciously influence them. This can range from muscle training to deliberate slowing of the heartbeat and relaxation of muscle tone, and to a deliberate manipulation of vessel width. The goal remains the same: to demonstrate to the patient that even slight changes can have an impact on physical processes, and that they can learn how to positively influence a therapeutic or rehabilitation process.4

Benefits of biofeedback therapy

  • No additional medication
  • Relearning of movement patterns
  • Ideal for incontinence therapy
  • Specially designed, user-friendly devices enable therapy in the home environment
  • Can reduce the need for incontinence aids
  • No invasive treatment
  • Virtually no side effects


  • Chronic pain
  • Migraine
  • Urinary and faecal incontinence
  • Sleep disorders
  • Tinnitus
  • Irritable stomach, irritable bowel
  • Epileptic disorders
  • Cardiac arrhythmia
  • Anxiety disorders, depression, post-traumatic stress disorder
  • Rehabilitation after stroke
  • Prevention of muscle atrophy
  • Psychovegetative disorders


  • Bladder infection
  • Menstruation
  • Incomplete diagnostics
  • Inflammatory or scarring disorders of the rectum
  • Epilepsy
  • Severe mental trauma

EMG in biofeedback therapy

The EMG (electromyogram) measures the resting and action potential of the affected muscles and thus provides the basis for implementing biofeedback therapy. During the relaxation or tensing state, thresholds are set that must be exceeded or maintained. This provides the patient not only with accurate insights into their muscular activities, but also means that they can train their muscles in a transparent, measurable and targeted manner. The objective could be to learn certain patterns of movement or – as in incontinence therapy – to strengthen certain muscles.

Benefits of an EMG

An electromyogram can answer the fundamental question "How does the muscular system behave?" and allow a course of treatment to be derived from the answer. The quantitative and objective measurement of muscular function offers several benefits:

  • The measurements can help with surgical decisions.
  • Regular measurements allow the course of therapy and training to be documented. This promotes long-term success.
  • It also ensures that the right muscles are trained.
  • An EMG allows movement sequences to be analysed and optimised, for example in rehabilitation or sports medicine
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Biofeedback in pain therapy

Biofeedback therapy can be highly effective in the treatment of chronic and acute pain. Pain can be reduced by 50–60%, which is equal to the effectiveness of pharmaceutical treatment. It should be emphasised here that such an effect can only be achieved after several sessions. Compared to a drug intake, however, the effect is more sustainable and does not stress the organism through the intake of chemical substances.6

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