PHYSIOTHERAPY IN CHILDHOOD BLADDER AND BOWEL DYSFUNCTIONS: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS

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.