3 Section 1 Introduction 1. Preface Urotherapy is the first line treatment for functional bladder and bowel problems like daytime urinary incontinence, nocturnal enuresis, functional constipation, and faecal incontinence. The treatment is non-invasive and focuses on re-education and rehabilitation for bladder and bowel management. Urotherapy aims to reach the normalization of the voiding and bowel pattern and to prevent further functional disturbances by repeated training. Standard urotherapy emphasizes the education of the family and the child and suggests simple lifestyle changes as treatment. Such lifestyle changes include how much fluid to drink throughout the day and how often the child should be urinating. Urotherapy also aims to teach the child the correct way to urinate i.e., posture and muscle contractions. Regular follow-ups alongside a bladder diary are then used over a period of months as the child implements the treatment advice. Bowel problems can result in lower urinary tract dysfunction. Bladder-bowel problems can be complex, and the causes can be intertwined, making treatment plans challenging. Problems such as constipation and any urinary tract infections (TI) are addressed at the start of the treatment plan. The endpoint of urotherapy treatment is considered to be when both parents and child are sufficiently satisfied with the progress and healthcare professionals are satisfied that any intake and voiding factors that can affect bowel and bladder function have been addressed. If standard urotherapy doesn’t work, then specific urotherapy is recommended. Specific urotherapy focuses on intensive training of the child whereby three learning elements, how to void, when to void and how often to void, are essential to teach adequate voiding behaviour. Specific urotherapy involves multidisciplinary elements, like psychological support and behavioural modification, biofeedback by the use of a flow meter and/or physiotherapy.
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