PHYSIOTHERAPY IN CHILDHOOD BLADDER AND BOWEL DYSFUNCTIONS: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
Main Article Content
Abstract
Background: Bladder and bowel dysfunctions include daytime urinary incontinence, enuresis, urgency as well as constipation and faecal incontinence. Bladder and bowel dysfunctions are common in children of all ages worldwide. Dysfunction of the pelvic floor muscles is a major suggested cause of the bladder and bowel dysfunctions. Therefore, physiotherapists as musculoskeletal specialists, using standard motor control interventions, might play a role. There are no systematic studies that support this assumption.
Aims: To determine whether physiotherapy has beneficial effects on bladder and bowel dysfunctions in otherwise healthy children, aged 4-18 years compared to standard medical care or urotherapy. Secondary aims are to investigate whether physiotherapy have any effect at all on childhood bladder and bowel dysfunctions and if so, which type of physiotherapy is preferable.
Methods: A systematic review of randomised controlled trials (physiotherapy versus physiotherapy or physiotherapy versus no intervention, standard medical care, urotherapy, sham-intervention) was undertaken. The primary outcome was the number of cured children from bladder and bowel dysfunctions at six and twelve months. The methodological quality was assessed using the Physiotherapy Evidence Database-scale. To grade and assess the quality of the evidence, the Grading of Recommendation, Assessment, Development and Evaluation-tool was used.
Results: Sixteen out of 1728 retrieved publications were eligible for this review. Compared to standard medical care or urotherapy, in favour of physiotherapy, significantly more children were cured from faecal incontinence at 6 months, and from urinary incontinence, day and night, and urgency at 12 months. Significantly more children were cured at 6 and 12 months from all bladder dysfunctions and constipation when receiving physiotherapy. Making substantiated statements about aspects of physiotherapy intervention was impossible.
Conclusion: Physiotherapy in children over four years seems to be justified in bladder and bowel dysfunctions, but firm evidence is lacking. Further research is required. Larger pragmatic studies must be executed. Studies should be more tailored to specific age groups, taken in account the natural attrition of symptoms and developmental differences. Methods should include a range of primary and secondary outcomes which are most suitable, including questionnaires of psychometric sufficient quality. Adverse events, or its absence, should be reported.
Keywords:
children, motor control interventions, physiotherapy, standard medical care, urotherapy, biofeedback, electrical stimulation, pelvic floor muscles, bladder and bowel, daytime urinary incontinence, enuresis, constipation, faecal incontinence
Article Details
How to Cite
VAN ENGELENBURG – VAN LONKHUYZEN, Marieke L et al.
PHYSIOTHERAPY IN CHILDHOOD BLADDER AND BOWEL DYSFUNCTIONS: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS.
Medical Research Archives, [S.l.], v. 11, n. 5, may 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3841>. Date accessed: 09 may 2024.
doi: https://doi.org/10.18103/mra.v11i5.3841.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Velasco-Benítez CA, Collazos-Saa LI, García-Perdomo HA. A systematic review and meta-analysis in schoolchildren and adolescents with functional gastrointestinal disorders according to Rome iv criteria. Arq Gastroenterol. 2022;Apr-Jun 59(2):304-301.
3. Dos Santos J, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J. 2017 Jan-Feb 11(1-2Suppl 1): S64-S72.
4. Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga MA. Functional defecation disorders in children with lower urinary tract symptoms. J Urol. 2013;189(5):1886-1891.
5. Burgers RE, Mugie SM, Chase J, et al. Management of Functional Constipation in Children with Lower Urinary Tract Symptoms: Report from the Standardization Committee of the International Children's Continence Society. J Urol. 2013;190(1):29-36.
6. Aguiar LM, Franco I. Bladder Bowel Dysfunction. Urol Clin North Am. 2018; Nov;45(4):633-640.
7. Sampaio C, Sampaio Sousa A, Fraga LGA, Veiga L, Murillo Bastos Netto J, Barroso Jr U. Constipation and Lower Urinary Tract Dysfunction in Children and Adolescents: A Population-Based Study. Front Pediatr. 2016; Oct 3(4 ):101.
8. Austin PFSB, Wendy. Bower, Janet. Chase, Israel. Franco, Piet. Hoebeke, Søren. Rittig, Johan. Vande Walle, Alexander. von Gontard, Anne. Wright, Stephen. S. Yang and Tryggve. Nevéus,. The Standardization of Terminology of Bladder Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children’s Continence Society (ICCS). 2016.
9. Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. Lancet Child Adolesc Health 2019;3(7):492-501.
10. Sarici H, Telli O, Cem Ozgur B, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol. 2016;Jun 12(3):159
11. Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol 2020;Feb;16(1):10-19.
12. Neveus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol. 2010b;183(2):441-447.
13. Drossman DA, Dumitrascu DL. Rome IV: New standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 2016.
14. Hyams JS, Di Lorenzo C, Saps M, Schulman RJ, Staiano A, van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150:1456-1468.
