Neurourology and urodynamics · 2026
Multimodal Therapy for Monosymptomatic Nocturnal Enuresis: Nocturnal Bladder and Pelvic Floor Dynamics.
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Seyhan Canan, Ozturk Asli, Kopru Burak, Asik Rabia, Irkilata Hasan Cem, Dayanc Murat
Аннотация
OBJECTIVE: This study aimed to evaluate pelvic floor muscle activity (PFMA) in children with monosymptomatic nocturnal enuresis (MNE) and to investigate the effectiveness of multimodal treatment including standard urotherapy, alarm therapy, and pelvic floor muscle rehabilitation (PFMR) approach by assessing nocturnal bladder and pelvic floor dynamics.
METHODS: In this retrospective cross-sectional study, medical records of children with primary MNE were reviewed. All participants received a multimodal treatment consisting of (i) standard urotherapy based on International Children's Continence Society recommendations, (ii) enuresis alarm therapy with objective nocturnal urine volume monitoring, and (iii) individualized PFMR. PFMR was designed according to baseline PFMA assessed objectively using surface electromyography and included relaxation-oriented interventions for pelvic floor overactivity, coordination training, and strength and endurance exercises integrated with core muscles. Nocturnal bladder dynamics, PFMA parameters, and treatment outcomes were retrospectively analyzed. Treatment response was classified as complete, partial, or no response.
RESULTS: A total of 65 children were included. At baseline, 67.7% of children had pelvic floor overactivity, and 64.7% had nonfunctional or weak functional pelvic floor. Both pelvic floor dysfunctions coexisted in 25 children (38%). During multimodal therapy, objective nocturnal measures demonstrated a significant reduction in alarm activations and diaper urine volume, alongside increased voided volumes (all p < 0.001). Resting tone, contraction and functional contraction amplitude were significantly improved after treatment (all p < 0.001). Complete response was achieved in 75.4% of children at 12 weeks and increased to 93.8% at 16 weeks.
CONCLUSION: Multimodal treatment combining standard urotherapy, alarm therapy with individualized PFMR based on objective PFMA assessment appears highly effective in children with MNE and may optimize both pelvic floor function and nocturnal bladder dynamics.
METHODS: In this retrospective cross-sectional study, medical records of children with primary MNE were reviewed. All participants received a multimodal treatment consisting of (i) standard urotherapy based on International Children's Continence Society recommendations, (ii) enuresis alarm therapy with objective nocturnal urine volume monitoring, and (iii) individualized PFMR. PFMR was designed according to baseline PFMA assessed objectively using surface electromyography and included relaxation-oriented interventions for pelvic floor overactivity, coordination training, and strength and endurance exercises integrated with core muscles. Nocturnal bladder dynamics, PFMA parameters, and treatment outcomes were retrospectively analyzed. Treatment response was classified as complete, partial, or no response.
RESULTS: A total of 65 children were included. At baseline, 67.7% of children had pelvic floor overactivity, and 64.7% had nonfunctional or weak functional pelvic floor. Both pelvic floor dysfunctions coexisted in 25 children (38%). During multimodal therapy, objective nocturnal measures demonstrated a significant reduction in alarm activations and diaper urine volume, alongside increased voided volumes (all p < 0.001). Resting tone, contraction and functional contraction amplitude were significantly improved after treatment (all p < 0.001). Complete response was achieved in 75.4% of children at 12 weeks and increased to 93.8% at 16 weeks.
CONCLUSION: Multimodal treatment combining standard urotherapy, alarm therapy with individualized PFMR based on objective PFMA assessment appears highly effective in children with MNE and may optimize both pelvic floor function and nocturnal bladder dynamics.