Urotherapy Book

41 Pelvic floor muscle function; assessment and biofeedback Within specific urotherapy, it is recommended to evaluate pelvic muscle function, this can be done by medical doctors, well trained urotherapists /physiotherapists. Physiotherapists: In most countries physiotherapist are trained to evaluate pelvic floor function, by assessing the child’s pelvic floor muscle system to determine if these muscles might be weak, tight, or present difficulty with coordination for proper bladder and bowel function. Assessing pelvic floor function: Regarding assessing the pelvic floor muscles, this is an issue that likely may raise some concerns and questions and in generally should be avoided for reasons of propriety. If necessary and considered reasonable by the parent, the pelvic floor muscles could be assessed externally by visualization/ palpation of the contraction of the anal muscles. It is inappropriate to assess the pelvic floor muscles in children internally. Digital Palpation: The child can be taught to identify and isolate the pelvic floor by external palpation of the anal sphincter. Palpate the perineum when the child lays in a side position on the examination bed with the legs up against its abdomen and the trousers down. Place one finger (girls) or two fingers (boys) on the perineal muscle in front of the anus. Ask the child if he/she feels the pressure and ask them to contract the muscles where they feel the pressure from the fingers. Try to guide them not to use the surrounding muscles (abdomen, gluteus, or thighs). If you feel the least muscle contraction in the perineum in a correct way, tell them this and ask them to repeat what they just did. In this way it is possible to make the child aware of the contraction and make them aware of the correct way to do it.12, Visual observation: Ultrasound: Ultrasound of the pelvic floor provides a visual assessment of muscle activity, it enables the visualization and measurement of urethral length and pelvic floor musculature activity in real-time. Ultrasound-based biofeedback, visualize the effect of the pelvic floor muscles on the bladder, during relaxation and contraction(5,6,7,) Transabdominal ultrasound assessment of the pelvic floor muscles is correlated to digital palpation This method is much more appropriate to children as well as being educative and less stressful. 5,12 Trans perineal ultrasound is performed by placing the probe on the urethral meatus in girls or behind the scrotum in boys. Scanning is then carried out in the sagittal (mostly midsagittal) plane aligning the transducer with both the pubic symphysis and the posterior urethra. In boys, only little perineal pressure should be applied to avoid distortion of the urethral anatomy. Several determinants can be visualized. Dynamic determinants emanate from variable conditions of the pelvic floor like stress, relaxation, or pressurizing moments. 7,1