The vagus nerve links our autonomic nervous system to our emotions and It is a neurobiological evidence for the mind-body connection. The pelvic floor is one of the most fascinating connections with the vagus nerve. Stress inhibits the vagus nerve and many pelvic floor dysfunction-related symptoms and diseases (constipation, incontinence , chronic pelvic pain, irritable bowel syndrome) may be related to low (inhibited) vagal nerve tone due to different type stressors.Therefore  vagus nerve stimulation may be an additional holistic approach  therapy for conventional pelvic biofeedback therapies mainly due to its relaxing and anti-inflammatory properties during stress.The MYMOP2 has been shown to be validated and highly sensitive/responsive outcome measure (reference 1).
Aimed to observe the effects of vagus nerve stimulation protocols added to pelvic biofeedback therapy by using MYMOP2 tool on patients with pelvic ffoor disorders.

This is a retrospective comparison of 2 patient groups treated with different biofeedback modalities. Group A included the patients (n:76) with anorectal disorders dysfunctions who admitted to our pelvic floor unit  between September 2022-March 2023 and   treated with biofeedback therapy and vagus nerve stimulation protocols (table 1) . Group B  included the patients (n:35) with similar symptoms to group A but admitted to our unit  during  the first months of 2019 who were selected for the Turkish validation study for MYMOP2  (reference2) tool and were treated with biofeedback treatment but without any vagus nerve stimulation protocols. In both group A and B, all patients symptoms were assessed via MYMOP2 tools (with Turkish validated forms)  at  initial (before treatment) and follow-up (after two months)  periods. Then the results  of MYMOP2 evaluation scores of group A and B are statistically compared.

According to MYMOP2 assesment, a minimum clinically important change in score after intervention should be between 0.5-1.0 which means ‘no change’ with the intervention and  greater than 1.0 is considered clinically significant improvement/change. Clinically significant MYMOP2 score ratio of Group A are found to be statistically clinically significant than Group B (90.58 % vs 57.1%, p-value is lower than 0.05 chi-square test).

Adding vagaus nerve stimulation protocols may increase the success rate of the biofeedback treatment including pelvic floor exercises. 
Weakness of the study : Apart from the vagal protocols given to group A , same biofeedback therapy modality were given to both groups but with different pelvic physiotherapists which can be a bias factor in evaluating  the positive effectiveness of vagal protocols.

Noninvasive vagus nerve stimulation protocols could be a complimentary therapy  (not a substitute)  to other treatment options (like biofeedback therapy) for  pelvic floor dysfunctions.

Hermann K, Kraus K, Herrmann K, Joos S. A brief patient-reported outcome instrument for primary care: German translation and validation of the Measure Yourself Medical Outcome Profile (MYMOP). Health and quality of life outcomes. 2014 Dec;12(1):112.
Ersoy Ö, Temel YE, Alptekin HK. Validity and reliability of the measure yourself medical outcome profile 2 (MYMOP2) questionnaire among Turkish patients having anorectal disorders. Turk J Gastroenterol 2019; 30: 28-32.