What is the role of biofeedback-assisted therapy in the treatment of overactive bladder (OAB) in children?

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

In children who fail to improve with such voiding regimens, biofeedback-assisted therapy and pharmacologic therapy are the next treatment options.

Biofeedback is a technique in which physiologic activity is monitored, amplified, and conveyed to the patient as a visual or acoustic signal, providing the patient information about unconscious physiologic processes. It has been used for both filling-phase (detrusor overactivity) and voiding-phase (voiding dysfunction) abnormalities.

Biofeedback can help children identify and suppress involuntary detrusor contractions, as well as identify and relax their pelvic floor muscles. The limitation of biofeedback in the management of detrusor overactivity is the need for the placement of a catheter and the potential need for multiple sessions.

In children with associated pelvic floor dysfunction, biofeedback may be performed via the use of a uroflow with electromyography (EMG). The EMG activity can be identified on the monitor and followed as the child first locates and then learns to relax his or her pelvic floor muscles.

Few studies have evaluated urodynamic-based biofeedback in children with detrusor overactivity. The small numbers of patients and the variability in study design limit the value in drawing conclusions.

Kjolseth et al performed cystometrography-assisted biofeedback in 15 children aged 6-12 years with idiopathic detrusor overactivity. The children received 1-2 inpatient sessions, and follow-up sessions were determined by the severity of the child’s symptoms and the ease of learning for the child. A pronounced improvement was noted in 60% of children, and some improvement was noted in 13% of them. The children were monitored for up to 2 years after the end of therapy, and, in all children but one, the beneficial effects were maintained. [28]


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