Biofeedback Therapy Supports Urology Patients at Shriners Children’s New England

Topics like constipation and incontinence can be embarrassing for children to talk about, making it difficult for families to seek solutions. The outpatient therapy team at Shriners Children's New England offers biofeedback therapy to support patients experiencing these issues related to pelvic floor dysfunction. Trained therapists use mind-body techniques to help patients learn how to better control the muscles that control bladder and bowel function. Biofeedback therapy, when combined with targeted lifestyle changes, can help patients resolve symptoms and achieve long-term success.

Patients are referred for biofeedback therapy by Christina Kim, M.D., pediatric urologist at Shriners Children’s New England, or by their pediatrician. Most patients first receive an electromyography (EMG) uroflow test, which provides information about the activation of their pelvic floor muscles and their bladder function.

“If a patient’s pelvic floor muscles function abnormally when they empty their bladder, it tells us they need help with relaxation. If a patient has weak pelvic floor muscles and experiences leaking with activities like running and jumping, we know they require assistance with strengthening. Often kids need both,” said Caryn France, MSPT, manager of outpatient therapy services at Shriners Children’s New England.

Ten-year-old Yaneliz was referred for biofeedback therapy because of bowel and bladder issues caused by partial sacral agenesis, a condition in which the lower spine doesn’t form properly. As a result, her nerves don’t properly signal her muscles when she needs to use the bathroom. “Pelvic floor exercises were recommended to improve her sensation and awareness of those muscles,” said Yaneliz’s mom, Ginaliz. “We liked that it was a non-invasive approach, and her therapist made it into a game.”

Biofeedback therapy works by placing electrodes around the patient’s anus that are connected to a biofeedback computer system. A signal is sent, and a visual image is displayed on a monitor representing muscular contraction and relaxation. Squeezing the pelvic floor muscles makes the graphic move up, while relaxing them makes the graphic move down.

“Since we can’t see the pelvic floor muscles at work, the images on the monitor allow both the therapist and patient to see what the pelvic floor muscles are doing,” said Caryn. Instructions to pull up and in and raise and lower like an elevator are exercises therapists use to help children learn how to control these muscles.

Family involvement is directly related to the overall success of each patient. Therapists incorporate education for parents into their plan of care to help develop a home program. “Patients who have family support and are committed to making additional lifestyle changes see the most improvement in symptoms,” said Caryn. “We discuss the importance of core strengthening, hydration and dietary changes.” Encouraging children not to rush when using the bathroom, reminding them to practice therapy exercises at home, and never punishing them for accidents are other important reminders for parents.

Yaneliz practiced her pelvic floor exercises at home and was encouraged as she became more aware of those muscles. According to Ginaliz, “It took a few sessions for her to stay focused and feel comfortable, but she was excited about her progress. She is working on gaining more control over those muscles now that she has better awareness. We are hoping that this therapy really benefits her in the long term.”

A typical course of biofeedback therapy lasts six sessions, followed by a repeat EMG uroflow test to reassess bladder function. Some children may experience initial success but may fall back into old habits. Instead of resuming therapy right away, Caryn recommends that parents document what is happening at home and rely on the strategies they learned during treatment. “They may be able to pick up on what their child is doing and make modifications to their program at home,” she said. “Therapy provides the tools but families, and especially the patients, need to do the work to achieve lasting improvement.”