The aim of this study was to evaluate the efficacy of breathing-combined biofeedback training, added to standard urotherapy, on symptom severity, pelvic floor muscle function, quality of life, and treatment satisfaction in children with Spina Bifida and Neurogenic Bladder and Bowel Dysfunction (NBBD).

A total of 37 children with Spina Bifida, aged 5–13 years, diagnosed with NBBD were included in the study. Participants were randomly assigned to three groups: a breathing-combined biofeedback training group (n = 12), a urotherapy training group (n = 13), and a control group (n = 12). The intervention was administered as two sessions per week for 12 weeks. Assessments included the Dysfunctional Voiding Symptom Score (DVSS) to evaluate symptom severity, the Pediatric Quality of Life Inventory (PedsQL) to assess quality of life, the Treatment Rating Scale to evaluate treatment satisfaction, and superficial electromyography (sEMG) to assess pelvic floor muscle function. The statistical power of the study was calculated as 89% based on DVSS.

At baseline, the groups had similar DVSS and PedsQL scores. sEMG parameters, including resting activity, maximum voluntary contraction (MVC), and mean values, were also comparable across groups. In post-treatment intergroup comparisons, the biofeedback group showed greater improvement in DVSS scores compared to the urotherapy and control groups (p < 0.05). Analysis of PedsQL change scores revealed a significantly greater improvement in the biofeedback group (−15.91 points) compared to the urotherapy (−4.84) and control (−2.08) groups (p < 0.001). The Treatment Rating Scale score was also higher in the biofeedback group (5.08 ± 1.31) compared to the other groups (p < 0.001). Although no statistically significant differences were found between groups in pelvic floor muscle activity parameters assessed by sEMG (p > 0.05), clinical observations indicated improved muscle coordination in the biofeedback group.

In children with spina bifida and NBBD, biofeedback training combined with breathing exercises and added to standard urotherapy was more effective than standard urotherapy alone in reducing bladder symptoms, improving quality of life, and increasing treatment satisfaction.

In rehabilitation programs for children with NBBD, pelvic floor biofeedback training may be considered as an adjunct to standard urotherapy. Furthermore, combining this training with diaphragmatic breathing exercises may enhance treatment outcomes by promoting relaxation.

Continence 19S (2026) 102612
DOI: 10.1016/j.cont.2026.102612