Abstract and Introduction
Abstract
This study sets to determine the optimal duration of behavioral urotherapy necessary to achieve maximal improvement in the management of pediatric bowel and bladder dysfunction.
Introduction
Pediatric bowel and bladder dysfunction is a result of paradoxical pelvic floor contraction during voiding and encompasses a wide spectrum of symptoms, including urinary incontinence, nocturnal enuresis, urgency, frequency, and constipation/fecal incontinence. Children with this condition contract the urethral sphincter during voiding, producing a decreased and often staccato or intermittent pattern of urinary flow during urethral sphincter and pelvic floor contraction (Chase, Austin, Hoebeke, & McKenna, 2010). Presenting symptoms include incontinence, urgency, frequency, and constipation (Farhat et al., 2000; Halachmi & Farhat, 2008; Kibar et al., 2007).
Although complex cases may require more aggressive therapies, such as biofeedback or medications, for most patients, it is appropriate to begin with conservative management, such as urotherapy, which is composed of behavioral modification training sessions directed at educating children regarding proper voiding practices, schedules, and pelvic floor relaxation techniques. Children with bowel and bladder dysfunction benefit from bladder emptying re-education, and initial emptying efficiency and post-void residual volumes significantly improve following both shorter outpatient and longer inpatient training regimens (Bachmann et al., 2008; Bower, Yew, Sit, & Yeung, 2006; Chase et al., 2010; Nelson, Cooper, Boyt, Hawtrey, & Austin, 2004). In some instances, biofeedback has been utilized as a successful adjunct to behavioral modification in improving symptoms in children with bowel and bladder dysfunction (de Jong et al., 2007; Kajbafzadeh et al., 2011; Vasconcelos et al., 2006).
Urol Nurs. 2014;34(6):312-317. © 2014 Society of Urologic Nurses and Associates
