90913 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separate

Name of the Procedure:

Biofeedback Training, Perineal Muscles, Anorectal or Urethral Sphincter (Including EMG and/or Manometry, Each Additional 15 Minutes of One-on-One Contact)

Summary

Biofeedback training for the perineal muscles focuses on strengthening and improving control over the anorectal or urethral sphincter muscles. This training often includes the use of electromyography (EMG) and manometry to assess muscle function during the sessions.

Purpose

Biofeedback training is aimed at treating conditions such as urinary incontinence, fecal incontinence, and pelvic floor dysfunction. The primary goal is to enhance muscle strength and control, leading to improved symptoms and better quality of life.

Indications

• Urinary incontinence
• Fecal incontinence
• Pelvic floor dysfunction
• Chronic constipation
• Postoperative recovery for pelvic surgeries

Preparation

• Patients may be advised to arrive with a full bladder or may be asked to drink water before the session.
• No specific fasting or medication adjustments are usually required.
• Diagnostic tests like baseline EMG or manometry assessments may be performed beforehand.

Procedure Description

1. The patient lies down or sits comfortably, usually in a private setting.
2. EMG sensors or manometry catheters are placed in the appropriate areas for accurate muscle activity measurement.
3. The healthcare professional provides real-time feedback based on the readings to guide the patient's muscle contractions and relaxations.
4. The session generally involves performing various exercises to strengthen the pelvic floor muscles.
5. Each additional session lasts for 15 minutes of one-on-one training with the healthcare professional.

Duration

Each biofeedback session typically lasts an additional 15 minutes, but the overall program may consist of multiple sessions spread over several weeks.

Setting

The procedure is commonly performed in an outpatient clinic or physical therapy center specialized in pelvic health.

Personnel

• Physician or other qualified healthcare professionals (e.g., physical therapist, nurse specialized in pelvic health)
• Occasionally, a technician to assist with equipment setup

Risks and Complications

• Mild discomfort from sensor placement
• Rare risk of infection at the sensor sites
• Minimal risk of incorrect biofeedback if sensors are not accurately placed

Benefits

• Improved muscle strength and control
• Reduction in symptoms of incontinence and pelvic floor dysfunction
• Enhancements in overall quality of life
• Benefits may be realized within a few sessions

Recovery

• No significant recovery time is required after each session.
• Patients may be advised to perform exercises at home to reinforce training.
• Regular follow-up sessions to monitor progress and adjust treatment as necessary

Alternatives

• Pelvic floor exercises without biofeedback
• Medications for incontinence management
• Invasive surgical procedures for severe cases
• Pros: Non-invasive and promotes natural muscle strengthening
• Cons: May require several sessions to achieve desired results

Patient Experience

• Patients might feel a sensation of muscle contractions when performing exercises.
• Minimal discomfort from sensor placement.
• Healthcare professional provides guidance to ensure comfort and effective training.
• Pain management is not typically needed, but any discomfort should be communicated to the practitioner for adjustments.