title: Successful treatment for giggle incontinence with biofeedback.
abstract: OBJECTIVE
  Giggle incontinence is the involuntary and often unpredictable loss of urine during giggling or laughter in the absence of other stress incontinence. The pathophysiology is unclear, urodynamics are seldom helpful, and the efficacy of timed voiding and pharmacotherapy is limited. We postulated that improving sphincter tone and muscle recruitment using biofeedback techniques might be helpful in children with giggle incontinence.
  
  
  METHODS
  The charts of 12 patients with giggle incontinence were reviewed. Giggle incontinence severity, voiding patterns, associated symptoms and medical history including prior treatment were reviewed. Children were evaluated with uroflowmetry-electromyography and ultrasound measurement of post-void residual urine. They were assessed by the ability to isolate, contract and relax perineal muscles. They were taught Kegel exercises and instructed to perform them at home between weekly-biweekly sessions. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society.
  
  
  RESULTS
  The 10 females and 2 males were 6 to 15 years old. Only 1 child had a partial response to first line therapy with timed voiding and bowel management. Seven children were treated with anticholinergic agents and/or pseudoephedrine with a partial response in 3. The 9 children with refractory giggle incontinence underwent biofeedback with a median of 4.5 sessions per child (range 2 to 8). The 6 patients who underwent 4 or more sessions had a full response that endured for at least 6 months and the 3 with fewer than 4 sessions had a partial response.
  
  
  CONCLUSIONS
  Patients with giggle incontinence can heighten external urinary sphincter awareness and muscle recruitment using biofeedback techniques. Treatment with education and pharmacotherapy only led to a partial response in some cases. Biofeedback supplemented this treatment or avoided pharmacotherapy when at least 4 sessions were performed. Biofeedback therapy should be incorporated in the treatment algorithm for giggle incontinence in children and it should be considered before pharmacotherapy.
authors.affiliation: Division of Pediatric Urology, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, Long Island, New York, USA.
authors.forename: Ingride
authors.initials: I
authors.lastname: Richardson
authors.forename: Lane S
authors.initials: LS
authors.lastname: Palmer
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology; D002648:Child; D005260:Female; D006801:Humans; D007845:Laughter; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000628:therapy*