Pelvic Floor Muscle Training and Dynamic Neuromuscular Stabilization Exercises in Pediatric Patients

Effects of Adding Dynamic Neuromuscular Stabilization to Pelvic Floor Muscle Training on Voiding Dysfunction in Children: A Randomized Controlled Trial

Dysfunctional voiding (DY) is one of the most common conditions in children. Various treatments are available. Participants will be randomly assigned to either PFMT (Group I) or PFMT+DNS (Group II). PFMT is the gold standard and routinely administered in hospitals for children diagnosed with dysfunctional voiding who are referred by a urologist. The PFMT group serves as the control group, and treatment will be scheduled for a total of 10 weeks, three days a week. During PFMT, children receive instruction about the pelvic floor using video visuals and increase awareness of their pelvic floor muscles. They are then instructed on how to contract and relax their muscles to control urination. DNS training is an exercise model that begins with spinal stabilization and addresses muscle synergies. Patients included in the study will be evaluated twice, at the beginning and at the end of the treatment: Voiding Disorders Symptom Score (VODS), Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), Pediatric Incontinence Questionnaire (PIN-Q), Bladder Bowel Dysfunction Scale (BDS), Bristol gaita scale, and Children's Body Image Scale.

Inclusion Criteria:

• Having been diagnosed with voiding dysfunction according to ICCS diagnostic criteria in a urology outpatient clinic,
• Being 5-18 years old,
• The child and their parent/guardian agree to participate in the study voluntarily and provide signed consent.

Exclusion Criteria:

• Organic pathologies such as urethral obstruction, ectopic ureter, spinal dysraphism, and diabetes
• Diagnosis of VUR or neurogenic bladder
• Cognitive and mental impairment
• Having spina bifida
• Being under 5 years of age
• Receiving treatment such as PTC training or electrical stimulation