Biofeedback in the Management of Urinary Continence in Children

Abstract

Significant progress has been made over the past 15 years regarding the development of bladder control and the evaluation and management of pediatric voiding dysfunction. Incontinence is a problem of significant social consequence that is commonly due to dysfunctional voiding (ie, discoordination between the detrusor and the external sphincter). Biofeedback was introduced in 1979 but was relatively forgotten until the late 1990 s. Nonanimated biofeedback relates sphincter activity to electromyographic activity as reflected as tracing on a computer screen or auditory feedback. This successful modality was exclusively available until recently when animated biofeedback became available, allowing for a more rapid grasp of the physiologic event to be modulated. Biofeedback has been shown to be very effective in children to correct incontinence secondary to dysfunctional voiding, as well as in treating giggle incontinence and to help resolve vesicoureteral reflux.

Biofeedback Treatment for Overactive Bladder

“…In addition, an early study of biofeedback in children noted that some children were able to inhibit the detrusor contractions without increasing sphincter activity when receiving visual feedback on their bladder pressures [7]. Biofeedback has an extensive history of use in pediatric voiding disorders, which is beyond the scope of this article (for a review of biofeedback in children, see a 2010 article by Palmer [8]). …”

Objective versus subjective outcome measures of biofeedback: What really matters?

“…Protocols for BFB, which types of patients should be referred, which outcome measures should be used and how long patients should be treated, are variable among practitioners [3,9,10]. Positive clinical outcomes of BFB have included reduction in post-void residual urine, improved vesicoureteral reflux, increased bladder capacity, reduction of EMG activity during voiding, and a reduced incidence of UTIs [9,11].…”

Overactive Bladder in Children

“…Fortunately for children, this practice was found to be unnecessary as what was felt to be an inborn urethral abnormality was found in truth to be a dyssynergic contraction of the pelvic floor that is treatable with the less traumatic biofeedback therapy [2]. Whether the pelvic floor dyssynergia is an inborn or learned behavior (most common theory) is still up for debate, but an area that also should be considered is that there may be another, underrepresented cause of the dyssynergia that has been described but remains less well-understood [3].…”