Effects of BeBo® Pelvic Floor Muscle Training with and Without Electromyographic Biofeedback After Vaginal Delivery and Cesarean Section: A Randomized Controlled Trial

Abstract

Background/Objectives: Pelvic floor dysfunctions, including urinary incontinence (UI) and impaired sexual quality of life, are common postpartum complications. Although pelvic floor muscle training (PFMT) is recommended as first-line treatment, evidence regarding the additional benefits of electromyographic (EMG) biofeedback, particularly after different modes of delivery, remains limited. The objective was compare the effectiveness of BeBo®-based PFMT performed with and without EMG biofeedback on pelvic floor muscle function, urinary continence, health-related quality of life, and sexual quality of life in women following vaginal delivery (VD) and cesarean section delivery (CD). Methods: This randomized assessor-blinded controlled trial was conducted at the University of Physical Culture in Cracow, Poland. A total of 120 primiparous women (29.0 ± 1.9 years), assessed 6–8 weeks postpartum after VD (n = 60) or CD (n = 60), were randomly allocated to BeBo® training, BeBo® training combined with EMG biofeedback, or a control group. Intervention groups completed a supervised 6-week BeBo®-based PFMT program with or without EMG biofeedback, whereas controls received standardized postpartum pelvic floor health education only. Primary outcomes were pelvic floor muscle strength and endurance assessed using perineometry and the PERFECT scheme. Secondary outcomes included urinary incontinence (UDI-6), health-related quality of life (KHQ), and sexual quality of life (SQoL-F). Results: Both intervention protocols significantly improved pelvic floor muscle function compared with controls, with the greatest improvements observed following BeBo® training combined with EMG biofeedback. Significant effects of time and intervention were demonstrated for muscle strength and endurance (p < 0.001). Both interventions reduced UI symptoms, particularly after VD, and improved health-related and sexual quality of life. Women receiving EMG biofeedback achieved superior muscle endurance and functional performance compared with controls and, for several outcomes, compared with BeBo® training alone. Greater UI severity was associated with poorer sexual quality of life. Conclusions: BeBo®-based PFMT effectively improves postpartum pelvic floor function and urinary continence. The addition of EMG biofeedback provides further benefits, particularly in muscle endurance and functional control, supporting its integration into postpartum urogynecological rehabilitation after both VD and CD. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12622000563763.