Related Experiment Video
Updated: Aug 21, 2026
Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
Published on: May 30, 2025
Multimodal Therapy for Monosymptomatic Nocturnal Enuresis: Nocturnal Bladder and Pelvic Floor Dynamics
Canan Seyhan1, Asli Ozturk1, Burak Kopru2
1Graduate School of Health Sciences, Faculty of Physical Therapy and Rehabilitation, Physiotherapy and Rehabilitation in Pelvic Health and Women's Health, Hacettepe University, Ankara, Turkey.
Insights
This study shows that a multimodal treatment effectively improves pelvic floor muscle activity (PFMA) and bladder control in children with monosymptomatic nocturnal enuresis (MNE). The approach combines urotherapy, alarm therapy, and pelvic floor muscle rehabilitation (PFMR) for better outcomes.
Area of Science:
- Pediatric Urology
- Pelvic Floor Dysfunction
- Nocturnal Enuresis Management
Background:
- Monosymptomatic nocturnal enuresis (MNE) is common in children.
- Pelvic floor muscle activity (PFMA) plays a role in bladder control.
- Dysfunctional PFMA, including overactivity and weakness, is observed in children with MNE.
Purpose of the Study:
- To evaluate PFMA in children with MNE.
- To assess the effectiveness of a multimodal treatment for MNE.
- To investigate the impact on nocturnal bladder and pelvic floor dynamics.
Main Methods:
- Retrospective analysis of 65 children with primary MNE.
- Multimodal treatment: standard urotherapy, enuresis alarm therapy, and individualized pelvic floor muscle rehabilitation (PFMR).
- PFMR based on objective PFMA assessment (surface electromyography) including relaxation, coordination, and strengthening exercises.
Main Results:
- Baseline PFMA dysfunction (overactivity/weakness) present in a majority of children.
- Significant improvements in nocturnal measures: reduced alarm activations, decreased urine volume, increased voided volumes (p < 0.001).
- Significant improvements in PFMA parameters: resting tone, contraction, and functional contraction amplitude (p < 0.001).
- High treatment response rates: 75.4% at 12 weeks, increasing to 93.8% at 16 weeks.
Conclusions:
- Multimodal treatment combining urotherapy, alarm therapy, and individualized PFMR is highly effective for MNE.
- This approach optimizes pelvic floor function and nocturnal bladder dynamics in children.
- Objective PFMA assessment is crucial for tailoring effective PFMR interventions.
Objective:
This study aimed to evaluate pelvic floor muscle activity (PFMA) in children with monosymptomatic nocturnal enuresis (MNE) and to investigate the effectiveness of multimodal treatment including standard urotherapy, alarm therapy, and pelvic floor muscle rehabilitation (PFMR) approach by assessing nocturnal bladder and pelvic floor dynamics.
Methods:
In this retrospective cross-sectional study, medical records of children with primary MNE were reviewed. All participants received a multimodal treatment consisting of (i) standard urotherapy based on International Children's Continence Society recommendations, (ii) enuresis alarm therapy with objective nocturnal urine volume monitoring, and (iii) individualized PFMR. PFMR was designed according to baseline PFMA assessed objectively using surface electromyography and included relaxation-oriented interventions for pelvic floor overactivity, coordination training, and strength and endurance exercises integrated with core muscles. Nocturnal bladder dynamics, PFMA parameters, and treatment outcomes were retrospectively analyzed. Treatment response was classified as complete, partial, or no response.
Results:
A total of 65 children were included. At baseline, 67.7% of children had pelvic floor overactivity, and 64.7% had nonfunctional or weak functional pelvic floor. Both pelvic floor dysfunctions coexisted in 25 children (38%). During multimodal therapy, objective nocturnal measures demonstrated a significant reduction in alarm activations and diaper urine volume, alongside increased voided volumes (all p < 0.001). Resting tone, contraction and functional contraction amplitude were significantly improved after treatment (all p < 0.001). Complete response was achieved in 75.4% of children at 12 weeks and increased to 93.8% at 16 weeks.
Conclusion:
Multimodal treatment combining standard urotherapy, alarm therapy with individualized PFMR based on objective PFMA assessment appears highly effective in children with MNE and may optimize both pelvic floor function and nocturnal bladder dynamics.
Related Concept Videos
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating urine...
01:30Urinary Tract Calculi III: Medical Management
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:28Urinary Tract Calculi V: Nursing Management
01:17Urinary Tract Infection IV: Nursing Management