Background: Urinary incontinence (UI) is a public health issue from which many women suffer. There are different forms of UI and various causes of why the problem occurs, but the common factor is that UI contributes to shame and has a negative impact on women's quality of life (QoL). Aim: To find out if women find pelvic floor muscle training (PFMT) effective on UI-symptoms, and whether the effect differs depending on whether it is performed with or without aids: or as group versus individual training. The aim was also to illustrate the impact of PFMT on women's quality of life. Method: A literature review based on 15 scientific original articles with quantitative studies. The search was conducted in the databases PubMed and Cochrane Library. Results: The studies show that PFMT is an effective method to reduce symptoms of UI, both in combination with aids and without. Individual training proved more effective in strengthening the pelvic floor muscles (PFM) and in reducing urinary leakage, compared with group training. All articles that studied the relationship between PFMT and QoL showed that women's QoL increased when the symptoms of UI decreased. Four themes were identified regarding PFMT and UI in the study. Themes consisted of; effect, aid, training arrangements and QoL. Conclusion: All forms of PFMT showed positive results on symptoms of UI in women. PFMT reduced leakage, increased PFM strength and improved QoL. Intravaginal aids combined to PFMT proved to be the most effective method in reducing symptoms of UI. Keywords: Urinary incontinence, Pelvic floor muscle training, Women / Bakgrund: Urininkontinens är ett folkhälsoproblem som många kvinnor lider av. Det finns olika former av urininkontinens och olika orsaker till varför problemet uppstår. Den gemensamma faktorn är att urininkontinens bidrar till skam och har en negativ inverkan på kvinnors livskvalitet. Syfte: Att ta reda på om kvinnor finner bäckenbottenträning verksamt avseende urininkontinenssymtom, samt om verkan av bäckenbottenträning skiljer sig beroende på om den utförs med eller utan hjälpmedel, eller som grupp- kontra individuell träning. Syftet var även att belysa vilken inverkan bäckenbottenträningen har på kvinnors livskvalitet. Metod: En litteraturöversikt baserad på 15 vetenskapliga originalartiklar med kvantitativa studier. Sökningen genomfördes i databaserna PubMed och Cochrane Library. Resultat: Studierna visar att bäckenbottenträning är en verksam metod för att minska urininkontinenssymtom, både i kombination med hjälpmedel och utan. Individuell träning visade sig vara effektivare i att stärka bäckenbottenmusklerna och minska urinläckage, i jämförelse med gruppträning. Alla artiklar som studerade sambandet mellan bäckenbottenträning och livskvalitet visade att kvinnors livskvalitet ökade när symtomen av urininkontinens minskade. Fyra teman identifierades avseende bäckenbottenträning och urininkontinens i studien; verkan, hjälpmedel, träningsupplägg och livskvalitet. Slutsats: Samtliga former av bäckenbottenträning visade positiva resultat på symtom av urininkontinens hos kvinnor. Bäckenbottenträning minskade läckage, ökade bäckenbottenmuskelstyrka och förbättrade livskvalitén. Intravaginala hjälpmedel kombinerat med bäckenbottenträning visade sig vara den mest effektiva metoden för att minska symtom av urininkontinens. Nyckelord: Urininkontinens, Bäckenbottenträning, Kvinnor

No description available.

The purpose of this thesis was to explore the relationships between pregnancy, childbirth and incontinence (both urinary and faecal) and the effect of preventive activities during pregnancy on continence. Two papers comprise this thesis. The first paper, a scoping review, focused on examination of how pregnancy and childbirth affect continence in nulliparous women. Several key considerations were identified from the published literature that we suggest are crucial to understanding these relationships. The second paper, a systematic review, is focused on the effect of preventive measures during pregnancy on continence. Pelvic floor muscle training was found to be effective in reducing the incidence of incontinence at 3 months postpartum. Few studies met our inclusion criteria thus limiting analysis of data. Based on these two papers, further prospective research is suggested. The final chapter of this thesis outlines a developing PhD project that addresses gaps identified through the scoping and systematic reviews.

