Non-drug approach can ease kids' urinary problems

NEW YORK (Reuters Health) - Children with bladder problems may be successfully treated without medication, according to a team of Brazilian researchers.

They found that biofeedback, a technique in which a person learns how to exert conscious control over the pelvic muscles involved in regulating urination, was useful in treating various types of urinary dysfunction. Also, mild electrical stimulation of certain nerves was helpful for some conditions.

"In this short-term follow-up, the nonpharmacological treatment of voiding dysfunction using biofeedback, and of urge syndrome by electrical stimulation, was effective for treating lower urinary tract dysfunction in children," the researchers write in the journal BJU International.

Lower urinary tract dysfunction, characterized by urge syndrome or urge urinary incontinence, when a person cannot control the flow of urine once they feel the need to urinate, is traditionally treated with medication, which has been shown to reduce symptoms. Yet, at least one previously published study found that less than 30 percent of children are completely cured of their symptoms by medication, and many experience side effects such as dry mouth or constipation.

Many patients with voiding disturbances have been treated effectively with biofeedback, yet those with urge syndrome continue to be treated with medication.

Dr. Ubirajara Barroso Jr. and colleagues from the Federal University of Bahia, Bahiana School of Medicine and Public Health, and the Federal University of Sao Paulo investigated whether biofeedback and electrical stimulation can be used as an across-the-board treatment for various types of lower urinary tract dysfunction.

Their study involved 36 children, aged 3 to 14 years, who were assigned to one of two groups: those with urge syndrome, who were treated with electrical stimulation and those with voiding problems, who were treated with biofeedback.

The 19 children with urge syndrome were treated with an average 13 20-minute electrical stimulation sessions. The procedure involved the placement of two electrode patches on the lower back and application of an electrical current at a maximum level tolerated by the child. Eighteen of them afterwards improved by 80 percent or more; the remaining child, who initially had intense urgency, having to go more than 19 times daily, improved by 30 percent.

The 17 children treated for voiding dysfunction participated in six biofeedback sessions, on average. These sessions taught the children how to control pelvic muscles to achieve normal voiding. Ten children experienced 100 percent improvement in their symptoms and one child improved by 90 percent. The remaining six children showed lesser improvement, study findings indicate, and they underwent further treatment with electrical stimulation, after which five of them improved by 90 or 100 percent and one child improved by 40 percent.

In other findings, 13 (62 percent) of the 21 children who experienced nighttime bedwetting, continued to exhibit this symptom after treatment with biofeedback or electrical stimulation Also, of the 25 children who had initially experienced urinary tract infection, only four of those who had been treated for voiding dysfunction later experienced isolated episodes of such infection, the researchers note.

"In conclusion, the non-pharmaceutical treatment of voiding dysfunction using biofeedback, and treatment of urge syndrome by electrical stimulation, is in the short-term safe and effective treatment for LUTD," the authors write.

SOURCE: BJU International, July 6, 2006.