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Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation
H De Paepe1, C Renson, E Van Laecke
1Departments of Urology and Paediatrics, Paediatric Uro-Nephrologic Centre, Ghent University Hospital, Ghent, Belgium.
Insights
A noninvasive training program effectively treated voiding dysfunction in young children, resolving incontinence and encopresis in most cases. This approach is suitable for children aged 4-5 years with elimination disorders.
Area of Science:
- Pediatric Urology
- Behavioral Therapy
- Urodynamics
Background:
- Voiding dysfunction is common in young children, often presenting with incontinence and encopresis.
- Urodynamic assessment is crucial for diagnosing specific voiding dysfunctions.
- Noninvasive treatments are preferred for this age group to minimize psychological impact.
Purpose of the Study:
- To evaluate the efficacy of a noninvasive training program for treating voiding dysfunction in children aged 4-5 years.
- To assess the resolution of urinary incontinence and fecal incontinence (encopresis) symptoms.
- To determine the applicability of this therapeutic approach in very young children.
Main Methods:
- A cohort of 20 children (mean age 4.45 years) with urodynamically confirmed voiding dysfunction participated.
- Treatment involved voiding/drinking charts, toilet posture training, home-based rules, and pelvic floor muscle biofeedback.
- Success was defined by the resolution of incontinence and other urological symptoms.
Main Results:
- Good outcomes (complete dryness and resolved encopresis) were achieved in 13 out of 20 children.
- Moderate success was observed in six children, with persistent incontinence in some.
- Encopresis persisted in two children, while one showed improvement.
Conclusions:
- A noninvasive training program is a viable and effective treatment for young children with dysfunctional elimination.
- The program demonstrated success in managing both urinary and fecal incontinence in this pediatric population.
- Early intervention with behavioral and training strategies can significantly improve outcomes for voiding dysfunction.
Objective:
To analyse experience in treating young children (4-5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive training programme.
Patients And Methods:
Between January 1996 and October 1997, 20 children (all < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic floor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic-floor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed.
Results:
Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation.
Conclusion:
This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces.