44 child to stay in the position with maximum belly out for 10 seconds and then exhale. While exhaling, tell the child to return to the original position without squeezing the pelvic floor and abdominal muscles, imagining the balloon deflating.6,8 Biofeedback with uroflowmetry and ultrasound Biofeedback on the voiding pattern is an essential element of specific urotherapy. It improves the physiological processes of micturition, by teaching children how to urinate with a relaxed pelvic floor and teach them good bladder emptying techniques. Feedback on correct voiding can be given in the following ways: 1.Real time uroflowmetry in which the child can observe the flow curve during voiding. Children are taught to recognize when they urinate incorrectly and will keep on trying (through a relaxed posture and softly blowing or whistling to relax the pelvic floor) until they achieve a continuous, bell-shaped curve. Eventually the child learns to urinate with a relaxed pelvic floor. Positive: It is an easy way, not embarrassing, non-invasive, fun to see how you get a bell shape pattern. Negative: You need equipment of a screen and flowmetry to show the patterns while voiding. 2. Ultrasound/ bladder scan can be used to check if the bladder is empty after urination and report this to the child. Beforehand you can ask the child if she/he thinks their bladder is empty. By doing that the child becomes aware of an empty bladder. Positive: It is non-invasive and an easy way to teach the child. Negative: None
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