Benefits of Biofeedback for Teens
By Tiffany Ellsworth Lee, MA, OTR, BCB-PMD and Jane Kaufman, PT, MEd, BCB-PMD
Teen years can be tumultuous – more independence, more responsibilities, bigger classes, new schools, physical growth, raging hormones and other changes. For some, it can be a time of anxiety and stress that can influence how the body functions.
Stress and anxiety can increase activity in the sympathetic nervous system, which controls our heart rate, and other bodily functions and can form of bladder urgency and/or frequency. For some, heading to the bathroom can be something to do when bored, or when faced with anxious social situations.
Bladder urgency is a strong desire to void immediately and frequency refers to an abnormally repeated desire to void (usually in small amounts). In some, the urgency may lead to incontinence, especially as you get closer to the toilet. In others, the frequent trips to the toilet lead to “toilet mapping,” or knowing where all the toilets in your community are located.
When these symptoms become severe, teenagers may ask to use the toilet during class time, making teachers question the need or wonder about the student’s motive. Others excuse themselves from social situations for fear their peers will remark on the frequent toileting or discover their incontinence.
Rest assured, there is help available and your teenager is not alone with this problem! Once medically cleared by a qualified health care professional the teen should see a specialty trained health care professional such as a physical therapist, occupational therapist or advanced practice continence nurse to recieve biofeedback services. One organization that certifies such specialists to perform these services is the Biofeedback Certification International Alliance (BCIA) in Pelvic Muscle Dysfunction (BCB-PMD). These board certified professionals have a thorough understanding of bladder anatomy and physiology, biofeedback instrumentation and behavioral principles underlying treatment.
We see many patients in our clinic with urgency and frequency. Sara, a 16-year-old girl, was referred to us by her urologist. She lives with her mother who divorced three times in recent years. Her mother recently lost her job with a local marketing firm. Sara voids every 30-60 minutes during the day and is up three times a night to void. She moves her bowels daily. She consumes two diet sodas and one glass of juice a day. She wears pads for fear of urinary incontinence if she can’t make it to the toilet quickly enough. She has begun missing school because of this problem. At her last teacher conferences, her teachers complained about her inattentiveness during class and her numerous requests to use the toilet during each class period. She avoids socializing after school and on weekends. Her friends have begun teasing her about her toileting pattern.
Sara confided this to her pediatrician in a recent office visit and was referred to the local urologist, who determined through various tests that behavioral therapies and biofeedback would help.
Sara was evaluated in our clinic. She was educated in proper bladder function, good fluid choices and intake amounts, as well as how to achieve normal bladder behavior. Addtionally, she was instructed in urgency suppression techniques (relaxing, breathing, distracting and contracting the pelvic floor muscles to calm the bladder) and placed on a timed voiding schedule. Sara was evaluated with surface EMG biofeedback to assess her muscle function and coordination. As she contracted and relaxed her pelvic floor muscles, she could see a colorful graph on the computer screen.
Through the biofeedback evaluation, we were able to determine Sara’s pelvic muscle function, and relate her muscle function to her bladder control. By visualizing her muscle function in a comfortable, safe and interesting manner, Sara was able to learn how to make her pelvic muscles work effectively to restore normal bladder control.
Sara was given exercises to perform based on our findings from her biofeedback muscle assessment. She was asked to return one week later.
At her subsequent appointments, Sara continued to receive treatment with surface EMG biofeedback to review her muscle function and she continued her training exercises designed specifically to enhance bladder control. Her fluid consumption was increased, her voiding schedule progressed and all questions were answered regarding her progress toward goals.
At the time of discharge from therapy, Sara was on a voiding schedule of every three to four hours. She slept through the night and could go shopping or sit through a movie with friends without feeling the need to use the toilet. Her fluid consumption included five glasses of water a day plus one glass of juice.
On her last visit to our clinic, Sara stated, “My fear of an accident had controlled my life; the more nervous I got about it, the worse it was. I was afraid to leave home! Now, I know I am in control of my bladder, and I have new skills that let me use the toilet only when really necessary.”
Behavior therapies along with surface EMG biofeedback treatment may be helpful to your child or teenager with bladder urgency or frequency. In some cases the urgency may lead to involuntary leakage of urine (incontinence). Be sure to talk with your child’s physician for an appropriate referral. To locate a board certified biofeedback practitioner in your area, visit the "Find A Practitioner" section of this website: www.bcia.org.
If you are a practitioner interested in becoming certifited to perform biofeedback, please visit Tiffany and Jane's website.
About the Authors
Tiffany Ellsworth Lee, MA, OTR, BCB-PMD, holds a Bachelor of Science degree in Occupational Therapy from the University of Texas Medical Branch, and a Masters of Arts in Health Services Management from Webster University. She has worked as an occupational therapist and a manager in a variety of rehabilitation settings for the past 17 years. In 1996 she began specializing in the treatment of neurological disorders utilizing surface EMG biofeedback. She received her training at the University of Miami under the direction of Dr. Bernard Brucker, a world renowned rehabilitation psychologist. In 1997 she became the Director of the Florida Hospital’s Biofeedback Clinic in Orlando, Florida. Her biofeedback clinic specialized in treating neurological conditions (CVA, TBI, CP, and SCI), and facial paralysis. In 2004, she received her certification in pelvic muscle dysfunction from the Biofeedback Certification International Alliance (BCIA). Since 1999 she has been working at Central Texas Medical Center’s Physical Therapy and Rehabilitation Institute in San Marcos, Texas. Her clinical practice is exclusively dedicated to treatment of urinary and fecal incontinence, and pelvic floor disorders. She offers clinical consultation, training workshops, and she mentors health care professionals working toward their BCIA certification.
Jane Kaufman, PT, M.Ed., BCB-PMD, has been a practicing PT for more than thirty years. She is a graduate of the Ithaca College Physical Therapy program and earned her Masters Degree at the University of Vermont. In 2005, Jane became certified in the use of surface EMG biofeedback for pelvic floor muscle dysfunction (BCB-PMD) from the Biofeedback Certification International Alliance. Jane is President of Phoenix Physical Therapy, PLC in South Burlington, VT which she began in 2004. Jane’s clinic specializes in the treatment of pelvic floor dysfunction, incontinence and pelvic pain for men, women and children. Additionally, Jane offers workshops for other healthcare providers in the use of biofeedback for pelvic muscle dysfunction, mentors healthcare professionals toward certification in this field through BCIA and offers consultation to begin practices in this area of expertise through her involvement in Biofeedback Training and Incontinence Solutions (www.pelvicfloorbiofeedback.com ). Jane’s career has included practice at Columbia Presbyterian Medical Center in New York City, Brattleboro Memorial Hospital in Vermont, and at the former Medical Center Hospital of Vermont where she supervised the Department of Physical Therapy. She has also worked with and managed Burlington area physical therapy practices. Jane has been an adjunct faculty member in the University of Vermont’s School of Rehabilitation and Movement Science for more than thirty years. She has served on many professional boards and committees, and her most recent focus is as the Chair of the Advisory Board for UVM’s College of Nursing and Health Sciences and as a member of the Regional Board for the University of Vermont. Jane may be reached through her website at www.phoenixpt.com.