From Urgency to Control: Using mTrigger Biofeedback in Urge Urinary Incontinence Rehabilitation

Urinary incontinence is often discussed as a pelvic floor strengthening problem, but that description does not fully capture urge urinary incontinence (UUI). For patients experiencing urgency, treatment is not simply about producing a stronger contraction. It is about improving awareness, coordination, timing, and control of the pelvic floor while also addressing the behaviors surrounding bladder function.

For pelvic health physical therapists, surface EMG biofeedback can help make these otherwise difficult-to-see processes more understandable. Research findings provide useful principles for incorporating sEMG biofeedback into the treatment of urinary incontinence.

What Is Urge Urinary Incontinence?

Stress urinary incontinence typically occurs when increases in intra-abdominal pressure—such as coughing, jumping, bending, or lifting—result in leakage. Urge urinary incontinence (UUI) presents differently. UUI involves involuntary urine loss associated with a strong sensation of urgency and is described in the literature as having greater involvement of neurologic and autonomic mechanisms. Mixed urinary incontinence combines features of both stress and urge incontinence. 

This distinction matters clinically. A patient with stress incontinence may need improved pelvic floor strength and the ability to coordinate the appropriate response in the presence of increases in pressure. A patient with urgency may also need to develop better voluntary control over the pelvic floor and greater confidence in responding when urgency occurs.

Physical Therapy Is About More Than Strength

Conservative management of urinary incontinence is a multistage process. In addition to pelvic floor muscle exercise, the literature describes behavioral interventions addressing habits, fluid intake, lifestyle factors, and other behaviors associated with bladder function as helpful interventions. In terms of pelvic floor exercise, conscious, repeated contraction and relaxation of the muscles rather than simply maintaining constant tension is important.

For a patient with UUI, physical therapy may therefore focus on several interconnected goals:

• Improving awareness of the pelvic floor
• Learning to correctly contract and relax the muscles
• Developing the ability to produce an appropriate contraction when needed
• Reducing urinary leakage and symptom frequency
• Improving the patient’s confidence in managing bladder symptoms.

The treatment target is ultimately control, not simply strength.

Making an Invisible Muscle Visible

One of the challenges of pelvic floor rehabilitation is that patients cannot easily see the muscle they are being asked to use. Research has demonstrated that some patients have difficulty performing an appropriate pelvic floor contraction even after instruction. 

mTrigger biofeedback helps address this problem by converting muscle activity into information that the patient can see or hear. With EMG biofeedback, electrical activity generated by muscle contraction is recorded and displayed, allowing the patient to monitor the quality of their performance in real time.

With mTrigger, a clinician can use this information to answer an important question early in treatment: Can the patient intentionally turn the pelvic floor on and then turn it back off?

Begin with simple contractions. Ask the patient to contract while watching the activation signal rise. Then have them relax and observe whether the signal returns toward baseline. Here is an example. 

Sometimes the inability to relax the pelvic floor will perpetuate urinary urgency. The feedback connects an internal sensation with an external result.

Practice Both Sides of the Signal

Pelvic floor rehabilitation should not become a race to make the mTrigger number as high as possible.

Research using sEMG-assisted pelvic floor training has specifically included instruction in both correct contraction and relaxation, with participants watching their pelvic floor activity on a monitor.

This is particularly relevant when the goal is improved control. A patient needs to recognize not only how to recruit the pelvic floor but also how to release it appropriately.

With mTrigger, consider making relaxation part of the task:

Contract → hold → relax → return toward baseline → repeat.

The patient can begin to recognize what each phase feels like instead of simply performing repeated contractions without understanding what the muscle is doing.

Progress Toward Urge Suppression and Better Bladder Control

Once a patient can reliably identify and contract the pelvic floor, biofeedback can be used to support urge-suppression training rather than simply progressing toward faster or more sustained contractions. For patients with UUI, clinicians may teach a series of 5–10 strong pelvic floor muscle contractions when urgency occurs to help engage the pelvic floor–bladder inhibitory reflex and allow the urge to settle before moving toward the bathroom.

mTrigger can help patients practice this strategy by confirming that each contraction is strong and intentional rather than being replaced by abdominal, gluteal, or other compensatory muscle activity. Visual feedback can also help patients recognize when they have fully released between contractions and build confidence in their ability to reproduce the strategy without the device.

The goal is not to achieve a higher sEMG value but to develop a reliable pelvic floor response that the patient can use when urgency occurs. 

Why Does Contracting the Pelvic Floor Help? 

Teaching someone to activate their pelvic floor in a moment of urinary urgency activates the pelvic-detrusor inhibitory reflex (or the pudendo-bladder reflex). Contracting the pelvic floor activates the pudendal nerve. As the signal from the pudendal nerve travels up your spinal cord, it communicates to the detrusor muscle to calm down (urgency is felt when the detrusor muscle contractions). This is the body’s shortcut to override the urge signal, which will help get you more time to get to the bathroom. However, to do this properly, you need the nerve to turn on and off repeatedly (5-10 times), not just continually stay on.

Biofeedback Supports the Process

Biofeedback is most valuable when it is used to improve how well a patient learns and controls the pelvic floor, rather than as a stand-alone treatment. Research suggests that adding biofeedback to pelvic floor muscle training can improve coordination, muscle control, and the patient's ability to recognize even small or weak contractions—particularly early in rehabilitation. 

For clinicians using mTrigger, this supports a targeted approach. The device can provide immediate feedback while patients learn to contract, relax, and coordinate the pelvic floor, then be gradually reduced as those skills become more automatic. mTrigger can serve as a bridge between clinical instruction and independent pelvic floor control. 

Summary

Urge urinary incontinence requires more than simply strengthening the pelvic floor. Successful rehabilitation focuses on helping patients improve awareness, timing, coordination, relaxation, and voluntary control while also addressing bladder habits and behavioral strategies. Biofeedback can support these goals by making pelvic floor muscle activity visible and giving patients immediate information about how effectively they are contracting and relaxing. Used with a clear clinical purpose, mTrigger can help patients better understand their pelvic floor, practice more intentional muscle control, and gradually carry that awareness into real-life situations where urgency occurs.

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References

1. Matsi AE, Billis E, Lampropoulou S, Xergia SA, Tsekoura M, Fousekis K. The effectiveness of pelvic floor muscle exercise with biofeedback in women with urinary incontinence: a systematic review. Appl Sci. 2023;13:12743. doi:10.3390/app132312743.
2. Kopańska M, Torices S, Czech J, Koziara W, Toborek M, Dobrek Ł. Urinary incontinence in women: biofeedback as an innovative treatment method. Ther Adv Urol. 2020;12:1-12. doi:10.1177/1756287220934359.
3. Chmielewska D, Stania M, Kucab-Klich K, et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises. PLoS One. 2019;14(12):e0225647. doi:10.1371/journal.pone.0225647.
4. Paasch C, Soeder S, Lorenz E, et al. The effect of biofeedback pelvic floor training with ACTICORE1 on urinary incontinence: a multicenter randomized clinical pilot trial. Ann Med Surg (Lond). 2023;85:4860-4865. doi:10.1097/MS9.0000000000001181.