# U Control Biofeedback: How low to go?



## Hyposensitive Guy (Jun 14, 2014)

*My background:*

I've suffered from chronic constipation for ten years now; originally, the problem involved the constant urge to go, but about six years ago, it switched over to where I never have the urge to go (and some urological difficulties started then as well); this has now been diagnosed as rectal hyposensitivity.

About three years ago, I went to the Mayo Clinic biofeedback program for pelvic floor dyssynergia/paradoxical contraction/anismus/whatever you call it. I'd been through several rounds of biofeedback at other places which had been universally unhelpful, frustrating experiences, but the Mayo Clinic's program of multiple sessions per day, every day for two weeks, + home training was wonderful. I made a huge amount of progress in relaxing my pelvic floor.

Alas, it did not solve my constipation, or, in particular, my rectal hyposensitivity (which I suspect is now the stumbling block to relief). C'est la vie.

*My current question:*

I still have the Thought Technology "U-Control" device the Mayo Clinic gave me, and I've recently decided to try using it again. I keep it on x1 mode, and notice that, with the side dial being 3, I start off at a level of A or B easily, standing, sitting, you name it. And even when I start at B [on side dial 3], I quickly get to a consistent A.

As I recall, that's what my Mayo Clinic therapist had told me to get to: A on level 3. So I would appear to be just fine now, by that metric. I think I maintain this level of relaxation throughout the day, too.

But now I'm wondering, particularly after reading some other posts here: This A on level 3 corresponds to about a D on level 1. Do people go even lower than that as their normal resting tone? Should I be shooting to get my resting tone down to A on level 1 now [even though I'm pretty sure my therapist had only said A on level 3 was the goal]? Or is A on level 1 just to be aimed for while actively bearing down, or what?

Thanks for your help, fellow (/former?) sufferers!


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## annie7 (Aug 16, 2002)

Hi

that's wonderful you've made such great progress in relaxing your pelvic floor!!

i have the U Control too and have been using it since mid february. i did not go to mayo for biofeedback though. i did it locally--an excellent program conducted through the University of Michigan. my PT is fantastic. she helped me tremendously. really helped me to relax.

sounds like you've probably read Dreamcatcher's posts about her mayo visit. she told me where to get the U Control and also told me her mayo PT told her the ideal setting was "1" and the goal was to get to "A" when it's set at "1". in all positions, bearing down or otherwise. she said her PT told her to : "Live at "A" (when set at 1) as the goal. and of course stay relaxed like that all day not just when using the machine.

i'm sure when Dreamcatcher sees your post she will reply with helpful information.

everyone is different in their needs and problems. biofeedback/PT is not supposed to be cookie cutter--the PT should tailor it to fit each particular patient's particular problems and needs. a good PT will consider the patient's entire medical history, health problems etc when offering advice and guidance. perhaps your therapist felt that A at "3" was a good goal for you? can you call or e-mail her for follow up advice? she would be your best source for advice since she knows your history and has worked with you.

like you, i also have rectal hyposensitivity. also megarectum. never get the urge except if i use laxatives. i started biofeedback/PT locally last summer but my sessions were interrupted by my needing emergency surgery, subsequent long hospitalization and even longer recovery period. i have just started biofeedback up again with the same wonderful PT and am picking it up where we left off. my gastro recommended that i try the balloon expulsion training in addition to working with the biofeedback machine in the hopes that working with the balloon will help with my rectal hyposensitivity. so i'll be starting up with that mid july. fingers crossed it works. did you do the balloon expulsion training at mayo? sounds like it's part of their program?

good luck with everything.


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## Dreamcatcher32 (Nov 12, 2013)

Glad to hear the Mayo Clinic Biofeedback was quite helpful for you! It was for me too. I honestly can't say what a man should be at when it comes to the u-control device. I think it's best to contact the nurse you work with and see what she says in regards to what your 'ideal' resting tone should be at. I do think men have tighter pelvic floors then women, though I've also heard the reverse is true. Are you also using the balloon to help relax the muscles down and train yourself on how to have a relaxed bowel movement? Try using the sensor AFTER the balloon and you will notice the difference. 

