The aim of the study was to assess the position of the urethra after performing exercises using surface electromyography in the form of telerehabilitation. It was assumed that patients with stress urinary incontinence, after using surface electromyography in the form of biofeedback and telerehabilitation, will obtain better parameters in terms of pelvic floor muscle contraction, as well as during coughing or Valsalva maneuver than patients exercising without surface electromyography.

The study involved 52 (n=52) patients aged 45-60 who declared stress urinary incontinence. They were randomly assigned to 2 groups: group A, which performed pelvic floor muscle exercises using a surface electromyography biofeedback device, and group B, which performed the same pelvic floor muscle exercises without using surface electromyography biofeedback. The exercises were proposed in an identical form for both groups and were performed every second day. The number of days on which exercises were performed during 2 months was 30. The exercises included the activation of both slow-twitch and fast-twitch muscle fibers.
Assessment of the position of the urethra and its behavior in the event of coughing and straining was performed in both groups at the beginning and end of the study using ultrasound. Exercises in both groups were carried out for 2 months. A quality of life questionnaire, Incontinence Impact Questionnaire, Short Form (IIQ-7) was also performed before and after the exercises.
the research was approved by the relevant institutional bioethics committee, in accordance with Good Clinical Trials procedures. Participation in the study was voluntary, and each patient gave written consent.

As a result of the analysis of measurements of the position of the urethra during volitional tension of the pelvic floor muscles as well as coughing and sneezing, statistically significant differences were demonstrated in the scope of measurements performed as well as in the declared quality of life. Significant differences in the ability to perform volitional contraction of the pelvic floor muscles concerned patients exercising with surface electromyography in the form of biofeedback (group A)
There was a general improvement in the patients' quality of life in group A patients exercising with surface electromyography in the form of biofeedback.

Patients using surface electromyography from group A had biofeedback and could observe their pelvic floor muscle contraction results on the computer screen. Such observation probably strengthened the effect of engaging in the above process and also made the patients more aware of the possibility of using their own muscles. Patients from group B who did not use surface electromyography also achieved good results in terms of volitional contraction compared to the beginning and end of their exercises, however, the statistical difference is clearly visible in group A.

The use of surface electromyography in the form of biofeedback in patients with grade I stress urinary incontinence brings significant differences in the ability to contract and stabilization the pelvic floor muscle and thus improves their quality of life.

Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients Edyta Wlazlak, Tomasz Kluz2, Grzegorz Surkont, Jacek Kociszewski,
Junginger B, Vollhaber H, Baessler K. Submaximal pelvic floor muscle contractions: similar bladder-neck elevation, longer duration, less intra-abdominal pressure. Int Urogynecol J. 2018