My Biofeedback Machine

I wanted to show you the biofeedback machine that I rented. It is called U-Control Incontinence Trainer. It comes with either vaginal/anal or electrode sensors. I understand that using the vaginal/anal sensor gives a better EMG reading for the pelvic floor. I chose to get the electrode sensors, however, because I have other tight muscles and I figured I could multi-task on my rental. The three links attached will help fill you in on the details. The youtube video does a good job and gives you the information on how to use it and where to get the equipment. A youtube video shows the vaginal/anal sensor. If you use the electrode sensors, you place the yellow and blue connectors to the immediate right and left of your anus. The black connector goes on a bony part of your body like your iliac crest, aka hip bone, and is the ground. There are two sensitivity settings: x1 and x3. The x1 is more sensitive and probably what you want to eventually work with, but x3 also will read the electrical conductivity of your pelvic floor muscles. You may be able to get to the lowest reading (I rarely did), but feel good about just going lower into the A, B, and C range (you can see this on the photo below at the bottom of the unit). It means my nerves were pretty calm.

Overview

Equipment and Costs

I used this for 3 months and now can get to a relaxed state in about 2 minutes. I also learned what sitting and lying positions help relax my pelvic floor.

You can buy or rent this equipment. I rented for 3 months from the company listed on the unit. I made sure my doctor's prescription had "incontinence" on it as one of the symptoms to treat as it is part of the name of the machine proper "U-Control Incontinence Trainer". I have a P.T.'s recommendation, a doctor's prescription, and a good PPO plan and the reimbursement went through. I can't remember how much I paid out of pocket. The company offered to put my rental cost towards a purchase of the machine. I declined, but hope that was the right choice...

Update Nov. 26, 2015
I'm thinking of doing this again, this time as a purchase. To that end, the best price I found online for purchasing this is at http://www.lifematters.com/u_control.asp 

U-Control™ Home Continence Trainer 1 Channel of sEMG Price $334

Then you add: T3425: UniGel Pre-Gelled Single Electrodes. Package of 100 for $35 (each electrode lasts a while); or the T6050: vaginal sensor for $50, and the cable.

How to Kegel

After many, many years of not "getting it", I think I may understand how to Kegel.

First, if your Kegel muscles are very weak, you may not feel like you are doing it at all.

Second, if your pelvis is messed up, it is the release of the Kegel that is more significant that the contraction.

Third, for me I have figured out that a Kegel is 1. tightening my anus, 2. have my clitoris "nod down", and 3. closing up the vaginal entrance. Don't flex your butt and don't use your transverse abdominus.

If you are trying to release your pelvic floor, don't strain to hold it. Just initiate the Kegel for 1-3 seconds and then release and try for "non-doing" relaxation (i.e. don't try to consciously "enlarge" your anus). This may take a lot longer than the Kegel - 30 seconds? 1 1/2 minutes? 4 minutes?

If you are trying to strengthen your pelvic floor, then hold the Kegel just until you start to lose control and your Kegel gets shaky.

Here is where the biofeedback machine really helps as it measures your muscle contraction and relaxation through electric impulses.

Physical Therapy Continued...

I am now in week 5. The last two weeks have been biofeedback! Very challenging to get to a resting muscular reading. And that is lying down. I haven't figured out standing or walking. I am going to see if I can rent/buy a biofeedback machine for myself.

We are Kegel-ing which I never before understood because I was too weak to do it. Basic concept is to pull in your clitoris, vagina, and anus all tight. Then before you start shaking with weakness and lack of control, relax completely. Like really completely. This is perhaps more important than the Kegel itself - to get that release of the muscles of the pelvic floor.

She has a computer with a picture of a rose. The Kegel is trying to get the rose to close up and be a bud; the release is trying to get that rose as open and large as you can. I experimented with different thoughts: envisioning the rose, making my mind blank, thinking of my pelvic floor opening. The biofeedback machine gives you numbers as your muscle tension releases or increases.

Week 4
First session: Not great, but okay.
Second session: Pretty darn good, all things considered.

Week 5
Third session: Awful. Also, P.T. is taking away from my normal exercise/relaxation time so that is at odds. I am hanging in there, but hope to become more independent. If anyone knows of a biofeedback machine place, I am ready to rent or buy.

My psychotherapist and I will discuss "butt clenching" in our next session. The butt clenching, as I understand it for myself, is related to anxiety, mechanical instability and habit.

Physical Therapy Continued...

I have been in PT for 3 weeks now. An overview:

Week 1 (2 sessions) --
I didn't go in with this mind set, but the therapist focused on my bathroom habits. I had a chart to fill out of what I ate, drank, how much, how large my pee was, how often I pooped, etc.  to reduce "JICCING" meaning "just in case-ing" going to the bathroom. I learned that my "how to poop" back-up is called "splintting" medically (see my poop blog). Her point was that people with pelvic pain have weird bladder/bowel function.

Then the Q-tip test and looking at the balance of my hips and working on that. Also pressing around to find "trigger points" and tight fascia (fascia is the stuff that is white when you are pulling apart a chicken). I hurt later that day and for another day.

Week 2 (1 session) --
She introduced me to working on my transverse abdominus and Kegels. Transverse abdominus is a muscle that is shaped like a smile from one hip bone, scooping down to the pubis, and then scooping up. You activate it by breathing in and then making a hissing sound while trying to contract this muscle. Kegels are more vague to me. I tried. Both of these were incorporated into my normal P.T., meaning I did the same exercises, but tried to do the breathing/contracting. Oh!  I was in pain - worse pain than I have been in for a while going down my outer and inner legs and on my butt. Sitting became difficult again. I had the full-out sob-cry at home after it was still bad 5 days later. I cut doing the Kegels and transverse abdominus contractions and the pain slowly resolved.

Week 3 (1 session) --
I take charge of what I will and will not do. I had asked her her goals for me the week before and she had rattled off 18. That overwhelmed me. I talked to my therapist and then told my P.T. that the list was going to go down to two goals: getting my ankle working in the context of my pelvis and calming my nerve pain. Anything else is a bonus. I also told my P.T. I would no longer rank my pain on a numerical 1-10 scale and I would no longer participate in the pee/poop efforts. So there.

Something I had thought to ask for and had not yet done, was to do biofeedback. No previous therapist has done that and it seems like a very good idea for me. And it turned out that that was her plan for the day. She put the stickies on different pelvic floor muscles (externally, no in my vagina) and it measured electrical conductivity which is a measure of muscle contraction. "Wow, you are tight." No duh. But she had me watch the number while trying to relax. She put me in several different positions to see in what position I am the least tight (cross-legged for me) using the biofeedback machine. Then she had me try to Kegel. This time, there were two numbers. One for the Kegel and one for my overall muscle tightness. Up the Kegel number while maintaining the overall muscle number as low as possible. Didn't work out so well. My homework was to try to do a few Kegels and stop if I couldn't do it without involving my butt.

Finally, she taped my butt cheeks together to make my pelvis more stable and give some muscles support (this is in addition to the Serola sacral belt I always wear). The tape is 9" high and the lowest part of it is an 1 1/2" above the anus up to an 1" below the beginning of the butt crack. Guess what? No (or almost no) leg pain. So there is something magical about this taping for me. My husband has asked me how many days I am going to wear this bandage and the answer is as long as possible. It doesn't feel great, but is much better than burning pain. She used a special kind of P.T. tape and I will find out the name of it.

My ankle started behaving itself day-3 of wearing the bandage on my butt. I have been able to exercise everyday since I got the butt bandage.

As an aside, my psycho-therapist has asked me not to do web-research on vestibulitis when I am in pain. I get despondent, obsessive, and hopeless. No good can come of it she says. I say that this is when I am most motivated!