'Biofeedback' may help kids with urinary problems

NEW YORK - Learning how to relax muscles in the pelvis through "biofeedback" may help kids who wet their pants, get urinary tract infections, or are constipated, according to new research.

Those symptoms are common, occurring in up to one in ten kids, and can be affected by diet and kids trying to "hold it in." For the technique used in the new study, called animated biofeedback, kids played computer games where they had to tighten and relax pelvic muscles along with animations of dolphins and monkeys on the screen.

That teaches them how to control their bladder when they're outside the doctor's office, researchers said.

"When you go pee, you relax and you let the pee out. These kids actually tighten...muscles while they're voiding," explained Dr. Steve Hodges, a pediatric urologist from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

"You can't just tell a kid, relax your pelvic floor," he said, referring to the muscles than affect urine flow.

Biofeedback is an option, along with medications, in kids who don't get better with changes in diet or a specific schedule that tells them when they should go to the bathroom, said Hodges, who wasn't involved in the new research.

For the study, Dr. Abdol-Mohammad Kajbafzadeh from Tehran University of Medical Sciences in Iran and colleagues randomly split 80 kids with bladder problems into two groups. Kids in one group were treated with six to 12 sessions of animated biofeedback, while the other group was just taught about changes in diet and behavior that could improve their symptoms.

The kids were eight or nine years old, on average, and more than three-quarters of them were girls.

The symptoms generally improved in both groups, but the effect tended to be stronger in those who got the animated biofeedback therapy, the researchers reported in the Journal of Urology.

Six months after treatment, the proportion of kids who wet the bed had dropped from 28 per cent to eight per cent in the biofeedback group, and from 23 per cent to 13 per cent in the "conservative therapy" group.

Constipation fell from 63 per cent to 20 per cent in biofeedback participants, compared to a drop from 50 per cent to 30 per cent in the education-only group.

Pelvic muscle activity also improved to a greater extent among kids who had biofeedback treatment.

As an alternative to biofeedback or education about changes in diet and bathroom use, medications called alpha-blockers can also help relax the pelvic muscles, but "they're not perfect," Hodges said.

Dr. William Whitehead, who has used biofeedback (without the animations) in adults at the University of North Carolina at Chapel Hill, said that animated types of biofeedback "are very useful in children and adolescents."

In this new study, he told Reuters Health, the researchers "have really shown very clearly that this animated feedback can help children learn this response. Their attention span is more limited and their motivation is poorer (than in adults). I think animated biofeedback can help bridge that gap."

Adults, Whitehead explained, generally watch a drawing or hear sounds that reflect the relaxation or tension in their muscles during biofeedback therapy.

He recommended biofeedback for most adults with constipation, and said the improvements in kids' urinary symptoms and constipation also look promising. But one key issue is access -- the clinics that do biofeedback therapy are few and far between, he said. The cost of a single animated biofeedback session starts at around US$100, and the treatment is covered by some types of insurance.