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Biofeedback to Help Your Child's Bladder Control Problems

What are bladder control problems?

Bladder control problems mean that a child has trouble holding her urine (pee). A child with bladder control problems may have some of the following problems:

Bladder control problems can happen once in a while or very often. They can have several different causes.

Several different treatments can help children learn to hold their pee until they get to the toilet. Which treatment might help a child depends in part on the cause of the problem.

If a child's bladder problem has to do with the muscles of the bladder, biofeedback may be useful. Biofeedback can help the child learn to better control the muscles that are used for bladder control.

What is biofeedback?

Biofeedback is a system that monitors changes in a person's body and displays them to the person. Biofeedback can help people become more aware of body functions that are normally automatic, such as peeing. As a result, people can sometimes get more control over those functions.

Biofeedback for bladder control problems uses a special computer game to help your child learn to control the muscles that are used for holding urine and peeing.

How the urinary system works

The urinary tract system gets rid of waste from the body. Two kidneys filter the body's blood. The waste produced by the kidneys is called urine, or pee. Urine travels from the kidneys to the bladder through a tube called a ureter. There is one ureter for each kidney.

Urinary System (Female)
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The bladder is a muscular bag that can stretch to hold urine. A strong muscle at the bottom of the bladder stops the urine from coming out until you are ready to use the toilet. This muscle is called a sphincter. It is part of a group of muscles called the pelvic floor muscles.

When the bladder is full, it sends a message to the brain. It is up to you to decide whether to use the toilet to urinate or to hold your pee.

  • If you decide to use the toilet, your brain sends a message to your bladder to contract and for the sphincter to relax. Once the sphincter is relaxed, the urine flows from a tube called the urethra to the outside of the body.
  • If you decide not to pee, the bladder relaxes and the sphincter contracts to prevent the urine from coming out.

If your child's bladder problems are caused by poor control of the pelvic floor muscles, biofeedback may be a good therapy to try. Biofeedback can help teach a child to better control these muscles.

Flow rate test with electromyography (EMG)

A flow rate test with EMG will help doctors decide whether biofeedback may be a good therapy for your child to try.

A flow rate test is a test that checks how your child urinates. Electromyography (EMG) is a test that looks at how muscles and nerves work together.

Your child will have electrodes gently applied on the buttocks and hip. Electrodes are like stickers. They are connected to the EMG machine with wires. These electrodes let doctors check what your child's pelvic floor muscles are doing while she is peeing. The sphincter is part of the pelvic floor.

Your child will pee into a special toilet.

Preparing for the test with a full bladder

Your child will need to have a full bladder and will really need to urinate. Please make sure your child has something to drink before the test, such as water. It can take between 20 to 30 minutes for liquid to get down to the bladder. Your child can eat before the test if she is hungry.

When your child's bladder is full, the test will take about 10 minutes.

After the test, the doctor may recommend biofeedback

After the flow test with EMG, you will meet with the doctor in the clinic. He or she will talk to you about the results of your child's test.

Depending on the results of the test and your child's medical history, the doctor may recommend biofeedback for your child.

Biofeedback can help the urinary symptoms of children who have one or more of the following:

  • Squeeze their pelvic floor muscles instead of relaxing when urinating.
  • Have had more than one urinary tract infection.
  • Do not get better after a lot of bladder retraining.
  • Are not able to control their bladder during the day and do not get better from other therapies.

How biofeedback works

Biofeedback uses electrodes placed on your child's buttocks and hip. These electrodes are connected to a special computer game that your child will play. The game will help your child learn to relax her pelvic floor muscles.

At the end of each session, your child will be sent home with pelvic floor exercises. These exercises will help her practice what she learns during the biofeedback sessions.

It usually takes several biofeedback visits for a child to learn the skills needed to urinate properly. Some children need several weeks or even a few months of biofeedback sessions to learn the skills.

You can help make your child's biofeedback sessions more successful

Your child should arrive at the clinic with a full bladder.

It is also important for your child to want to learn these new skills. Between biofeedback sessions, your child should practice the pelvic floor exercises she has learned on her own.

Try to support and praise your child as much as you can. When parents are encouraging and supportive, the therapy tends to be more successful.

Key points

  • Children can have bladder control problems for several reasons.
  • If the cause of the problem has to do with the bladder muscles and the sphincter, biofeedback sessions may help the child.
  • A flow rate test with EMG will help doctors decide if biofeedback may be useful.
  • Biofeedback uses electrodes and video games to help your child learn to control the muscles needed for bladder control.
  • Your child should practice pelvic floor muscle exercises between biofeedback sessions.

Cathy Daniels, RN, MS, ACNP

Dalia Bozic, RN, BScN


At SickKids:

Your child will need to register in the Urology Clinic. The Urology Clinic is located on 6B in the Atrium.

The unit clerks will let the nurses know when you have arrived at the clinic.

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