The Effect of a Combined Pelvic Floor Muscle Training and Gross Motor Strengthening Program on Urinary Incontinence in School-Aged Children With Typical Development: A Descriptive Retrospective Case Series

Abstract

Introduction/Background: Daytime incontinence (DI) in a school-aged child with typical development has a substantial impact on the affected family and child’s quality of life. The purpose of this descriptive retrospective case series is to add to the existing knowledge of nonpharmacological treatments for dysfunctional voiding (DV) in the pediatric population. Case Description: Participants included 4 children (median age of 8.9 ± 1.7 years) with typical development who presented to physical therapy (PT) with symptoms of DI. All participants had been successfully toilet-trained during the day for more than 2 years prior to onset of DI. All participants completed a comprehensive rehabilitation program with varying symptom severity at the start of therapy. The case series includes participants with co-occurring disorders including attention-deficit hyperactivity disorder (ADHD), anxiety, and combination ADHD and encopresis. Each child was evaluated for the frequency of DI and the parent completed a urinary symptom questionnaire pretreatment and at a 1to 2-year follow-up (median time to follow-up: 1 year, 4 months). The frequency of DI was also recorded at the last PT treatment. INTRODUCTION Pelvic floor dysfunction with daytime incontinence (DI) limits full engagement and participation of schoolaged children. While these children often have a history of being fully toilet trained, pelvic floor dysfunction can occur. Although the prevalence is unknown, one population study reported up to 16.9% of schoolaged children experience daytime urinary incontinence ranging from very mild to severe.1 In children without pelvic floor dysfunction, voiding occurs when there is an absence of a pelvic floor muscle (PFM) contraction with detrusor contraction. This allows for children to fully empty and manage their bladder during voiding without abnormal urinary retention. Commonly pediatric DI is secondary 1Genesis Pediatric Therapy Center, Coralville, Iowa. 2University of Iowa Hospitals and Clinics, Iowa City, Iowa. 3Minneapolis, Minnesota. An abstract of this work was presented at the APTA Combined Sections Meeting on January 25, 2019, with support by the Elaine Meadows Research Scholar Award presented to Tara Rudolphi. The authors declare no conflicts of interest. Corresponding Author: Tara Rudolphi, DPT, PO Box 43, Williamsburg, IA 52361 (Tara.rudolphi@gmail.com). DOI: 10.1097/JWH.0000000000000162 Case Report The Effect of a Combined Pelvic Floor Muscle Training and Gross Motor Strengthening Program on Urinary Incontinence in SchoolAged Children With Typical Development: A Descriptive Retrospective Case Series Tara Rudolphi, DPT1 Douglas Storm, MD2 Kristine Bonnett, ARNP2 Tonya Rich, PhD, OTR/L3 VOLUME 44 • NUMBER 2 • 0