45 3. Using EMG with uroflow shows whether the pelvic floor relaxes or not when the child voids. Placing EMG-electrodes at 9 and 3 o’clock in the perineum on both sides of the anus. It is important to place the electrodes as close as possible to the anal sphincter without touching each other. Then position the child in a seated position with support for the feet on the floor or a foot stool. While viewing the screen, ask the child to contract and relax the pelvic floor. Look at the curve on the screen and talk on the importance of relaxation during voiding. The child can also try to contract the abdominal muscles to see the effect this has on the tension of the pelvic floor. Ask the child to remember how the pelvic floor feels in the relaxed state, when he/she then voids on the flowmeter. If the child voids and starts to contract the pelvic floor, a quick vocal reminder can make them aware of the need to relax again. Sometimes it seems that they are not aware that they contract the pelvic floor. They can also watch the screen when voiding in order to correct the relaxation by themself. Positive: Non-invasive and fun with the game Negative: Could be embarrassing to do for the child. Not certain if EMG changes are caused by PFM action, measurements can even be affected by posture, talking, breathing, and especially “cross-talk” from surrounding muscles. Treatment phase Tessa’s motivation for doing the treatment is assessed as well as her parents’ support. Final goal: Complete resolution of urine incontinence and normalisation of voiding function Short term goals: Increasing the voiding frequency and be able to relax pelvic floor during voiding. Long term goals: 1. Normalization of bladder capacity 2. Normalization of micturition frequency
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