65 Following treatment plan was suggested to parents and Jennifer; continuing with the biofeedback training alone or in combination with pharmacotherapy; methylphenidate. The parents and Jennifer got information from the urologists about methylphenidate. After good consideration, she and her parents preferred a trial of 10 mg of oral methylphenidate twice a day and continuing the voiding instructions at home, good toilet posture, attention for sufficient fluid intake. It was recommended to take first dose before school and the second dose 4 to 5 hours later to ensure coverage near the end of the school day. Methylphenidate could be omitted on weekends, as her symptoms would be less of an issue, and she would have easier access to a bathroom. Common side effects, such as mood, sleep, and appetite changes, were discussed as well. Ending phase In a telephone follow-up 6 months later, the mother stated that understanding why and when her incontinence happened and keeping the voiding rules, being aware of her pelvic floor muscles in combination with pharmacotherapy had helped, with no reported side effects. The symptoms were not completely gone but it was manageable. She thought that the giggle incontinence was either related to a growth spurt or the intensity of additional activities near the end of the school term. Jennifer said that her giggle incontinence was “not considered a big issue anymore” and she discontinued to use methylphenidate. There were no subsequent visits for her incontinence. Diploma
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