Bakgrund: För vissa kvinnor kan förlossningen medföra komplikationer som kan leda till en förlossningsbristning. Bäckenbottenträning med fysioterapeut kan hjälpa i rehabiliteringen efter en förlossningsbristning. Samtidigt kan en förändrad livsstil med ett nyfött barn försvåra rehabiliteringen. Idag finns det inga tydliga riktlinjer på hur fysioterapi efter förlossningsbristning ska upprätthållas vilket kan medföra skillnader i rehabiliteringen. Syfte: Att undersöka och beskriva förstagångsföderskors upplevelser och erfarenheter av hur de implementerar den fysioterapeutiska rådgivningen av bäckenbottenträning de fått efter en förlossningsbristning.  Metod: En kvalitativ intervjustudie har genomförts med ett bekvämlighetsurval där fyra förstagångsföderskor och en omföderska intervjuades. Intervjuerna var baserade på en semistrukturerad intervjuguide. En kvalitativ innehållsanalys användes vid databearbetningen.  Resultat: Innehållsanalysen resulterade i fyra kategorier och åtta subkategorier gällande informanternas upplevelser och erfarenheter av bäckenbottenträning i vardagen. Informanterna beskrev yttre hindrande faktorer exempelvis tidsbrist och vardagssysslor som resulterade i minskad följsamhet till bäckenbottenträningen. Informanterna hade olika strategier där planering och socialt stöd var viktiga för att upprätthålla bäckenbottenträningen. Samtliga informanter uttryckte en önskan om mer uppföljning och tydligare instruktioner från fysioterapeuten, vilket kunde ha påverkat implementeringen av bäckenbottenträningen i vardagen.  Konklusion: Informanterna upplevde både underlättande och hindrande faktorer till utförandet av bäckenbottenträningen. Exempelvis var planering och socialt stöd underlättande medan tidsbrist och obehag var hindrande faktorer till att följsamheten upprätthölls. Önskan om mer uppföljning och tidigare fysioterapeutkontakt beskrevs som förbättringar till framtida postpartumvård. / Background: For some women, childbirth could bring complications that could lead to a birth injury. Pelvic floor muscle training (PFMT) with a physiotherapist could be a part of rehabilitation after a birth injury. Together with a changed lifestyle with a newborn child rehabilitation could be more difficult. Today, there are no clear guidelines on how physiotherapy after a birth injury should be maintained which can lead to differences in rehabilitation.  Objectives: To examine and describe new mothers' experiences of how to implement the physiotherapist’s advice of PFMT that they received after their birth injury.   Method: A qualitative method with semi-structured interviews with four first-time mothers and one mother of three, based on convenience sampling. Qualitative content analysis was used for data analysis. Results: The qualitative content analysis resulted in four categories and eight subcategories regarding the informants' experiences of PFMT in everyday life. Lack of time and chores were examples of obstructive factors that made it difficult with compliance in their PFMT. Planning and social support were examples of strategies that helped maintain PFMT. A desire for more follow-up and clearer instructions from the physiotherapist were expressed, which could have affected the implementation of their training in everyday life.  Conclusion: The informants experienced both facilitating and obstructive factors to practice PFMT. For example, planning and social support were facilitating factors, while lack of time and discomfort reduced compliance. More follow-up and earlier contact with the physiotherapist were described as desirable for future postpartum care.

