Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation

Objective To analyse experience in treating young children (4-5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive trai ning programme. Patients and methods Between January 1996 and October 1997, 20 children (al l < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain cause d by spasms of the pelvic floor. Eight children had encopresis based on chr onic obstipation. Therapy consisted of keeping a voiding and drinking chart , instructions on proper toilet posture, daily rules for application at hom e, and if possible relaxation biofeedback of the pelvic-floor muscles. Ther apy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed. Results Of the 20 children, 13 had a good result; they all became dry durin g the day and night, and encopresis resolved. Six children had moderate suc cess; in one, nocturnal incontinence persisted, and in two diurnal and noct urnal incontinence continued. In two children encopresis persisted and in o ne the faecal incontinence ameliorated. In one child the therapy was premat urely interrupted because of lack of motivation. Conclusion This experience suggests that a noninvasive training programme i s applicable in very young children with symptoms of dysfunctional eliminat ion of urine and faeces.