Interactive computer game-based biofeedback in childhood functional outlet obstruction...25th National Conference on Incontinence in association with the Urogynaecological Society of Australasia 9-12 November 2016 Adelaide Convention Centre, Adelaide, South Australia

Abstract

Introduction: Functional outlet obstruction in children is a common subtype of constipation.1 Failure to adequately relax the pelvic floor muscles during defaecation can lead to a vicious cycle of large hard stools and painful defaecation.2 This study aimed to investigate whether the use of a computer gamebased biofeedback system could be a useful adjunct in the treatment of functional outlet obstruction. Materials & method: 36 children with functional outlet obstruction, who presented for treatment between March 2010 and December 2014, were included in this prospective observational study. Only those children with functional outlet obstruction who were referred by a paediatric gastroenterologist were included. Intervention included standard therapy, computer gamebased biofeedback and non-invasive uroflowmetry. Computer game-based biofeedback uses surface electromyography to facilitate visualisation and control of pelvic floor muscle activity through a computer game.3 Uroflowmetry technology enables simultaneous recording of surface electromyography and urine flow, with visual display of pelvic floor muscle activity, flow rate and volume.3 Quantitative data comparisons are made between initial and final treatment transverse rectal diameters, pelvic floor activity, voiding pattern flow rates and episodes of soiling. Qualitative data comparisons are made to assess perceived severity of constipation and impact of constipation on quality of life, measured via visual analogue scales. Results: Ages ranged from 5 to 12 years. Average number of treatment sessions was 6.3 (range 2-14). Thirty-three subjects (92%) demonstrated improvement in constipation and soiling. Statistically significant (p<0.05) improvements were observed in episodes of soiling, voiding pattern flow rates, perceived severity of constipation score and qualityof- life score. Twenty-two subjects (61%) sustained their improvement for at least six months following therapy. Conclusions: An interactive computer game-based biofeedback system is demonstrated to be a useful adjunct to standard therapy in the management of functional outlet obstruction. This novel treatment approach provides fun, safe and non-invasive options for children experiencing symptoms of encopresis and constipation. Further research involving randomised controlled trials, and future investigation into surface EMG biofeedback on external anal sphincter as a potentially more targeted approach to treatment for functional outlet obstruction, is warranted.abstract; research. Journal Subset: Australia & New Zealand; Expert Peer Reviewed; Nursing. <br />