Does Adding TENS to Pelvic Floor Rehabilitation Effect on Urodynamics and Clinical Results in Children With Spina Bifida?
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Published on: April 17, 2019
Özge Özdemir Ayla1, Ş Kerem Özel2, Gönül Acar1
1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
Insights
Pelvic floor rehabilitation (PFR) combined with transcutaneous electrical nerve stimulation (TENS) may help reduce bladder pressure in children with spina bifida (SB). While both PFR and PFR+TENS improved voiding symptoms, only PFR+TENS significantly lowered maximum detrusor pressure.
Area of Science:
- Pediatric Urology
- Neurorehabilitation
- Spina Bifida Research
Background:
- Children with spina bifida (SB) often suffer from neurogenic bladder dysfunction, increasing their risk of renal failure and reducing quality of life.
- Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) are recognized for their efficacy in managing various bladder dysfunctions in pediatric populations.
Purpose of the Study:
- To investigate the combined effects of PFR and TENS in pediatric patients with spina bifida and neurogenic detrusor overactivity (NDO).
- To assess the potential clinical value of this combined therapeutic approach for improving bladder management in children with SB.
Main Methods:
- A randomized study involving 28 children (ages 5-15) with SB and NDO.
- Two groups were formed: one receiving PFR alone (Group PFR) and the other receiving PFR plus TENS (Group PFR+T).
- Evaluations included clinical data, symptom scores (DVSS), lower urinary tract symptoms, quality of life, and urodynamic parameters before and after a 6-week treatment period.
Main Results:
- Both groups showed a decrease in voiding and lower urinary tract symptoms (p < 0.05).
- Maximum detrusor pressure significantly decreased in the PFR+TENS group (from 82.1 to 58.1 cmH2O, p < 0.05).
- No significant differences were observed between groups in clinical parameters, quality of life, or other urodynamic outcomes.
Conclusions:
- PFR, with or without TENS, can be effective in reducing voiding symptoms and protecting the bladder from high pressures in children with SB and NDO.
- The addition of TENS to PFR may specifically help in reducing maximum detrusor pressures.
- Further research is needed to establish personalized, holistic treatment strategies for these patients.
Introduction:
Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice.
Materials And Methods:
Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated.
Results:
Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups.
Discussion:
PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients.
Conclusion:
Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence-related quality of life.
