Влияние функционального биологического управления в режиме электромиографии на психологическое состояние детей с нарушениями мочеиспускания и дефекации неорганического генеза

Abstract

Study Objective: To identify and evaluate the impact from functional biological management (FBM) in the electromyography (EMG) mode on clinical manifestations and psychological state in children with non-organic urination and defecation impairment. Study Design: prospective controlled clinical study in parallel groups. Materials and Methods. We examined 255 children of 7 to 18 years old (mean age: 10.3 ± 3.1 years) with urinary incontinence (as the only one complaint or one of a number of complaints upon hospitalisation) and non-organic (functional) urination impairment. The study group included 153 children (66 boys and 87 girls) who had daily FBM sessions (FBM therapy) in the EMG mode (10 sessions) with the standard intensity without prior electrical stimulation. The comparison group included 102 children (43 boys and 59 girls) who were treated with oral metabolic support (MS) for 1 month. A complex examination included history, physical examination, physical development assessment, complete blood test and biochemical blood assay, urinalysis, monitoring of spontaneous urination and defecation rhythms, qualimetric tables, US examination of kidneys, urinary bladder and abdominals, urofluometry, and, if indicated, X-ray or endoscopic examinations and rectum sphincter examination. A complex psychological assessment was performed prior to and after therapy, and prevailing emotions, anxiety levels, ambitions, and self-esteem were identified. Study Results. It was found out that the children with non-organic urination impairment had mostly non-monosymptomatic enuresis (non-ME) (148 (58%)); monosymptomatic enuresis (ME) was diagnosed in 61 (24%) patients, while daytime urinary incontinence (DUI) was recorded in 46 (18%) children, with the peak detectability being at the age of 7 to 10 years. In 41.2% and 43.1%, non-organic urinary impairments (33.3% children with non-ME and 7.8% and 9.8% children with DUI) were combined with chronic constipation and faecal incontinence associated with accompanying pelvic organs impairment. FBM therapy in EMG mode was highly efficient in children both with non-organic urination impairment (84.4%) and accompanying pelvic organs impairment (74.6%); while metabolic support was efficient only in 48.3% and 40.9% of cases, respectively (р < 0.001 in both cases). Children with non-organic urination impairment and accompanying pelvic organs impairment had mostly negative emotions, increased anxiety, low ambitions and self-esteem because of the disease. Unlike metabolic support, FBM therapy in EMG mode had statistically significant impact on the shift to positive emotions, reduced anxiety, improved ambitions and self-esteem. Conclusion. When used in children with non-organic urination impairment and accompanying pelvic organs impairment, FBM therapy in EMG mode can not only arrest clinical symptoms of the disease, but also replaces negative emotions with positive ones, reduces anxiety, improves ambitions and self-esteem, resulting in higher quality of life. Keywords: impaired urination, enuresis, daytime urinary incontinence, accompanying pelvic organs impairment, functional biological management, anxiety, ambitions, self-esteem.