Effectiveness of multimodal pelvic floor rehabilitation program in children with different types of urinary incontinence

This study aimed to explore the effects of a multimodal pelvic floor rehabilitation program on lower urinary tract symptoms and pelvic floor and related muscle function in children with different types of urinary incontinence. The study included 35 children aged 5–18 years who had been diagnosed with urinary incontinence. They were divided into three groups: daytime incontinence (n=13), enuresis (n=11) and combined daytime incontinence and enuresis (n=11). All children participated in a 10-week multimodal pelvic floor rehabilitation program, held twice a week for approximately 50 minutes each session. This program included child and parent education, healthy bladder and bowel education, postural education, manual approaches, exercise training, biofeedback therapy, and a home program. Lower urinary tract symptoms were assessed using the Dysfunctional Voiding and Incontinence Scoring System (DVISS), the Bladder and Bowel Dysfunction Questionnaire (BBDQ), the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ), bladder and bowel diaries. The functions of the pelvic floor and related muscles were assessed using perineal evaluation, surface electromyography and ultrasound measurements. After treatment, DVISS, BBDQ and CBBDQ scores decreased significantly in all three groups (p<0.05). While the resting activity and muscle tone of the pelvic floor muscles decreased in all groups, contraction activity, muscle strength, endurance and phasic contraction increased (p<0.05). While the activity of other related muscles decreased during rest and contraction of the pelvic floor muscles, an increase in muscle thickness was determined (p<0.05). In this study, it was described that multimodal pelvic floor rehabilitation program improved lower urinary tract symptoms and pelvic floor and related muscle functions in children with different types of urinary incontinence. Therefore, multimodal pelvic floor rehabilitation program can be recommended as an effective approach for all incontinence subtypes in children.