***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To assess the effect of pelvic floor education after vaginal delivery on pelvic floor characteristics in nulliparous women . Methods We examined 107 nulliparas during pregnancy and at 9 weeks and 10 months after vaginal delivery . Methods used included a question naire , clinical examination , perineosonography , urethral pressure profiles , and intravaginal and intra-anal pressure recordings during pelvic floor contraction . After the second examination , the women were assigned in alternating manner to either 12 sessions of pelvic floor exercises with biofeedback and electrostimulation ( n = 51 ) or no training ( n = 56 ) . The two groups were compared at the third examination . Results Stress urinary incontinence incidence decreased in 2 % of control subjects compared with 19 % of women who underwent pelvic floor education ( P = .002 ) , whereas the incidence of fecal incontinence ( 5 % versus 4 % , P = 1 ) and the percentage of women who recovered predelivery pelvic floor contraction strength ( 33 % versus 41 % , P = .4 ) were no different . We observed no significant differences in bladder neck position and mobility , urethral functional length , maximal urethral closure pressure , pressure transmission ratio , residual area of continence at stress st and ing , or intravaginal or intra-anal pressures during pelvic floor contraction between groups at the third examination . Conclusion Pelvic floor education , begun 2 months postpartum , significantly reduced the incidence of stress urinary incontinence , but not fecal incontinence or weak pelvic floor . Similarly , bladder neck behavior , urodynamic characteristics , intravaginal or intra-anal pressures during pelvic floor squeezing also were not modified Background and aims A subgroup of constipated patients complain of absent or diminished sense of wanting to defecate , suggesting that one of the causes of constipation is impaired rectal sensation . Electrical stimulation therapy ( EST ) has recently been used to treat patients with urinary and /or fecal incontinence . This study evaluated the efficacy of EST in constipated patients , especially those with impaired rectal sensation . Patients and methods Of the 130 patients with functional constipation as defined by Rome II criteria , 22 patients who had impaired rectal sensation ( rectal desire threshold volume ≥ 90 ml ) on an anorectal manometry were selected . We treated 12 with EST and 10 with biofeedback therapy ( BFT ) according to a r and omized order . Results Overall symptoms of patients significantly improved after each therapy in both groups . Interestingly , frequency of sense of wanting to defecate improved only after EST . On objective findings there was significant improvement in anal residual pressures on attempted defecation only after BFT solely . On the other h and , rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume improved significantly only in the EST group . Conclusion Our findings show that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients , especially those with impaired rectal sensation . EST might be considered as an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation Background and aims A r and omised trial was undertaken to compare the clinical and functional results of two novel transanal stapled techniques in patients with outlet obstruction syndrome . Material s and methods Ninety-six females with outlet obstruction were treated with medical therapy and biofeedback for 2 months ; 67 non-responders were evaluated by the Constipation Scoring and Continence Grading Systems , clinical examination , endoscopy , dynamic defecography , anorectal manometry , transanal ultrasound and anal EMG , and 50 of them , all affected with descending perineum , intussusception and rectocele , were r and omly assigned to two groups and operated on : 25 patients ( mean age 53.2±15.3 years ) underwent a single Stapled Trans-Anal Prolapsectomy , associated with Perineal Levatorplasty ( STAPL Group ) , and the other 25 ( mean 54.6±14.2 years ) underwent a double Stapled Trans-Anal Rectal Resection ( STARR Group ) . Patients were followed-up for a mean period of 23.4±5.1 months in STAPL Group and 22.3±4.8 in STARR Group . Results STARR Group showed a significantly ( p < 0.0001 ) lower pattern of postoperative pain and a greater decrease ( P = 0.0117 ) of the rectal sensitivity threshold volume ; otherwise , no differences were found in operative time , hospital stay , or time of inability to work . Complications included delayed healing of the perineal wound ( ten ) , dyspareunia ( five ) , urinary retention ( two ) and stenosis ( one ) in STAPL Group , and urge to defecate ( four ) , transitory incontinence to flatus ( two ) , urinary retention ( two ) , bleeding ( one ) and stenosis ( one ) in STARR Group . All constipation symptoms significantly improved without worsening of anal continence and with excellent/good outcome at 20 months in 76 and 88 % of patients of STAPL Group and STARR Group , respectively . Seven patients of STAPL Group had a little residual rectocele , while both intussusception and rectocele were corrected in all patients of STARR Group . Neither operation modified anal pressures or caused lesions of anal sphincters . Conclusions Both techniques are safe and effective in the treatment of outlet obstruction ; nevertheless , the double Stapled Trans-Anal Rectal Resection seems to be preferable due to less pain , absence of dyspareunia , reduced rectal sensitivity threshold volume and absence of residual rectocele at defecography Abstract BACKGROUND : A prospect i ve , three-armed , r and omized , controlled trial was performed to assess whether pelvic floor exercises with biofeedback using anal manometry or transanal ultrasound are superior to pelvic floor exercises with feedback from digital examination alone in terms of continence , quality of life , physiologic sphincter strength , and compliance . Its secondary objectives were to assess whether there are any differences in these outcomes between biofeedback with transanal ultrasound vs. anal manometry and to correlate the physiologic measures with clinical outcome . METHODS : One hundred twenty patients with mild to moderate fecal incontinence were r and omized into one of three treatment groups : biofeedback with anal manometry , biofeedback with transanal ultrasound , or pelvic floor exercises with feedback from digital examination alone . Commencing one week after an initial 45-minute assessment session , patients attended monthly treatments for a total of five sessions . Each session lasted 30 minutes and involved sphincter exercises with biofeedback that involved instrumentation or digital examination alone , and patients were encouraged to perform identical exercises twice per day between outpatient visits . RESULTS : One hundred two patients ( 85 percent ) completed the four-month treatment program . Across all treatment allocations , patients experienced modest but highly significant improvements in all nine outcome measures during treatment , with 70 percent of all patients perceiving improvement in symptom severity and 69 percent of patients reporting improved quality of life . With the possible exception of isotonic fatigue time , there were no significant differences between the three treatment groups in compliance , physiologic sphincter strength , and clinical or quality -of-life measures . Correlations between physiologic measures and clinical outcomes were much stronger with ultrasound-based measures than with manometry . CONCLUSIONS : Although patients in this study who completed pelvic floor exercises with feedback from digital examination achieved no additional benefit from biofeedback and measurement with transanal ultrasound or manometry , it may be that the guidance received through digital examination alone offered patients in the pelvic floor exercise group an effective biofeedback mechanism . Contrary to our hypothesis , the use of transanal ultrasound offered no benefit over manometry , but the use of ultrasound for isotonic fatigue time and isometric fatigue contractions provided potentially important physiologic measures that require further study . This study has confirmed , through a large sample of patients , that pelvic floor retraining programs are an effective treatment for improving physiologic , clinical , and quality -of-life parameters in the short term Purpose This study was design ed to determine whether biofeedback is more effective than diazepam or placebo in a r and omized , controlled trial for patients with pelvic floor dyssynergia-type constipation , and whether instrumented biofeedback is necessary for successful training . Methods A total of 117 patients participated in a four-week run-in ( education and medical management ) . The 84 who remained constipated were r and omized to biofeedback ( n=30 ) , diazepam ( n=30 ) , or placebo ( n=24 ) . All patients were trained to do pelvic floor muscle exercises to correct pelvic floor dyssynergia during six biweekly one-hour sessions , but only biofeedback patients received electromyography feedback . All other patients received pills one to two hours before attempting defecation . Diary data on cathartic use , straining , incomplete bowel movements , Bristol stool scores , and compliance with homework were review ed biweekly . Results Before treatment , the groups did not differ on demographic ( average age , 50 years ; 85 percent females ) , physiologic or psychologic characteristics , severity of constipation , or expectation of benefit . Biofeedback