12 impression of therapy adherence. Some children who have a very dilated rectum with no sense of filling will require help with washouts or enemas to kick start the toileting regime. Standard urotherapy Standard urotherapy combines assessment (with registration of voiding frequencies, voiding volumes and incontinence episodes in a bladder diary) and education and demystification, behavioural modification instructions, lifestyle advice regarding fluid intake, and support and encouragement to children and their parents.4,5,6, 1. A crucial part of urotherapy is providing parents and children with good explanations regarding aetiology, prevalence, and pathophysiology. This will reassure parents and help them understand the causes of the child’s wetting accidents and the rationale of the therapy. This will improve compliance. 2. Instructions are given on appropriate fluid intake and regular voiding during the day. Child is encouraged to try to go to the toilet seven times and drink seven glasses per day. 3. Explanation of the correct toilet posture is provided and advised to use a stepping stool for foot support if feet don’t touch the floor easily. Also, they are taught to relax the belly when they voiding. 4. A bladder diary should be kept for self-monitoring and motivation, and to provide the child and parents with insight into treatment progress, compliance and adherence. After introducing the elements of urotherapy, the child practices at home for a maximum of three months. During this practice period, counselling is given during frequent followups which may be face-to-face or telephone/or video. Specific urotherapy When the results of standard urotherapy are unsatisfactory, specific urotherapy is recommended for select sub-types of LUTD. Specific urotherapy is multidisciplinary and comprises specific interventions such as psychological support and behavioural modification, biofeedback, physiotherapy, alarm training, and neuromodulation. It can be combined with pharmacotherapy if indicated. 5-8
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