Effects of connective tissue manipulation on clinical symptoms and pelvic floor muscle functions in children with lower urinary tract dysfunction

The aim of this study is to evaluate the effects of connective tissue manipulation (CTM) applied in addition to pelvic floor muscle rehabilitation (PFMR) on LUTD symptoms, pelvic floor muscle (PFM) activation, uroflowmetry and bladder diary parameters, and quality of life compared to PFMR applied alone in children with lower urinary tract dysfunction (LUTD). 40 children with LUTD were included in the study. Children were divided into two groups as PFMR+CTM (n:20)(CTG) and PFMR (n:20)(PFG) by block randomization. PFMR and CTM were applied 3 days a week for a total of 8 weeks. Uroflowmetry parameters with EMG-Uroflow, PFM activation with Myoplus Pro 4 device, post-void residual urine (PVR) with ultrasonography, bladder functions with bladder diary, symptom severity with Dysfunctional Voiding and Incontinence Scoring System (DVISS), quality of life with the Pediatric Urinary Incontinence Quality of Life Score (PIN-Q) was evaluated. All assestments were performed baseline and post-test. After itntervention, a decrease in symptoms, improvement in uroflowmetry, PVR and bladder diary parameters, and improvements in PFM activation values and quality of life were observed in both groups (p<0.05). Between-group comparisons showed a greater decrease in the DVISS score on CTG, a greater increase in the QAve value on uroflowmetry and voided volume in the bladder diary, a greater increase in the contraction average activation of the PFM, and a greater decrease in the Pin-Q questionnaire (p=0.001). To our knowledge, our study is the only study that uses and compares PFMR and CTG together in children with LUTD. As a result, PFMR is an effective method on symptoms, uroflowmetry and bladder diary parameters, PFM activation and quality of life when applied both alone and together with CTM. However, when applied together with CTM, the symptom score, some uroflowmetry and bladder diary parameters are more effective in the development PFM contraction activation and quality of life. It can be preferred as an effective method without side effects in children with LUTD. Keywords: Pelvic floor, connective tissue, lower urinary tract symptoms