15. Koppen IL, Benninga MA. Functional Constipation and Dyssynergic Defecation in Children. Front Pediatr. 2022;Febr 16(10: 832877):eCollection 2022.
16. Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA. Functional Fecal Incontinence in Children: Epidemiology, Pathophysiology, Evaluation, and Management. J Pediatr Gastroenterol Nutr. 2021;Juni 72(6):794-801.
17. Koppen IJ, Vriesman MH, Saps M, et al. Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. The Journal of Pediatrics. 2018(April):1-17.
18. Nieuwhof-Leppink AJ, Hussong J, Chase J, et al. Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). J Pediatr Urol. 2021;17(2):172-181.
19. Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 2020; 17(1):21-39.
20. Yang. S, Chua ME, Bauer S, et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol. 2018;Dec;33 (12):2207-2219.
21. Riegler G, Esposito I. Bristol scale stool form. A still valid help in medical practice and clinical research. Tech Coloproctol. 2001; 5(3):163-164.
22. Buckley BS, Sanders CD, Spineli L, Deng Q, Kwong JS. Conservative interventions for treating functional daytime urinary incontinence in children (Review). Cochrane Database Syst Rev. 2019;Sep 18;9(9).
23. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006; 18(7):507-519.
24. Broens PMA, Jonker JE, Trzpis M. The puborectal continence reflex: a new regulatory mechanism controlling fecal continence. Int J Colorectal Dis. 2018;May 33(5):627-633.
25. Heitmann PT, Vollebregt PF, Knowles CH, Lunniss PJ, Dinning PG, Scott SM. Understanding the physiology of human defaecation and disorders of continence and evacuation. Nat Rev Gastroenterol Hepatol. 2021;Nov; 18(11):751-769.
26. Vodusek D. Neuroanatomy and neurophysiology of pelvic floor muscles. In: Bo K, Berghmans B, Morkved S, van Kampen M, eds. Evidence-based Physical Therapy for the Pelvic Floor. Bridging science and clinical practice., Edinburgh Elsevier Churchill Livingstone.; 2015:35-42.
27. Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007; 26(3):362-371.
28. Junginger B, Baessler K, Sapsford R, Hodges PW. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J. 2010;21(1):69-77.
29. World Confederation for Physical Therapy. Policy Statement: Description of physical therapy. London:
http://www.wcpt.org/what-is-physical-therapy; 2015.
30. van Engelenburg-van Lonkhuyzen ML, Bols EMJ, Benninga MA, Verwijs WA, de Bie RA. Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings. Eur J Pediatr. 2017; 176:207-216.
31. Zivkovic V, Lazovic M, Vlajkovic M, et al. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med. 2012; 48(3):413-421.
32. Vasconcelos M, Lima E, Caiafa L, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol. 2006; 21(12):1858-1864.
33. Ladi-Seyedian SS, Sharifi-Rad L, Ebadi M, Kajbafzadeh AM. Combined functional pelvic floor muscle exercises with Swiss ball and urotherapy for management of dysfunctional voiding in children: a randomized clinical trial. Eur J Pediatr. 2014.
34. De Paepe H, Renson C, Hoebeke P, Raes A, Van Laecke E, Vande Walle J. The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children. Scand J Urol Nephrol. 2002;36(4):260-267.
35. De Paepe H, Renson C, Van Laecke E, Raes A, Vande Walle J, Hoebeke P. Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int. 2000;85(7):889-893.
36. Chase J, Schrale L. Childhood incontinence and pelvic floor muscle function: Can we learn from adult research? J Pediatr Urol. 2017;13:94-101.
37. Chase JW, Stillman BC, Gibb SM, et al. Trunk strength and mobility changes in children with slow transit constipation. J Gastroenterol Hepatol. 2009;24(12):1876-1884.
38. Bo K, ., Berghmans B, Morkved S, Van Kampen M. Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice 2nd Edition. Croydon: Elsevier; 2015.
39. van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, Bluijssen NM, de Bie RA. The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial. BMC Pediatr. 2013;13(1):112.
40. Beaudry-Bellefeuille I, Lane SJ, Lane AE. Sensory Integration Concerns in Children With Functional Defecation Disorders: A Scoping Review. Am J Occcup Ther. 2019; 73(3):1-13.
41. van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA. Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation, Compared with Standard Medical Care. Gastroenterology. 2017;152(152):82-91.
42. Pollock MR. The Association Between Sensory Processing Disorder and Dysfunctional Elimination Syndrome in Children. Toledo: Department of Rehabilitation Sciences, , The University of Toledo; 2012.
43. van Engelenburg–van Lonkhuyzen ML, Bols EMJ, Benninga MA, Groen L-A, Chase J, de Bie RA. Physiotherapy interventions for functional bladder and bowel dysfunctions in neurologically normal and otherwise healthy children (Protocol). . Cochrane Database of Systematic Reviews 2016(11).
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