Pelvic Floor Dysfunctions in Children With Lower Urinary Tract Dysfunction and Relationship With Urine Flow

Pelvic floor muscle (PFM) dynamics play a significant role alongside bladder and rectal dynamics in the pathophysiology of lower urinary tract dysfunction (LUTD) in children. This study aimed to determine PFM activities (PFMA), including resting tone and contractile functions, of LUTD subtypes in children according to their voiding patterns.

160 children presenting to our clinic with symptoms of lower pelvic floor voiding (LUTD) were evaluated using noninvasive diagnostic methods, and LUTD subtypes were determined. Based on voiding patterns, 31 had intermittent, 59 had staccato, 28 had tower, 31 had bell and 11 had plateau voiding pattern. 18 healthy children served as a control group and also exhibited bell curve voiding. PFMA was measured using superficial electrodes after voiding. Children performed five cycles of 5-s relaxation followed by 5-s voluntary PFM contraction, resulting in a total recording period of 50 s. Mean relaxation and contraction EMG values were recorded for analysis. According to PFMA measurements, pelvic floor dysfunction (PFD) subtypes defined and frequencies determined.

According to the LUTD subtype, the frequency of pelvic floor overactivity (PFO) ranged from 59% to 86%, and the overall frequency of contractile dysfunctions (Nonfunctional or weak functional pelvic floor) ranged from 64% to 78%. As the voiding pattern improved, the resting tone decreased and normalized, thus the frequency of PFO reduced from 84% to 45% (p = 0.0001).

The measurement of PFMA enables the identification of PFD subtypes in children with LUTD. The pathophysiology of LUTD can be better understood noninvasively.