What is biofeedback?

Biofeedback is a method to help your child learn how to control parts of his body that aren’t usually thought to be under conscious control. During biofeedback a computer is used to measure, record and display (or feed back) information about a body process. The purpose of biofeedback is to help your child better understand how the body works and how to control it in healthier ways.

How is biofeedback used in urology?

Biofeedback is a way to treat and manage daytime wetting, urinary tract infections and reflux (backward flow of urine from the bladder into the kidneys) in children. At CHOP, we have several trained nurses who have been teaching and coaching children through biofeedback therapy for years.

In pediatric urology biofeedback, we teach your child to retrain the pelvic floor muscles. The pelvic floor muscles help the bladder store and empty urine. When the muscles are tight, the bladder stores urine without leaking. When the muscles are relaxed, the bladder can empty. Children who have discoordinated voiding tend to have more tension in their pelvic floor muscles.  They have trained their pelvic floor muscles to hold and NOT to relax, causing them to hold urine longer and not to empty their bladder completely. Biofeedback is used to teach children how to relax their pelvic floor so their bladder can empty completely.

What happens during biofeedback?

During a biofeedback session, stickers are placed on your child’s belly and buttocks. These stickers have wires connected to a computer. The wires send signals to the computer telling it how well the pelvic floor muscles are squeezing and relaxing. This information is turned into picture and sound messages your child can hear and see on the computer. By hearing and seeing these messages, your child can know exactly what their muscles are doing. If they change what their muscles are doing, the feedback on the computer will also change. These exercises help your child learn to control his pelvic floor muscles, even when he is not hooked up to the computer. The overall goal is to improve your child’s ability to store urine and empty his bladder more effectively.

Who needs biofeedback?

Biofeedback is offered as a treatment option for:

• Children who “strain” to void
• Children who do not empty their bladder completely
• Children with recurrent urinary tract infections
• Children who void with a start-stop-start pattern
• Children who void with a prolonged flow without much “force”

What is involved in a biofeedback training session?

We ask that your child arrive to her appointment with a full bladder. Your first appointment is scheduled for 90 minutes, follow-up biofeedback appointments are scheduled for one hour.

At the beginning of all sessions the nurse will obtain a detailed voiding history:

• How often does your child urinate?
• Does your child wet?
• Does your child have a daily bowel movement?
• How much water does your child drink?

The nurse will discuss the accomplishments since your last visit, progress at home, any recent urinary tract infections and address any questions you have.

To start biofeedback, special stickers will be placed on your child’s buttocks and abdomen to record muscle activity. Your child will be fully clothed and in a reclining chair to help her relax. Our biofeedback nurse will take your child through a series of exercises using video games. Your child controls the games by using her pelvic floor muscles. She will be asked to urinate on a special toilet called a uroflow meter. The toilet looks like a bedside commode with a special cup to collect the urine. As your child urinates, the flow meter records the flow rate and time. An ultrasound of your child’s bladder will then be performed to see if there is any urine left in her bladder.

How many biofeedback sessions do children need?

Each child is different. In general, children need two to five sessions to learn the proper methods to help relax their pelvic floor muscles and improve their bladder emptying. The more they practice at home and during their voiding program, the sooner results will appear.