mTrigger Pelvic Protocol Final User Guide

mTrigger Pelvic Protocol Final

Specifications

Dyssenergic Defecation Exercises

Supine Diaphragmatic Breathing:
- Position: Supine
- Probe/Electrode: Electrode: 9:00 and 3:00 on External anal sphincter. Probe: rectal probe.
Seated PFM Relaxation with Use of Low Tone:
- Position: Feet supported on stool /squatty potty.
- Probe/Electrode: Electrode: 9:00 and 3:00 on External anal sphincter. Probe: Rectal only if sitting on a commode or toilet.
Belly Big Belly Hard:
- Position: Sitting on toilet/commode with stool under feet OR Sitting on chair with stool under feet.
- Probe/Electrode: Electrode: 9:00 and 3:00 on External anal sphincter. Probe: Rectal only if sitting on a commode or toilet.

Introduction

Pelvic health physical therapists are uniquely positioned at the intersection of several disciplines of physical therapy. When it comes to pelvic floor dysfunction, one of the greatest barriers to progress remains the same: patients can’t effectively contract—or relax—what they cannot feel or see. Without objective feedback, we are often relying on subjective cues and manual assessment alone. This is where mTrigger biofeedback becomes a powerful clinical tool.
For clinicians, mTrigger biofeedback offers a way to standardize and elevate pelvic floor training. By transforming neuromuscular activity into measurable data, clinicians can assess baseline function, dose exercise with greater specificity, and track meaningful change over time. When integrated thoughtfully into a comprehensive plan of care, it can improve patient engagement, accelerate skill acquisition, and reinforce carryover into functional tasks.
For patients, mTrigger biofeedback transforms pelvic floor muscle activity into visual or auditory signals, making the difference between intention and execution achievable.
Whether treating urinary incontinence, pelvic pain, postpartum dysfunction, pelvic organ prolapse, or dyssenergic defecation, biofeedback provides objective data that enhances patient awareness, improves recruitment strategies, and reinforces carryover into functional activities such as toileting, maintaining continence, and returning to sport.
mTrigger biofeedback is the tool you need for pelvic floor rehabilitation.

Dyssenergic Defecation

Exercise	Position	Probe/Electrode	Cueing/Instructions	Dosage
Supine Diaphragmatic Breathing	Supine	Electrode: 9:00 and 3:00 on External anal sphincter Probe: rectal probe	On an inhale fill belly up with air, feeling ribs expand laterally, posteriorly and anteriorly, allowing pelvic floor to relax	Between 2-8 minutes or as long as the patient needs to grasp the movement
Seated PFM Relaxation with Use of Low Tone	Feet supported on stool /squatty potty	Electrode: 9:00 and 3:00 on External anal sphincter Probe: Rectal only if sitting on a commode or toilet	On an inhale fill belly up with air, feeling ribs expand laterally, posteriorly and anteriorly, allowing pelvic floor to relax On an exhale make a low tone, a MOOOO, an OOOOOO, or OAMMM to decrease recoil of the pelvic floor during exhalation	Between 2-8 minutes or as long as the patient needs to grasp the movement
Belly Big Belly Hard	Sitting on toilet/commod e with stool under feet Sitting on chair with stool under feet	Electrode: 9:00 and 3:00 on External anal sphincter Probe: Rectal only if sitting on a commode or toilet	Big Belly = True Abdominal Expansion Take a slow breath into your belly and low ribs. Let your belly soften and expand forward. Melt your sit bones apart. Let your tailbone gently widen. Drop your pelvic floor like you’re passing gas. Imagine your anus opening like a flower. Hard Belly = Controlled Abdominal Wall Tension (NOT Valsalva) Gently firm the abdominal wall outward — not inward Think: Expand and gently press down. Exhale the entire time Keep your pelvic floor dropped while your belly firms. Goal: have patient relax pelvic floor during belly big, have them maintain relaxation with gentle pressure on exhale to learn new PFM coordination during bowel movements	As many repetitions as it takes for the patient to relax pelvic floor and properly sequence the push without contraction

Weakness

Exercise	Electrode/probe	Cuing/Instructions	Dosage
PERF	See decision tree	P– strongest contraction (looking for max microvolts) E– endurance- how long can they hold at max contraction R– how many repetitions can the patient do the max and endurance hold for F– how many fast contractions can the patient do	Do this whole series at the start of a session to practice and to track progress in strength over time
Adductor Squeeze + PFMC	See decision tree	On an exhale engage pelvic floor then squeeze knees together against a ball or yoga block for isometric contraction	3x 8-12
Bridge + PFMC	See decision tree	On an exhale engage pelvic floor then lift into a bridge, slowly inhale on the decent back to the mat	3x 8-12
Walking w/ 50% PFMC	See decision tree	Engage pelvic floor to 50% of MVC, hold at that level while walking in place or around available space	Start with a couple of steps then walking until patient starts to drop below the 30% threshold.

Stress Incontinence

Exercise	Electrode/probe	Cuing/Instructions	Dosage
KNACK	See decision tree	Just before any increase in abdominal pressure (cough, sneeze, lift, jump), perform a quick strong pelvic floor squeeze	For neuromuscular re-education, practice as many times as needed to build muscle memory
Sit to Stand + PFMC	See decision tree	Engage pelvic floor on an exhale before going from sitting to standing. Maintain contraction until in standing, then gently relax pelvic floor	3x 8-12
Lifting/Squat + PFMC	See decision tree	Engage pelvic floor as you lift the object or come into standing. Be sure to perform an exhale as well. Add weight to simulate ADLs or periods of leakage	3x 8-12
Modified Mountain Climber + PFMC	See decision tree	On an exhale perform a PFMC, then slowly start doing a mountain climber while softly breathing and maintaining PFMC working to increase speed	Perform 4 repetitions of 45 seconds or until patient drops PFMC

Resources

Cleaning guide
Clean with cold soapy water and then rinse before and after each treatment. Dry with a paper towel. Alcohol is not suitable for cleaning.

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