Urotherapy Book

62 1. Explanation & demystification: she and her mother have gained an adequate understanding of how the bladder works and what goes wrong when laughing. 2. Voiding regimes: She and mother know what the average fluid intake is, appropriate his age and how to properly distribute the fluid intake throughout the day.  How to void: She has gained insight into her toilet position, knows how to adjust it, and what aids are needed for this.  When to void: She understand that when it is best for her to go to the toilet, ‘’when you feel you have to go, you need to go’’  How often to void: She understand how often it is best for her to go to the toilet. Jennifer gets information by the Urotherapist about how the bladder works and how giggle incontinence happens. She gets instructions about how to apply training rules at home. Physiotherapy -Biofeedback The physiotherapist is asked to see her and to provide her pelvic floor training physiotherapy. She also did a physical examination and did a perineal palpation; she noticed a moderate awareness of pelvic floor muscles. This was a reason to start her pelvic floor therapy. The physiotherapist started with pelvic floor awareness and control exercises. Instructions were given for the pelvic floor musculature with emphasis on relaxation and combined with correct relaxation on the toilet, so that urine comes easier and Jennifer empties properly. This was initially practiced in a lying and sitting position (including ultrasound control and digital palpation) and was quickly picked up. This pelvic floor awareness and control were enhanced by uroflow pattern and non-invasive abdominal or perineal EMG as biofeedback, as described in see case 3.