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A four month squatting-based pelvic exercise regime cures day/night enuresis and bowel dysfunction in children aged
Angel Garcia-Fernandez1, Peter Emanuel Petros2,3
1Universidad Nacional de Córdoba, Department of Pediatric Surgery, Córdoba, Argentina.
Insights
A new squatting-based pelvic floor rehabilitation method effectively treated daytime and nighttime enuresis in children. This simple, supervised exercise program demonstrated high cure rates with no adverse events, suggesting it strengthens muscles controlling the micturition reflex.
Area of Science:
- Pediatric urology
- Pelvic floor rehabilitation
- Neuro-urology
Background:
- Patricia Skilling developed a squatting-based pelvic floor rehabilitation method in 2004.
- This method focuses on strengthening three reflex pelvic muscles and ligaments.
- These muscles/ligaments are hypothesized to control closure and micturition reflexes.
Purpose of the Study:
- To test the hypothesis that day/night enuresis results from an inability of pelvic muscles/ligaments to control an inappropriately activated micturition reflex.
- To adapt and evaluate Skilling's squatting-based rehabilitation method for treating childhood enuresis.
Main Methods:
- A randomized control trial was converted to a prospective trial.
- 48 children (7.6 ±2.5 years) with daytime and nighttime enuresis participated.
- Strictly supervised daily exercises included squats, bridges, and fitball exercises with surface perineal electromyogram (EMG) biofeedback once weekly.
Main Results:
- At 4 months, 86% (41/48) of children were cured of both daytime and nighttime enuresis (p <0.001).
- A significant cure rate of 50% (12/24) was observed at the first review (4 weeks).
- No adverse events were reported; secondary outcomes like constipation and fecal incontinence also improved.
Conclusions:
- The adapted squatting-based method appears to accelerate the strengthening of muscles/ligaments controlling the micturition reflex.
- This strengthening is hypothesized to be the basis for treating daytime/nighttime enuresis.
- The treatment is simple but requires diligent application and further validation by other researchers.
Introduction:
In 2004, Patricia Skilling developed a new squatting-based pelvic floor rehabilitation method based on strengthening the three reflex pelvic muscles and ligaments hypothesized to control the closure and micturition reflexes. We adapted these methods to test our hypothesis that day/night enuresis was due to the inability of these muscles/ligaments to control an inappropriately activated micturition reflex.
Material And Methods:
The trial commenced as a randomized control trial to be conducted over 4 months, but was converted to a prospective trial at 4 weeks by order of the Ethics Committee. A total of 48 children, 7.6 ±2.5 years, 34 females, 14 males, had strictly supervised exercises twice daily, 10 squats, 10 bridge, fitball exercises involving proprioception exercises with surface perineal electromyogram (EMG) once a week.Eligibility criteria were daytime urine leakage plus night-time bedwetting. Exclusion criterion was refusal to sign consent forms. Assessment was done by intention to treat. The criterion for cure was complete dryness.
Results:
At 1st review (4 weeks) 12/24 in the treatment group reported total cure of wetting; 41/48 children (86%) were cured of both daytime/nighttime enuresis (p <0.001) at 4 months. There were no adverse events. Secondary outcomes were concomitant cure of constipation, fecal incontinence, urinary retention as predicted by the underlying integral theory of incontinence.
Conclusions:
We believe our methods accelerated normal childhood strengthening of muscles/ligaments which control inappropriate activation of the micturition reflex which we hypothesize is the basis for daytime/nighttime enuresis. This is a simple treatment, needs diligent application and validation by others.
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