Is there an additive effect of biofeedback or electrical stimulation with pelvic floor muscle exercises in the treatment of urinary stress incontinence

Overall Clinical Bottom Line: According to the current data, there is no additive effect of biofeedback with PFMT, although more studies need to be done utilizing a patient population from the United States that is strictly stress incontinent. There are promising results that electrical stimulation could have an additive effect, however more research needs to be done using larger sample sizes with a population from the United States. We do want to recognize the importance of research using randomization, however, this does not correlate well to a clinical scenario where the patient's treatment is decided upon, not only by their physical presentation, but also their motivation and preference. Because of that difference this clinical question is difficult to answer based off the research alone.\nClinical Scenario: A woman came into a physical therapy clinic with complaints of stress incontinence. She was 45 years old, and had had multiple children. She finally came to physical therapy because she heard that it could help and she would not have to live with always wondering where the nearest bathroom was. Current treatment to strengthen the pelvic floor includes pelvic floor muscle training, biofeedback, and electrical stimulation. We want to look at the best treatment to retrain the pelvic floor musculature in order to decrease the frequency of daily incontinence episodes.