Download Biofeedback

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
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Diagnostic – pPotential to avoid urodynamics (or aid)
Intensive urotherapy, 1:1 nursing, private environment
Non-invasive
Non-pharmacological
Empowerment for the patient
Disadvantages
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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
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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!!
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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”