was superior to diazepam by intention-to-treat analysis ( 70 vs. 23 percent reported adequate relief of constipation 3 months after treatment , chi-squared=13.1 , P<0.001 ) , and also superior to placebo ( 38 percent successful , chi-squared=5.7 , P=0.017 ) . Biofeedback patients had significantly more unassisted bowel movements at follow-up compared with placebo ( P=0.005 ) , with a trend favoring biofeedback over diazepam ( P=0.067 ) . Biofeedback patients reduced pelvic floor electromyography during straining significantly more than diazepam patients ( P<0.001 ) . Conclusions This investigation provides definitive support for the efficacy of biofeedback for pelvic floor dyssynergia and shows that instrumented biofeedback is essential to successful treatment The effect of exercise on pressure developed by the circumvaginal muscles ( CVM ) in postpartum women was studied . The CVM assessment system described earlier by Dougherty , Abrams , and McKey used an intravaginal balloon device ( IVBD ) developed from an impression and model of the vagina . The system ( IVBD , pressure transducer and strip chart recorder ) provided permanent CVM pressure tracings with high test-re-test reliability ( n = 16 ; r = .85 ) for maximum pressure ( MP ) . The hypothesis in the research reported here was that exercise with and without an IVBD , when compared to no exercise , would result in significantly higher MP and pressure over time ( POT ) . Forty-five healthy PP volunteers were r and omly assigned to a 10-minute per day home training program , for six weeks . The baseline and six-week assessment s consisted of CVM pressure tracings during contraction . Dependent variables were MP ( highest pressure attained ) and POT ( area under the pressure curve ) . Although no significant differences were found between the home training groups , greater improvement was found in the exercise groups . Variability within subjects partly accounts for the results . Pressure changes before and after pregnancy and before and after CVM exercise are demonstrated in a case study . The findings support the use of CVM exercise in the postpartum OBJECTIVE : To estimate whether treatment gains for provoked vestibulodynia participants r and omly assigned to  vestibulectomy , biofeedback , and cognitive – behavioral therapy in a previous study would be maintained from the last assessment —a 6-month follow-up — to the present 2.5-year follow-up . Although all three treatments yielded significant improvements at 6-month follow-up , vestibulectomy result ed in approximately twice the pain reduction as compared with the two other treatments . A second goal of the present study was to identify predictors of outcome . METHODS : In a university hospital , 51 of the 78 women from the original study were reassessed 2.5 years after the end of their treatment . They completed 1 ) a gynecologic examination involving the cotton-swab test , 2 ) a structured interview , and 3 ) vali date d pain and sexual functioning measures . RESULTS : Results from the multivariate analysis of variance conducted on the pain measures showed a significant time main effect ( P<.05 ) and a significant treatment main effect ( P<.01 ) , indicating that participants had less pain at the 2.5-year follow-up than at the previous 6-month follow-up . Results from the multivariate analysis of variance conducted on sexual functioning measures showed that participants remained unchanged between the 6-month and 2.5-year follow-up and that there were no group differences . Higher pretreatment pain intensity predicted poorer outcomes at the 2.5-year follow-up for vestibulectomy ( P<.01 ) , biofeedback ( P<.05 ) , and cognitive – behavioral therapy ( P<.01 ) . Erotophobia also predicted a poorer outcome for vestibulectomy ( P<.001 ) . CONCLUSION : Treatment gains were maintained at the 2.5-year follow-up . Outcome was predicted by pretreatment pain and psychosexual factors . LEVEL OF EVIDENCE : Urinary incontinence is one of the most common problems afflicting older adults and a major contributor to healthcare costs for homebound older individuals . The authors conducted a r and omized controlled clinical study examining the effectiveness of  biofeedback-assisted pelvic floor muscle training  and prompted voiding in treating urinary incontinence in homebound older adults . This article briefly describes the assessment and treatment protocol s utilized during this study and describes their subsequent application to clinical practice within a large urban home health agency BACKGROUND & AIMS Constipation is a common disorder , and current treatments are generally unsatisfactory . Biofeedback might help patients with const 
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The results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction