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Effect of biofeedback training on paradoxical pelvic floor movement in children with dysfunctional voiding
Tom P V M de Jong1, Aart J Klijn, Marianne A W Vijverberg
1Pediatric Renal Center, University Children's Hospital University Medical Center Utrecht, Utrecht, The Netherlands. T.P.V.M.dejong@umcutrecht.nl
Insights
Children with dysfunctional voiding (DV) often have paradoxical pelvic floor function. Physical therapy, including biofeedback, effectively restored normal pelvic floor muscle control in most treated children.
Area of Science:
- Pediatric Urology
- Pelvic Floor Dysfunction
- Diagnostic Imaging
Background:
- Dynamic perineal ultrasonography reveals paradoxical pelvic floor muscle use in children with micturition issues.
- Many children with daytime incontinence or recurrent UTIs exhibit poor voluntary pelvic floor control or paradoxical straining.
Purpose of the Study:
- To record pelvic floor function in children with dysfunctional voiding (DV).
- To evaluate the efficacy of physical therapy regimens for children exhibiting paradoxical pelvic floor function.
Main Methods:
- Sixty-five children diagnosed with DV and paradoxical pelvic floor movement underwent dynamic perineal ultrasound.
- Physical therapy involved biofeedback sessions with rectal examination and anal balloon expulsion, with some patients continuing home training.
Main Results:
- Of 52 treated patients, 50 achieved normal voluntary pelvic floor muscle control within 6-10 months.
- 39 out of 40 control patients demonstrated normal pelvic floor control.
Conclusions:
- Pelvic floor dysfunction is common in children with DV and is treatable with targeted physical therapy.
- Further prospective studies are needed to clarify the clinical significance and long-term effects of pelvic floor dysfunction in DV.
Objectives:
Dynamic perineal ultrasonography to assess the function of the pelvic floor muscles in children with micturition complaints shows that many children with daytime incontinence or recurrent urinary tract infections use their pelvic floor paradoxically. They strain when asked to withhold urine, or they have no voluntary control of the pelvic floor muscles at all. The aim of this study was to record the pelvic floor function and evaluate the physical therapy regimens for children with dysfunctional voiding (DV) and paradoxical pelvic floor function.
Methods:
A total of 65 patients with DV, many who also had constipation, were diagnosed with paradoxical movement of the pelvic floor. The patients were asked to contract their pelvic floor muscles during a perineal dynamic ultrasound investigation. Of the 52 patients treated by physical therapists, 32 had a single 1-hour biofeedback session with rectal examination and anal balloon expulsion. In the remaining 20 patients, this was followed by 2 weeks of biofeedback balloon expulsion training at home. Forty control patients were observed.
Results:
In 13 of the 65 patients, the diagnosis could not be confirmed by the physical therapists. At 6 to 10 months after training, 50 of the 52 other patients had normal voluntary pelvic floor muscle control. Of the 40 control patients, 39 had normal pelvic floor control.
Conclusions:
The results of this study have demonstrated that pelvic floor dysfunction occurs frequently in children with DV and can be cured by dedicated physical therapy. The clinical importance of this phenomenon is not yet clear. Prospective studies will teach us more about the true incidence and therapeutic effect of pelvic floor dysfunction on DV.
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