Bakgrund: Förlossningsskador är vanligt förekommande och graderas på en skala mellan 1–4 beroende på typ av skada och kan påverka individens sexuella funktion samt livskvalitet. Bäckenbottenträning är en vanlig behandlingsmetod för kvinnor efter förlossning.  Syfte: Denna systematiska litteraturstudie syftade till att undersöka det aktuella vetenskapliga underlaget gällande effekten av bäckenbottenträning efter en obstetrisk skada på sexuell funktion och/eller livskvalitet, samt om bäckenbottenträning kan medföra eventuella biverkningar.  Metod: En systematisk litteraturundersökning i databaserna; PubMed, Cinahl och Scopus. De inkluderade artiklarnas risk för snedvridning granskades enligt PEDro-skalan samt enligt en lokal bedömningsmall inspirerad av GRADE  Resultat: Fem artiklar inkluderades. En av fem studier hade signifikant skillnad mellan grupp gällande sexuell funktion efter bäckenbottenträning samt en studie visade signifikant skillnad rörande symtom relaterat till sexuell funktion. En av tre visade signifikant skillnad rörande livskvalitet efter bäckenbottenträning. Tre studier granskade eventuella biverkningar av träningen och fann inga. PEDro granskningen indikerade låg risk för snedvridning i alla fem artiklar. Den lokala bedömningsmallen inspirerad av GRADE visade en mycket låg evidens för bäckenbottenträningens effekt på sexuell funktion och livskvalitet efter obstetriska skador. Konklusion: Bäckenbottenträningens effekt efter en obstetrisk skada på sexuell funktion och/eller livskvalitet har vissa signifikanta effekter. Inga rapporterade biverkningar av bäckenbottenträningen enligt de inkluderade studierna. PEDro-granskningen visade låg risk för snedvridning. På grund av studiernas heterogenitet samt en mycket låg evidensstyrka är det svårt att fastställa effekten på sexuell funktion och livskvalitet. Fler studier av hög kvalitet behövs för vidare slutsatser om detta. / Background: Birth injuries are common and rated from 1-4 depending on the type of injury and can affect the individual's sexual function and quality of life. Pelvic floor training is a common treatment method for women after childbirth. Objective: To explore the scientific evidence regarding the effect of pelvic floor training post-obstetric injury on sexual function and/or quality of life and potential side effects.   Method: A systematic literature search conducted in the databases; PubMed, Cinahl and Scopus. The article’s risk of bias was assessed using the PEDro scale and a local tool inspired by GRADE  Results: Five articles were included. One study demonstrated significant differences in sexual function between groups and one study showed difference in symptoms related to sexual function after pelvic floor training. One in three studies found improved quality of life post-training. No side effects were reported in three studies. The PEDro-scale found low risk of bias regarding all articles. Local tool inspired by GRADE assessment of certainty showed very weak evidence for training's impact after obstetric injuries on sexual function and quality of life. Conclusion: Pelvic floor training post-obstetric injury has certain significant effects on sexual function and/or quality of life. No side effects were reported, however, due to heterogeneity and very weak evidence determining it effect on sexual function and quality of life remains challenging. More high-quality studies are needed for further conclusions on this matter.

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Syfte: Urininkontinens är ett folkhälsoproblem som berör åtminstone 500 000 svenskar.  Studiens syfte var att kartlägga sjukgymnastisk behandling med bäckenbottenträning, vid urininkontinens hos kvinnor, på primärvårdsnivå i Uppsala län. Metod: Studien hade en kvantitativ och deskriptiv design. Data samlades in via en webbenkät som skickades till alla sjukgymnaster på primärvårdsnivå i Uppsala, både offentligt anställda och privata sjukgymnaster med landstingsavtal. Resultat: 96 sjukgymnaster tillfrågades om deltagande i studien varav 65 besvarade enkäten (68 %). Drygt hälften av respondenterna behandlade med bäckenbottenträning. Antalet patienter som behandlades var lågt. Det var få patienter som remitterades från andra vårdgivare. Den vanligaste kontaktvägen var att patienten besökte sjukgymnast av andra orsaker och själv påtalade eller tillfrågades om urininkontinens. Det sjukgymnastiska omhändertagandet omfattade anamnes, information om bäckenbotten och knipteknik, praktisk träning samt muntlig utvärdering. Nära hälften av respondenterna önskade mer utbildning inom området.   Konklusion: Resultatet från studien visade att sjukgymnaster på primärvårdsnivå var en underutnyttjad resurs i behandlingen av urininkontinens hos kvinnor. I framtiden skulle ett utökat samarbete mellan sjukgymnaster och andra vårdgivare på primärvårdsnivå kunna ge effektivare patientflöden, så att fler kvinnor kan erbjudas behandling. För att möjliggöra detta behöver sjukgymnasterna själva informera lokalt om sin kompetens till berörda vårdgivare. Det behövs också utbildningsinsatser för att fler ska känna sig säkra i att behandla med BBT. / Objectives:  Urinary incontinence is a public health problem affecting at least 500 000 Swedes. The aim of this study was to conduct a survey examining physiotherapy treatment of pelvic floor muscle training, for urinary incontinence in women, at the primary care level in the county of Uppsala. Method:  The study had a quantitative and descriptive design. Data were collected with an online questionnaire that was sent to all physiotherapists with public contracts working at the primary care level in the county of Uppsala. Results:  96 physiotherapists were asked to participate in the study and 65 of them answered the questionnaire (68 %). More than half of the respondents gave treatment consisting of pelvic floor muscle training. The number of patients who received treatment was low. Few patients were referred by other health-care workers. The most common way for the patients to receive treatment was that they visited the physiotherapist because of other health problems and the subject of urinary incontinence came up. The treatment usually included medical history, information about the pelvic floor muscles, instructions on appropriate muscle contraction, practical training and verbal evaluation. Almost half of the respondents requested more education within the field. Conclusion:  The results from this study showed that physiotherapists at the primary care level were an underutilized resource in the treatment of women with urinary incontinence. In the future, improved cooperation between physiotherapists and other health-care workers at the primary care level would increase the number of women receiving treatment. To facilitate this outcome, physiotherapists need to engage in outreach activities to inform other health-care workers regarding their competence in this field. In addition, further education is required in order to help physiotherapists feel more confident in providing pelvic floor muscle training.

