Urotherapy Book

13 Biofeedback is an important component of specific urotherapy. It is the process of gaining greater awareness of pelvic floor muscle/sphincter action using external instruments that provide information about the action of these muscles to increase awareness and voluntary control by the child. Visual or auditory feedback can be used, and this together with coaching and encouragement from the therapist, aims to improve motor control. It involves showing the child when their bladder is empty by using real-time uroflowmetry, ultrasound and /or, electromyography (EMG). - Real-time flowmetry: In this method, the child can observe the flow curve during voiding. The child will be taught to recognise when urinating incorrectly and will be instructed to keep trying, through a relaxed posture (relaxed pelvic floor) until they can achieve a continuous, bell-shaped curve. - Ultrasound can be used to check if the bladder is empty after urination and this measure gives feedback to the child about performance. - In addition, trained and experienced physiotherapists/urotherapists can perform transabdominal or transperineal ultrasound which provides direct feedback to the child on the movement of pelvic floor muscles and its effect on the bladder neck when the child contracts and relaxes the pelvic floor.(5,6) - EMG electromyography provides additional information on the use of the pelvic floor during voiding, this will help the child to learn how to contract and relax the pelvic floor muscles at will. Pelvic floor muscle training Pelvic floor muscle awareness can be taught via the whole-body approach using techniques such as progressive relaxation, seated ball work and known synergistic patterns. PFM action on the voiding pattern is a sign of dysfunctional voiding. Characterized by a staccato or intermittent flow pattern with usually prolonged voiding time and incomplete bladder emptying. The aim is for the child to internalize the sensation of relaxation, and have sufficient awareness to practise correctly and apply it during the initiation of the void and throughout voiding. How to teach PFM awareness to a particular child depends on the