Bulbocavernosus Reflex as an Objective Measure of Improvement Following Directed Pelvic Floor Rehabilitation for Treatment of Urinary Incontinence

Abstract

Background: Abnormal bulbocavernosus reflex latency and subsequent improvement is an objective measure of improvement after directed pelvic floor physical therapy. The aim of the study was to utilize bulbocavernosus reflex testing as an objective measure of pelvic floor rehabilitation success in the treatment of urinary incontinence (UI) in a large screened population. Methods: This was a retrospective case series of 95 women with UI who were found to have abnormal bulbocavernosus reflex tests (UroVal System), then treated with guided pelvic floor exercise program for 6 - 12 weeks that included electrical stimulation. Charts were reviewed for demographics, prior treatment, baseline and post-treatment bulbocavernosus reflex latencies, pre-and post-treatment anal manometry, number of daily incontinence episodes, pad counts, patient perception of improvement using satisfaction at the conclusion and at 6 - 24 months post-treatment. Pre-to-post mean differences were calculated using paired t -tests with 95% bootstrap confidence based on 10,000 permutations. Results: Significant differences were found in pre-and post-treatment bulbocavernosus reflex latency (85.0 vs. 35.4 ms, P < 0.001), anal manometry (40.2 vs. 56.4 ms, P < 0.001), pad counts (1.0 vs. 0.1 per day, P < 0.001), and incontinence episodes (1.8 vs. < 1.0 per day, P < 0.001). Perceived improvement was 80% (standard deviation (SD) 17.8%) at the conclusion of treatment. At 6 to 24 months post-treatment, satisfaction persisted at 93% (SD 12.5%). Conclusions: The bulbocavernosus reflex is an effective objective screening tool to establish pelvic neuromuscular dysfunction. Abnormal bulbocavernosus reflex latency and subsequent improvement after guided pelvic floor rehabilitation is an objective measure that can be used in conjunction with the patient’s subjective improvement.