Nurse and physiotherapy led pelvic floor biofeedback unit

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This leaflet will give you information about what biofeedback is, how it works and the length of time the treatment takes. A member of the team will speak to you about everything in this leaflet, but if you have any questions, please ask us. 

What is biofeedback therapy for? 

Biofeedback is bowel and muscle retraining through behavioural changes. It is the conservative management of patients having trouble with the function of their bowel, such as: 

  • Constipation
  • Difficulty emptying the bowel
  • Needing to rush to the toilet
  • Losing control of the bowel
  • Pain when going to the toilet
  • Abdominal bloating
  • Loose stool
  • Rectal Prolapse

In some cases we can improve anal pain.

Patients attending the unit for nurse or physiotherapist led management will receive a comprehensive individualised assessment and appropriate written management plan, relevant explanation, advice, teaching and information evaluation, review, and appropriate follow up/referral.  

Do I need to do anything before my first appointment?

A detailed questionnaire relating to your bowel problem is included in your appointment letter. Please take time to complete all questions and bring the questionnaires to your appointment.

You do not need to have any special preparation before you come. You can eat and drink normally, continue to take your usual medication and you do not have to have emptied your bowel before you arrive. After your appointment, you can resume your normal day.

Are there any risks in this treatment?

No. You cannot come to any harm when you follow your programme plan, although it may take several visits before there is an improvement in your symptoms. The exercises and biofeedback are safe and have no known side effects.

Where will my appointment take place?

The appointment will take place in ACAD 5 Central Middlesex Hospital. When you arrive at the hospital’s main reception, ask to be directed to the unit. Please take a seat in the clinic reception area and your nurse or physiotherapist will meet you there.

Who will carry out this programme?

One of our clinical nurse specialists or physiotherapist will plan and work with you throughout your whole programme. They can refer you to a dietician or clinical psychologist if the need is identified.

If you need to contact your nurse or physiotherapist, please telephone 020 8963 7189 or 020 8453 2458. There is an answerphone for you to leave a message if nobody is there to answer your call.

What are the aims of my treatment plan?

Your plan can help to:

  • Improve your symptoms
  • Prevent your problems from worsening
  • Provide advice and information to help you understand your condition
  • Help you acquire practical skills and strategies to cope effectively with your bowel problem
  • Prepare you to manage your bowel so that if you later need surgery, you can actively contribute to your recovery.

Will my treatment plan improve my condition?

Around 70% of the people who are referred to our service experience an improvement in their symptoms, feel they can manage their problem more effectively and can resume activities that had previously been affected by their bowel problems. 

To achieve the best results, you will need to follow the agreed plan and put into practice the advice and exercises you have been given. We will give you all the information, exercises, and advice you need to put you back in control of your bowel condition and you will then need to continue with these new habits for life. This may seem like hard work, but most people find that the effort and commitment are worthwhile as their symptoms improve and their bowel no longer controls their life.

A small proportion of people find that, despite their best efforts, they do not benefit from the plan and continue to have bowel problems which disrupt their lives. If this happens to you, the nurse or physiotherapist will either discuss your case at the pelvic floor multidisciplinary team meeting held twice a month and or refer you back to the consultant in the clinic or to another member of the team who will explain other treatment options to you.

What will happen when I come for treatment?

Your first appointment will take around one hour. One of the clinical specialists will talk to you about your bowel problem and explain the results of the tests you have had and how they are linked to your symptoms. The nurse or physiotherapist will then carry out a physical examination of your pelvic floor by performing a digital rectal examination and or vaginal examination. They will use their gloved finger to check for any problem inside your rectum and or vagina. They will then work with you to develop a management plan to improve your bowel function.

You will be asked to give your consent for us to carry out these examinations and if you would like a chaperone to be with you during these tests, we can arrange this for you.

What will my management plan include?

The plan will be developed specifically for you and may include any of the following elements, depending on your particular needs:

  • Dietary changes
  • Medication
  • Advice on lifestyle changes to improve bowel function
  • Exercises to effectively empty your bowels, and to strengthen your pelvic floor and/or anal sphincter muscles.
  • Biofeedback (monitoring how well you are doing the above exercises using visual biofeedback equipment from a practitioner or simple equipment you can use at home. For example balloon expulsion test, pelvic health trainer, MMS, visual biofeedback system, EMG, porridge enema test)
  • Low volume or high volume transanal irrigation
  • Anal inserts or plugs
  • Percutaneous tibial nerve stimulation
  • Counselling for sacral nerve stimulation

Subsequent appointments are scheduled every four, six to 10 and or 12 weeks and is dependent on the unit waiting list. These appointments can last from 30 to 45 minutes. The nurse or physiotherapist will review your progress with you, answer any questions and then modify your plan if this is required.

How often will I need to visit the service?

Everyone is slightly different as the plan is developed specifically for you. Half of the people who come to us do so just once or twice, but others need about four-six sessions. The actual number depends on your progress and the improvement in your symptoms. We may ask you to make contact with your GP to ask for more sessions should you need psychology or dietician input in addition to seeing your nurse or physiotherapist.

Who can I contact for more information?

Please contact St Mark’s pelvic floor biofeedback team on 020 8963 7189 or 020 8453 2458. There is an answerphone for you to leave a message if nobody is there to answer your call.

Data Protection Act 2018

To enable us to improve the quality of the care that we provide, your health records are kept by the Trust and may be used for teaching, training, audit and research. Further information on how the Trust uses your information can be found on our website at the website

General Trust information

Patient Advice and Liaison Service (PALS)

PALS is a confidential service for people who would like information, help or advice about the services provided by any of our hospitals. Please call 020 8869 5118 between 9.30 a.m. and 4.30 p.m. or email Please note that this service does not provide clinical advice so please contact the relevant department directly to discuss any concerns or queries about your upcoming test, examination or operation.

If you would like this information in an easy to read format, large print, braille, different format or language, please contact the PALS team on 020 8869 5118 or email We will do our best to meet your needs.

Nurse and physiotherapy led pelvic floor biofeedback unit
First published: April 2023 Review date: April 2025 
Reference: 392022

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