Great to hear you're maintaining the lower level throughout the day. That is the hardest part! I find it's difficult for me to tell when walking or doing certain activities. Sitting is especially rough.

I am unsure about level 3 at A being level 1 at a D. That doesn't quite add up to me, might ask her about that also. Have you also tried Baclofen suppositories? These can be super helpful at getting you down to the lower level. I notice I am consistently at A & B if I use these on a daily basis for a good week or so. I can't really speak to the hyposensitivity as I do not have that.

Good luck to you!


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## Hyposensitive Guy (Jun 14, 2014)

Thanks for your responses!

I used to use the balloon, but eventually one of mine broke and I stopped (even though I still have the second one they gave me). I had gotten to a point where I expelled the balloon quickly and easily every time, though. [Alas, the Mayo Clinic gave me all these marked improvements, and yet still my day-to-day problems weren't relieved. Perhaps it never will be till someone figures out what to do about my rectal hyposensitivity...]

As for what A on level 3 corresponds to at level 1, see, for example, the table on page 11 of the U-Control manual, which notes that the threshold for A on level 3 is the same as the threshold for E on level 1. [Of course, A being the lowest possible letter, anything lower than E on level 1 will also show up as an A on level 3.]


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## Jinky (May 23, 2014)

Just for clarification, if biofeedback does not help with constipation, what does it do? I would think relaxing the pelvic floor would help relax the puborectalius (a muscle of the pelvic floor), thus help ease defecation. But I guess you can't keep it relaxed all the time, only when on the toilet? Because I would think if my puborectalius was relaxed all the time, the outlet obstruct would clear, and the pressure/backup that results from that would be relieved, improving transit.


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## annie7 (Aug 16, 2002)

this probably doesn't answer your question. but after reading your post the thoughts that came to my mind on the subject are:

i think biofeedback can teach us to keep those muscles relaxed--or at least more relaxed--most if not all of the time. at least that is what seems to be one of the goals--to "live at A" as Dreamcatcher said her PT told her. and i 've read this too.

biofeedback can help with constipation for those people who do not have slow transit that is caused by something other than tight pelvic floor muscles. in other words if tight pelvic floor muscles prevent you from getting stool out--or much stool out-- you get more and more backed up and that sends signals to the colon and ultimately the whole digestive system to slow down because there is a backup at the outlet. so learning to relax those muscles helps stool move along and helps move waste along through the whole digestive system.

but --some people--myself included --have slow colonic transit due to other reasons--not pfd. i know of people who have had a colectomy and the pathology report showed that their colon had been lacking the institial cells of cajal--the gut pacemaker cells that are the basis of peristalsis.

in my case i have mitochondrial disease which basically means my cells don't produce enough energy. and this slows down many bodily functions especially in high energy consuming organs such as the colon.

so with me the hope is that biofeedback will help me relax to help move stool out more easily once it is in the rectum. and i find that has gotten a bit easier since i started biofeedback. but because my colon is slow due to mito, i'll still have to take laxatives to move things down to the rectum. no laxatives, no movement.

i think all this depends on the particular person and what is causing their constipation problems.


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## Dreamcatcher32 (Nov 12, 2013)

Jinky said:


> Just for clarification, if biofeedback does not help with constipation, what does it do? I would think relaxing the pelvic floor would help relax the puborectalius (a muscle of the pelvic floor), thus help ease defecation. But I guess you can't keep it relaxed all the time, only when on the toilet? Because I would think if my puborectalius was relaxed all the time, the outlet obstruct would clear, and the pressure/backup that results from that would be relieved, improving transit.


If your pelvic floor is too tense, you WILL be constipated. Even if you have another cause for your constipation (which is less common than a simple pelvic floor problem), you still have to relax the pelvic floor - or the constipation will continue. Biofeedback is extremely difficult to get the hang of. I have found the only way to 'know' if you're relaxed enough without the sensor is to get an urge to go to the bathroom while relaxing down. If you just 'think' you're relaxed down - you might not be. Getting that urge to go to the bathroom is going to be a clear indicator that you're relaxed.

I think most get very frustrated by biofeedback as it isn't a 'quick' fix. The process can take years for some. For others, they'll always have to 'check in' with their pelvic floor and consider it maintenance.


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