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Precision Pelvic Floor Rehabilitation: The MAPLe by Novuqare and Its Role in Pelvic Health Physiotherapy

  • Apr 9
  • 7 min read

Pelvic Health Physiotherapy

Gráinne Walsh Clinical Specilist Physiotherapist in Pelvic Health Dublin Rep. of Ireland.


Pelvic floor dysfunction is one of the most common yet underdiagnosed conditions in healthcare. From urinary incontinence and overactive bladder to chronic pelvic pain, faecal incontinence, and the pelvic floor consequences of endometriosis, these conditions affect millions of people worldwide and can profoundly impact quality of life, relationships, and mental health.


As pelvic health physiotherapists, our ability to accurately assess and effectively treat the pelvic floor is only as good as the tools we use. That is why the MAPLe (Multiple Array Probe Leiden) by Novuqare Pelvic Health represents such an exciting advancement in our field. It is the first clinically validated system for high-definition electromyography (EMG) recording and targeted electrical stimulation of the pelvic floor muscles.[1][2]


What Is the MAPLe?

The MAPLe is an advanced pelvic floor therapy device developed in collaboration with Leiden University Medical Centre in the Netherlands.[3] It consists of a slim, single-patient-use probe containing 24 gold-plated electrodes arranged at six different heights and four different orientations along its length.[4] This unique design allows the device to perform two key functions:


  1. High-Definition EMG Biofeedback

Each of the 24 electrodes can independently measure the electrical activity in individual pelvic floor muscles. This means the MAPLe can detect not just whether the pelvic floor is contracting, but precisely which muscles are active, at what depth, and on which side of the pelvic floor.[5][6] This level of detail is simply not possible with traditional single-channel biofeedback probes.

The data is transmitted wirelessly to an iPad application, providing real-time visual feedback in an intuitive "bull's eye" pattern that both clinician and patient can view together.[7]


  1. Targeted Electrical Stimulation

Beyond assessment, each electrode can also deliver localised electrical stimulation to specific muscles within the pelvic floor complex.[8] This means that rather than stimulating the entire pelvic floor indiscriminately (as with conventional devices), the MAPLe can target the exact area that needs strengthening, sensory retraining, or down-regulation.[9]

The probe can be used both vaginally and rectally, making it suitable for treating both women and men.[1]


Why Does Precision Matter?

Traditional pelvic floor assessment relies primarily on digital palpation and, in some cases, single-channel EMG probes. While these methods are valuable, they have significant limitations:

  • Single-channel probes provide an average reading across the entire pelvic floor, potentially masking asymmetries or localised dysfunction[3]

  • Digital palpation, while clinically essential, is inherently subjective and cannot objectively quantify changes over time

  • Many patients have asymmetrical dysfunction: for example, following an episiotomy, forceps delivery, or surgery, one side of the pelvic floor may be significantly weaker than the other[10]

The MAPLe addresses all of these limitations. Its segmental EMG reveals asymmetries that are undetectable with single-channel probes, and its precision-targeted stimulation supports neuromuscular re-education at the exact site of dysfunction.[3]


What Does the Evidence Say?

What sets the MAPLe apart from many pelvic floor devices on the market is its clinical evidence base. A systematic review presented at the International Continence Society (ICS) found that the MAPLe was the only pelvic floor device supported with data from peer-reviewed journals. By contrast, the evidence for all other devices was, at best, limited.[2][2]


Reliability and Validation

The foundational validation study by Voorham-van der Zalm et al. (2013), published in Neurourology and Urodynamics, tested the MAPLe in 229 healthy volunteers and confirmed moderate to good intraclass correlation (ICC) for test-retest reliability across the device's electrode measurements. The study validated the probe's ability to reliably measure and differentiate EMG activity from different layers and sides of the pelvic floor musculature.[4][2] A further study confirmed good test-retest reliability of the MAPLe device in men with lower urinary tract symptoms when using a strict protocol.[11]


Overactive Bladder

A randomised controlled trial (Voorham et al., 2017) evaluated EMG biofeedback-assisted pelvic floor muscle therapy with the MAPLe compared to lifestyle advice alone in 58 women with Overactive Bladder Syndrome (OAB). After nine weeks of treatment, the MAPLe group showed significant improvements across multiple outcome measures, including the Pelvic Floor Inventories questionnaire, the King's Health Questionnaire, 24-hour voiding diaries (urgency, p = 0.008), daily pad use (p = 0.03), and 24-hour pad tests.[2][12]

Long-term follow-up data at one year confirmed that these improvements were sustained, with the study concluding that EMG biofeedback-assisted pelvic floor muscle therapy with the MAPLe significantly reduces symptoms and complaints of OAB and increases quality of life.[13]


Chronic Anal Fissure

A randomised controlled trial by van Reijn-Baggen et al. (2022) used the MAPLe as part of EMG-biofeedback-assisted pelvic floor physiotherapy for chronic anal fissure. The results showed a significant decrease in mean resting tone of the pelvic floor (measured with both digital rectal examination and EMG), along with improvement in fissure healing, pelvic floor function, pain, and symptom reduction.[14]


Lower Urinary Tract Symptoms in Men

Research exploring pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS) has used the MAPLe to map EMG activity across the pelvic floor, demonstrating the device's ability to identify patterns of dysfunction in the male pelvic floor that may not be detectable with conventional assessment methods.[7]


What Conditions Can the MAPLe Treat?

The MAPLe has clinical applications across a wide range of pelvic floor conditions in both men and women, including:

  • Stress urinary incontinence (SUI)[3]

  • Urge urinary incontinence and overactive bladder (OAB)[13][12]

  • Mixed urinary incontinence (MUI)[3]

  • Faecal incontinence and obstetric anal sphincter injuries (OASIS)[3]

  • Chronic anal fissure[14]

  • Chronic pelvic pain and endometriosis[3]

  • Coccyx pain[1]

  • Pelvic organ prolapse[1]

  • Pelvic floor hypertonicity (overactivity)[9]

A product review published in the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy (POGP, 2025) highlighted MAPLe's clinical applications across all of these areas, noting specific published evidence for OAB (Voorham et al. 2017; Dorien et al. 2020), anal incontinence and OASIS (Martín Prieto et al. 2023), chronic anal fissures (van Reijn-Baggen et al. 2022), and chronic pelvic pain and endometriosis (Muallem et al. 2023).[3]


The Pelvic Health Physiotherapist's Role

The MAPLe is a powerful clinical tool, but it is only as effective as the clinician using it. Pelvic health physiotherapists bring the expertise needed to:


Interpret Complex Data

The MAPLe produces detailed, multi-layered EMG data that requires skilled clinical interpretation. A qualified pelvic health physiotherapist understands the anatomy, neurophysiology, and biomechanics of the pelvic floor and can translate the MAPLe's readings into a meaningful clinical picture and an individualised treatment plan.[3]


Design Bespoke Rehabilitation Programmes

Based on the MAPLe assessment findings, the physiotherapist can design a truly personalised programme that targets the specific muscles and specific type of dysfunction identified. This might include:

  • Uptraining (strengthening) of weak or underactive muscles

  • Downtraining (relaxation) of overactive or hypertonic muscles, which has been proven effective in creating awareness and reducing pelvic floor tension[15][15]

  • Coordination training to improve the timing and sequencing of pelvic floor activation

  • Functional training in upright and weight-bearing positions, demonstrating the benefits of coordinated whole-core exercise on quality of pelvic floor activation[3]


Combine MAPLe with Other Physiotherapy Interventions

The MAPLe is one tool within a comprehensive physiotherapy toolkit. It integrates seamlessly with:

  • Manual therapy: myofascial release, trigger point therapy, and visceral mobilisation

  • Pain neuroscience education: helping patients understand their pain

  • Behavioural strategies: bladder retraining, toilet positioning, and lifestyle modification

  • Exercise prescription: core stability, breathing techniques, and graded return to activity

  • Psychological support: normalising symptoms, reducing anxiety, and supporting self-management

Monitor Progress Objectively

One of the MAPLe's most valuable features is its ability to provide objective, measurable comparisons across treatment sessions. The physiotherapist can track changes in individual muscle activity over time, giving both clinician and patient clear evidence of progress and informing ongoing treatment decisions.[6][16]


What Does a MAPLe Session Look Like?

A typical MAPLe session takes place in a private clinical setting with your pelvic health physiotherapist:

  1. Initial assessment (approximately 60–75 minutes): A comprehensive history taking, followed by insertion of the MAPLe probe and baseline measurements of pelvic floor activity at rest, during voluntary contractions, and during functional tasks such as coughing[16]

  2. Treatment sessions (weekly or fortnightly, approximately 30–45 minutes): Based on the assessment findings, targeted biofeedback and/or electrical stimulation is delivered to the specific muscles requiring rehabilitation[10]

  3. Home exercise programme: Alongside weekly clinic sessions, patients are given individualised exercises to practise at home to reinforce the neuromuscular retraining

  4. Progress reviews: Objective MAPLe data is compared session to session, allowing the physiotherapist to modify the programme as the patient's pelvic floor function improves

Most patients begin to notice improvements within 6 sessions, with some conditions such as overactive bladder responding particularly well to MAPLe-assisted therapy.[1]


The Broader Evidence for EMG Biofeedback in Pelvic Health

The MAPLe sits within a broader evidence base supporting EMG biofeedback in pelvic floor rehabilitation:

  • A systematic review and meta-analysis (Wu et al., 2021) of 21 studies comprising 3,865 patients found that EMG biofeedback combined with pelvic floor muscle training was effective in improving cure and improvement rates for stress urinary incontinence and pelvic floor dysfunction in women.[17]

  • A large multicentre RCT (Hagen et al., 2020) published in the BMJ assessed the effectiveness of PFMT with and without EMG biofeedback for urinary incontinence in women, contributing to the evidence that biofeedback-assisted training can enhance outcomes.[18]

  • A systematic review on pelvic floor hypertonicity (van Reijn-Baggen et al., 2022) published in Sexual Medicine Reviews (Oxford Academic) confirmed that pelvic floor physiotherapy, including biofeedback and electrical stimulation, is efficacious for conditions including chronic pelvic pain, vulvodynia, and dyspareunia.[19]


Conclusion

The MAPLe by Novuqare represents a significant step forward in pelvic floor assessment and treatment. Its 24-electrode high-definition technology offers a level of precision and personalisation that was previously unavailable, and it is backed by peer-reviewed evidence from one of Europe's leading pelvic health research centres at Leiden University Medical Centre.

But technology alone is not the answer. The real value lies in the hands of the specialist pelvic health physiotherapist who interprets the data, designs the treatment, and guides the patient through their rehabilitation journey. When skilled clinical expertise meets cutting-edge technology, the results for patients can be truly transformative.

If you are experiencing pelvic floor symptoms, or if you are a healthcare professional interested in learning more about how the MAPLe can enhance your practice, please do not hesitate to get in touch.


References

[1] Home - MAPLe  https://www.novuqare.com/

[2] Scientific evidence for pelvic floor devices presented at ... - PMC  https://pmc.ncbi.nlm.nih.gov/articles/PMC6852158/

[4] Reliability and Differentiation of Pelvic Floor Muscle ...  https://profundum.academy/wp-content/uploads/2023/09/voorham-vanderzalm2012-2-1.pdf

[5] Electrical Muscle Stimulation London | MAPLe Therapy  https://www.lucyallenphysiotherapy.com/maple-device

[7] Exploring pelvic floor muscle activity in men with lower urinary ...  https://pmc.ncbi.nlm.nih.gov/articles/PMC7027460/

[11] The test−retest reproducibility of the multiple array probe ...  https://onlinelibrary.wiley.com/doi/10.1002/nau.25157

[12] the effect of emg biofeedback assisted pelvic floor muscle ...  https://www.ics.org/Abstracts/Publish/241/000014.pdf

[13] 217 THE EFFECT OF EMG BIOFEEDBACK ASSISTED ...  https://www.ics.org/Abstracts/Publish/349/000217.pdf

[14] pelvic floor physical therapy in the treatment of chronic anal ...  https://scholarlypublications.universiteitleiden.nl/access/item%3A3655496/view

[17] Electromyographic Biofeedback for Stress Urinary ... - PMC - NIH  https://pmc.ncbi.nlm.nih.gov/articles/PMC8342347/

[18] Effectiveness of pelvic floor muscle training with and ...  https://www.bmj.com/content/371/bmj.m3719

[19] Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity  https://academic.oup.com/smr/article/10/2/209/6880344

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