Urotherapy

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Urotherapy is a non pharmacological and non surgical approach used in the management of bladder and bowel dysfunction (BBD), primarily in children and adolescents. [1] BBD refers to the coexistence of at least one lower urinary tract symptom (such as urinary incontinence or urgency) with one or more bowel related symptoms, including constipation or encopresis. [2] [3] [4] It is widely recognized in pediatric continence care and is considered the first line management strategy for children with BBD. The terminology and specific practices may vary internationally, but the overall goal remains the structured restoration of optimal bladder and bowel function without the immediate use of medication or surgery.

Urotherapy is delivered in clinical settings by a range of healthcare professionals, including pelvic floor physiotherapists, nurses, and occupational therapists, depending on regional practices. It comprises structured approaches aimed at supporting bladder and bowel function. Standard urotherapy, as described in clinical studies, typically includes education about bladder and bowel physiology, establishment of regular voiding routines, attention to proper posture while sitting on the toilet and pelvic floor awareness. Monitoring of urinary and bowel habits over time is an important component. Interventions also frequently address bowel function, incorporating dietary measures to promote regularity and, when clinically indicated, the use of stool softeners. Hydration is another element often considered to support normal urinary function. [5] [6] [7] [8]

In addition to standard urotherapy, some programs may include more targeted interventions, sometimes referred to as specific urotherapy, which can incorporate techniques such as pelvic floor muscle training, biofeedback, or electrostimulation. Evidence from systematic reviews suggests that urotherapy can improve uroflowmetry parameters, reduce urinary incontinence, and alleviate symptoms of functional constipation and recurrent urinary tract infections in pediatric populations. [9] [10] [11] [12] [13]

References

  1. Assis, Gisela Maria; Silva, Camilla Pinheiro Cristaldi da; Martins, Gisele (2019-11-01). "Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review". Jornal de Pediatria (English Edition). 95 (6): 628–641. doi:10.1016/j.jped.2019.02.007. ISSN   0021-7557.
  2. Assis, Gisela Maria; Silva, Camilla Pinheiro Cristaldi da; Martins, Gisele (2019-11-01). "Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review". Jornal de Pediatria. 95 (6): 628–641. doi:10.1016/j.jped.2019.02.007. ISSN   0021-7557.
  3. Santos, Joana Dos; Lopes, Roberto I.; Koyle, Martin A. (2017). "Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem". Canadian Urological Association Journal = Journal De l'Association Des Urologues Du Canada. 11 (1-2Suppl1): S64 –S72. doi:10.5489/cuaj.4411. ISSN   1911-6470. PMC   5332240 . PMID   28265323.
  4. Nieuwhof-Leppink, A. J.; Hussong, J.; Chase, J.; Larsson, J.; Renson, C.; Hoebeke, P.; Yang, S.; von Gontard, A. (April 2021). "Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS)". Journal of Pediatric Urology. 17 (2): 172–181. doi:10.1016/j.jpurol.2020.11.006. ISSN   1873-4898. PMID   33478902.
  5. Sumboonnanonda, Achra; Sawangsuk, Punnarat; Sungkabuth, Patharawan; Muangsampao, Janpen; Farhat, Walid A.; Piyaphanee, Nuntawan (2022-05-17). "Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study". BMC pediatrics. 22 (1): 288. doi:10.1186/s12887-022-03360-9. ISSN   1471-2431. PMC   9110931 . PMID   35581653.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  6. Rakowska-Silska, Magda; Jobs, Katarzyna; Paturej, Aleksandra; Kalicki, Bolesław (2020). "Voiding Disorders in Pediatrician's Practice". Clinical Medicine Insights. Pediatrics. 14: 1179556520975035. doi:10.1177/1179556520975035. ISSN   1179-5565. PMC   7705800 . PMID   33293883.{{cite journal}}: CS1 maint: article number as page number (link)
  7. Arlen, Angela M. (2017-02-17). "Dysfunctional Voiders—Medication Versus Urotherapy?". Current Urology Reports. 18 (2): 14. doi:10.1007/s11934-017-0656-0. ISSN   1534-6285.
  8. Ladi Seyedian, Seyedeh Sanam; Sharifi-Rad, Lida; Ebadi, Maryam; Kajbafzadeh, Abdol-Mohammad (2014-10-01). "Combined functional pelvic floor muscle exercises with Swiss ball and urotherapy for management of dysfunctional voiding in children: a randomized clinical trial". European Journal of Pediatrics. 173 (10): 1347–1353. doi:10.1007/s00431-014-2336-0. ISSN   1432-1076.
  9. Altunkol, Adem; Abat, Deniz; Sener, Nevzat Can; Gulum, Mehmet; Ciftci, Halil; Savas, Murat; Yeni, Ercan (2018). "Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?". International Braz J Urol: Official Journal of the Brazilian Society of Urology. 44 (5): 987–995. doi:10.1590/S1677-5538.IBJU.2018.0194. ISSN   1677-6119. PMC   6237517 . PMID   30130020.
  10. Fuentes, Mirgon; Magalhães, Juliana; Barroso, Ubirajara (2019). "Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children". Frontiers in Pediatrics. 7: 298. doi:10.3389/fped.2019.00298. ISSN   2296-2360. PMC   6673647 . PMID   31404146.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. Farahmand, Fatemeh; Abedi, Aidin; Esmaeili-Dooki, Mohammad Reza; Jalilian, Rozita; Tabari, Sanaz Mehrabani (June 2015). "Pelvic Floor Muscle Exercise for Paediatric Functional Constipation". Journal of clinical and diagnostic research: JCDR. 9 (6): SC16–17. doi:10.7860/JCDR/2015/12726.6036. ISSN   2249-782X. PMC   4525569 . PMID   26284199.
  12. Vasconcelos, Mônica; Lima, Eleonora; Caiafa, Letícia; Noronha, Alessandra; Cangussu, Renata; Gomes, Suzely; Freire, Raquel; Filgueiras, Maria Teresa; Araújo, Junia; Magnus, Gisele; Cunha, Cláudia; Colozimo, Enrico (2006-12-01). "Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study". Pediatric Nephrology. 21 (12): 1858–1864. doi:10.1007/s00467-006-0277-1. ISSN   1432-198X.
  13. Ferreira, Roseanne; Elterman, Dean; Rickard, Mandy; Freeman, Max; Brownrigg, Natasha; Varghese, Abby; Chua, Michael; Lorenzo, Armando; Dos Santos, Joana (August 2024). "Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction Insights from Canada's first pediatric cohort". Canadian Urological Association Journal = Journal De l'Association Des Urologues Du Canada. 18 (8): 239–244. doi:10.5489/cuaj.8881. ISSN   1911-6470. PMC   11326724 . PMID   39151156.