Incontinence training with urotherapy helps children with cerebral palsy

In the treatment of urinary incontinence, urotherapy appears to be effective in children with cerebral palsy (CP), helping reduce symptoms although at a slower rate compared with their typically developing counterparts, according to a study.

The study included 21 children with CP and 24 typically developing children aged 5–12 years old, all of whom had daytime incontinence or combined daytime incontinence and enuresis. All of them received individualized treatment (according to probable underlying conditions) for 1 year, starting with 3 months of standard urotherapy. After 3, 6, and 9 months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment, or neuromodulation) and/or pharmacotherapy could be added to the initial treatment.

The children underwent three-monthly examination by means of uroflowmetry, as well as completed a structured questionnaire and bladder diaries.

Compared with the typically developing group, the CP group had lower effectivity rate with incontinence training, with improvements occurring slower over 1 year of training. These improvements were for daytime incontinence (p<0.001), frequency of daytime incontinence (p=0.002), frequency of enuresis (p=0.048), storage symptoms (p=0.011), correct toilet posture (p=0.034), and faecal incontinence (p=0.026).

Maximum voided volume and fluid intake at baseline were significantly lower in the CP group and could explain a delayed effectiveness of urotherapy. Of note, treatment of constipation had a positive effect on maximum voided volume.

The findings suggest that constipation treatment should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. More studies with a larger sample size are needed.