60 Ultrasound Rectum diameter Postvoid residual Physical examination (done by a medical doctor) Neurologically and anatomically no deviations. Ultrasound of the kidneys: normal length normal size, normal ureters Rectum diameter: 1.2 cm. Bladder wall thickness after voiding <3 mm, small amount of postvoid residuals (8 ml) Conclusion and treatment plan: She has urinary loss during daytime, most frequently with laughter. She has no constipation or other complaints. Urotherapy with biofeedback therapy should be incorporated in the treatment for giggle incontinence in children and it should be considered before pharmacotherapy. Most children with giggle incontinence will Giggle incontinence Children with daytime urinary incontinence commonly have incontinence episodes during laughter. Pure giggle with no other urinary symptoms is a rare form of incontinence. Giggle incontinence results from detrusor instability and is provoked by laughter with no forewarning. It can persist into adulthood, but often resolves spontaneously at puberty. Management includes urotherapy. with biofeedback and/ or methylphenidate. 23-26 1. Biofeedback can be used in children with giggle incontinence to strengthen their pelvic floor muscles and allow them to remain continent during an uncontrolled detrusor contraction provoked by laughing. 2. Methylphenidate commonly used to treat ADHD, increases the ability to inhibit urination because of the presence of dopamine and to also inhibit relaxation of pelvic floor muscles and concurrent reflex of the detrusor muscle.
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