Pelvic Floor Rehabilitation and Biofeedback
Pelvic floor rehabilitation and biofeedback have gained an important role in the treatment of lower urinary tract dysfunction in children in the past 20 years. Since the identification and classification by the International Children’s Continence Society
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Sandro Danilo Sandri
26.1 History and Background While biofeedback (BFB) was introduced at the end of the 1970s and quickly gained favor for treatment of lower urinary tract dysfunction (LUTD), pelvic floor rehabilitation was introduced at the end of the 1980s and only slowly gained popularity. In the 1970s the Hinman syndrome became a well-recognized functional disease, thanks to the widespread use of urodynamics. Because of the refractory response to pharmacological treatment and lack of alternatives except for surgical treatment, BFB with the aim of relaxing the urethral sphincter was proposed. In the 1980s, Kegel exercises regained gradual success in treating adult female stress urinary incontinence and then mixed and urge urinary incontinence. It was then consequential to adopt the same therapeutic approach for urinary incontinence in the pediatric age group. But because pelvic floor hyperactivity was responsible for many dysfunctional voidings (DVs), the fear of worsening micturition delayed the use of perineal muscle training, impeding widespread use of this approach. Nevertheless, teaching how to correctly contract these muscles continued to be adopted by a few centers. In 1998 a survey of pediatric urology centers throughout the USA found that more than half of those that responded did not offer BFB as a treatment option [1]. In the next decade, many studies favored the use of BFB, and in 2010 the importance of BFB was finally endorsed by the standardization committee of the International Children’s Continence Society (ICCS) [2].
S.D. Sandri Department of Urology and Spinal Unit, Hospital of Legnano, Legnano, Italy Department of Urology and Spinal Unit, Hospital of Magenta, Milan, Italy e-mail: [email protected] © Springer International Publishing AG, part of Springer Nature 2018 G. Mosiello et al. (eds.), Clinical Urodynamics in Childhood and Adolescence, Urodynamics, Neurourology and Pelvic Floor Dysfunctions, https://doi.org/10.1007/978-3-319-42193-3_26
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S.D. Sandri
The main lesson derived from pediatric neurorehabilitation is that noninvasive diagnostic steps should proceed together with initial noninvasive treatment. For example, once incorrect contraction of the perineal muscles is recognized, it is time to start teaching how to use them. Furthermore when abdominal straining during voiding is observed, it is important to start at once to teach how to avoid the use of the abdominal muscles during micturition. And again, once we teach and the child learns how to avoid abdominal straining during micturition, we can better recognize the electromyographic behavior of the perineal floor. Many studies have described combinations of treatments for different LUTDs, which makes it difficult to evaluate the results. A significant improvement in this field was achieved by the ICCS standardization of terminology in 2006 [3].
26.2 Pelvic Floor Behavior in Asymptomatic Children Pelvic floor muscle (PFM) behavior in children without LUTD has received very poor attention in the literatur
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