Bakgrund: Bäckenbottendysfunktion innebär onormal funktion i bäckenbottenmuskulaturen som orsakas av ökad eller minskad muskeltonus och nedsatt koordination av bäckenbottenmusklerna.  Det innefattar flera olika funktionella problem och delas upp i urologiska, gynekologiska eller kolorektala. Biofeedback är en apparat som kan användas som ett tillägg till vanlig bäckenbottenträning. Den är till för att lära sig använda rätt teknik och kontrollera och identifiera rätt muskler. Man kan använda biofeedback till att träna styrka, uthållighet, koordination samt avslappning. Syfte: Undersöka effekten av bäckenbottenträning med biofeedback på blås- och tarmtömningsbesvär (utöver urin- och fekalinkontinens), livskvalitet och sexuell funktion jämfört med bäckenbottenträning utan biofeedback/sedvanlig behandling/ingen träning alls. Metod: Systematisk litteraturstudie med databaserna PubMed och Web of Science. Studiernas kvalitet granskades med PEDro och resultatets tillförlitlighet granskades enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter.  Resultat: Sju randomiserade kontrollerade studier inkluderades. Alla studier visade signifikant förbättring hos interventionsgrupperna. Fyra studier undersökte tömningssvårigheter, tre undersökte livskvalitet och två studier undersökte sexuell dysfunktion. Fem studier undersökte biverkningar av biofeedback utan fynd. Alla studier hade god kvalitet enligt PEDro, men samtliga visade på mycket låg tillförlitlighet (+) enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter. Konklusion: Det tyder på att bäckenbottenträning med biofeedback har positiv effekter på blås- och tarmtömningssvårigheter, livskvalitet och sexuell funktion hos personer med bäckenbottendysfunktion. Inga fynd av biverkningar av bäckenbottenträning med biofeedback hittades. Studierna hade god kvalitet enligt PEDro och dess sammanvägda resultat hade mycket låg tillförlitlighet (+). Resultatet bör därför tas med försiktighet och fler randomiserade kontrollerade studier behövs för att kunna dra några slutsatser. / Background: Pelvic floor dysfunction means abnormal function of the pelvic floor muscles caused by increased or decreased muscle tone and reduced coordination of the pelvic floor muscles. It includes several different functional problems such as urological, gynecological or colorectal. Biofeedback is a device that can be used as an addition to regular pelvic floor training. It helps people to use the right technique and to control and identify the right muscles. Biofeedback can be used to train strength, endurance, coordination and relaxation. Objective: Investigate the effect of pelvic floor training with biofeedback on bladder- and bowel voiding difficulties (except for urinary- and fecal incontinence), quality of life and sexual function compared to pelvic floor training without biofeedback/usual care/no training. Method: Systematic literature study which used the databases PubMed and Web of Science. The quality of the studies was reviewed using PEDro and the reliability of the results were reviewed according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Results: Seven randomized controlled trials were included in this study. All studies showed significant improvement in the intervention groups. Four studies examined voiding difficulties, three examined quality of life and two studies examined sexual dysfunction. Five studies investigated side effects of biofeedback with no findings. All studies had good quality according to PEDro, however all showed very low reliability (+) according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Conclusion: It indicates that pelvic floor training with biofeedback has positive effects on bladder- and bowel voiding difficulties, quality of life and sexual function in people with pelvic floor dysfunction. There are no findings of side effects of pelvic floor training with biofeedback. The studies were of good quality according to PEDro and their combined results had very low reliability (+). The result should therefore be taken with caution and more randomized controlled trials are needed to reach more reliable conclusions.