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Paediatric Incontinence Therapy Options When are Biofeedback or TENS useful? Caroline Ward, Paediatric Urology Nurse Specialist, QMC What is Biofeedback? 1st reported by Maizels, King and Firlit in 1979New approach to treat Detrusor Sphincter Dyssynergia. Pelvic floor rehabilitation/physiotherapy Interactive computer games engaging children…move over Kegal exercises!! A form of Alternative Medicine- Involves measuring a patient’s muscle potential using Elecromyography (EMG). Muscle contraction/relaxation conveyed in real-time:Raises patient awareness/conscious control of pelvic floor Fish Fairies Spacemen Monkeys Advantages Diagnostic – pPotential to avoid urodynamics (or aid) Intensive urotherapy, 1:1 nursing, private environment Non-invasive Non-pharmacological Empowerment for the patient Disadvantages Time consuming 6 weeks of continuous therapy Large initial financial outlay & costly to the GP/CCG Requires motivation, maturity and co-operation Consideration Indicators for Biofeedback Therapy Giggle incontinence Dysfunctional voiding (voiding phase defect) DSD – confirmed Recurrent UTIs Low-grade VUR Incomplete bladder emptying Giggle Incontinence Involuntary contraction of detrusor muscle Induced by laughing Pelvic floor awareness = improve symptoms? Dysfunctional Voiding Staccato or interupted uroflow rates – intermittent contractions of the urethral sphincter or pelvic floor during voiding. Neurologically normal patients Possible incomplete bladder emptying Learnt behaviour, ?Over training of Pelvic floor muscles/ Holding manoeuvres Detrusor sphincter dyssinergia (DSD) Stacato flow Interupted uroflow UFR with EMG Referral criteria …it’s all about the flows!! Non-invasive bladder assessment with uroflow(s) Irregular uroflow or staccato uroflow(s) - not tower DSD confirmed on diagnostic EMG – BPS Motivated child & carers mature enough to understand instructions > 7 years & older Don’t ignore the bowels!!! Offer an assessment session Criteria not exhaustive….! What do we expect from families? Supportive parents/carers Willing to commit to 6 weeks of treatment Committed to doing homework-daily…. welcome back Kegal Diaphragmatic breathing - humming, blowing on voiding Follow bladder and bowel routines i.e. timed toileting, consistent fluid intake & good bowel habits!! Cochrane Review 80% success rate in daytime wetting and UTIs Improvements in constipation, frequency, urgency, residuals and UFR max flow However – low level evidence, mainly case series – few RCTs To summarise Biofeedback can reduce the need for invasive urodynamics and medication Patient empowerment- Sustainable results noted on audit Patients & families report positive experience Think TENS for true OAB with TOWER UROFLOWS (and if unresponsive to medicine management) Comments “I didn’t think it would work but it has”