Received: 21 July 2022 | Accepted: 24 September 2022

DOI: 10.1002/nau.25060

CLINICAL ARTICLE

Home pelvic floor exercises in children with

non‐neurogenic Lower Urinary Tract Symptoms:
Is fitball an alternative to classic exercises?

Maria Laura Sollini MD, PhD1,2,3 | Maria Luisa Capitanucci MD2 |

1 1,3 4
Calogero Foti MD | Ugo Nocentini MD | Enrico Castelli MD |
2
Giovanni Mosiello MD, FEAPU

1
Clinical Sciences and Translational
Medicine, Physical and Rehabilitation
Medicine, University of Rome Tor
Vergata, Rome, Italy
2
Division of Neuro‐Urology, Bambino
Gesu' Children's Hospital, IRCCS,
Rome, Italy
3
“Santa Lucia” Foundation, I.R.C.C.S.,
Rome, Italy
4
Department of Neurorehabilitation,
Bambino Gesu' Children's Hospital,
IRCCS, Rome, Italy
Correspondence
Maria Laura Sollini, MD, PhD, Clinical
Sciences and Translational Medicine,
Physical and Rehabilitation Medicine,
University of Rome Tor Vergata, Via
Montpellier 1, Rome, Italy.
Email: marialaura.sollini@outlook.it
Abstract
Introduction: Biofeedback with home pelvic floor exercises were recom-
mended as non‐pharmacologic treatment for non‐neurogenic Lower Urinary
Tract Symptoms (LUTS) in children. Fitball is recommended to improve all‐
over flexibility, balance, and coordination, especially for pelvic floor. Aim of
the study was to investigate efficacy of standard home pelvic floor exercises
versus exercises using fitball.
Methods: From April 2021 to February 2022 to all children arrived in our
clinic with non‐neurogenic LUTS nonresponder at urotherapy, our pelvic floor
rehabilitative program was proposed. During the rehabilitation children
performed: standard urotherapy, pelvic floor animated biofeedback therapy
and pelvic floor exercises in a standard way and using a fitball. After the first
session, patients received prescription to repeat at home the same exercises
performed at hospital. Children who chose classic exercises were enrolled in
group A and they who chose fitball in group B. Continence rate, pelvic floor
muscles activity, adherence and satisfaction were evaluated by means of
bladder diary, external pubococcygeus test and Likert‐type psychometric scale
(from 1 = very unsatisfied to 5 = very satisfied) respectively.
Results: Twenty‐six children affected by LUTS were enrolled: 13 in group A
and 13 in B. At 4th control urinary incontinence was reduced by 72,5% in A
and 71.4% in B. Pubococcygeus test increased in both groups. Adherence at
home was 92% in group A and 62% in group B. Satisfaction with the treatment
(4 or 5 points) was 95% in both groups. Four patients of group A and all of
group B decided to maintain home exercises including fitball.
Conclusions: Our preliminary study shows that efficacy of home exercises,
with or without fitball, is comparable. Satisfaction with fitball is high,
regardless results obtained, because parents and children have learned a new,

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.

146 | wileyonlinelibrary.com/journal/nau Neurourol Urodyn. 2023;42:146–152.


SOLLINI ET AL.
interesting and stimulating way to manage urinary problems. The opportunity
to perform these exercises using fitball, it's an important finding for pediatric
population.
KEYWORDS
children, fitball, incontinence, kegel, LUTS, pelvic floor, rehabilitation
1 | INTRODUCTION
The International Children Continence Society recom-
mended standard urotherapy as first line therapy in children
affected by non‐neurogenic Lower Urinary Tract Symptoms
(LUTS).1 Standard urotherapy includes educating children
and parents about LUT anatomy and function, providing
information about correct fluid intake and urinary habits
and demystification. If standard urotherapy fails or to
improve results, specific urotherapy, as biofeedback can be
used.2,3 Biofeedback is a noninvasive treatment that has been
documented to be helpful for children with daytime wetting
and/or urinary tract infection secondary to voiding dys-
function.4,5 Pelvic floor exercises (PFE) are simple exercises
based on contraction and relaxation of pelvic floor (PF)
muscles, based on Kegel's theory. Efficacy for the treatment
of stress incontinence and urge incontinence was demon-
strated.6,7 PFE as identification of contraction and relaxation
of pelvic floor muscles have been recommended to treat
dysfunctional voiding, to obtain a relaxed voiding and
complete bladder emptying. Both are effective in children in
adolescents and both are used for rehabilitation. Anyway,
knowledges of PF action in children are limited, as well as
postural and respiratory roles on pelvic floor muscle actions.
Many children and adolescents today are performing sport
activity as well as well as their relatives, where especially in
western countries activities as yoga, pilates gymnastic are
very popular. Fitball is commonly used in all and for this
reason its use could be considered a recreational activity
instead of medicalized one.
In our study we retrospectively evaluated PFE
adherence, satisfaction and effectiveness using a fitball
for PFE.
2 | MATERIALS A ND METHODS
From April 2021 to April 2022 all children with LUTS
arrived at our urology clinic at “Bambino Gesù” Children
Hospital, underwent medical and voiding history, urinary
exam and culture, uroflowmetry with pelvic floor electro-
myography and ultrasound postvoiding residual urine
evaluation to diagnose a neurogenic or a non‐neurogenic
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 147
origin of LUTS. If non‐neurogenic LUTS were present,
children received urotherapy during consultation.
Children with neurogenic LUTS, with a diagnosis of
mental disorder or autism spectrum disorders and children
responded to urotherapy were role out the study.
In children with non‐neurogenic LUTS who have not
had benefits with standard urotherapy, our rehabilitation
program was proposed. Pelvic floor program included
four session, 1/20 days. During first session urotherapy
was repeated, bladder diary was delivered and explained
to parents and we required two evaluations before
returning to other session: one measurement of child's
urinary habits without parental influence and one with
parental influence and the application of drinking and
voiding rules explained. A pelvic floor evaluation, using
external pubococcygeus (PC) test was performed by a
medical doctor and information about phasic, tonic and
endurance components of PC muscle were saved. During
the session, pelvic floor exercises were taught in a
standard way and using a fitball. After the session,
patients received prescription to repeat at home the
exercises for 10 min/day.
During second and third sessions, patients repeat
exercises prescribed and performed for two times 5 min
of pelvic floor animated biofeedback (PFAB), with 5 min
of pause between the repetitions. PFAB required external
sensors, placed at the 3 and 9 o'clock positions at the
perineum, to record activity of the pelvic floor muscles
and to produces a visual representation of the muscle
activity in form of animated videogames (Figure 1).
During the fourth and last session, in addition to
exercises and PFAB, an external PC test was repeat and
we asked to family if they performed exercises in the
classic way or using a fitball. If children had performed
exercises in the classic way, they were placed in the
group A, if they had chosen the fitball, in group B.
Satisfaction with the treatment was asked too.
2.1 | External PC test execution
With the patient in modified gynecological position,
medical doctor placed his second and third fingers at the

148 | SOLLINI
F I G U R E 1 Position of external external sensors, placed at the 3
and 9 o'clock positions at the perineum
3 and 9 o'clock positions at the perineum. A single
contraction followed by a relaxation was asked to the
patient to evaluate PC phasic contraction. To evaluate
tonic part and endurance was asked to child, respec-
tively, to maintain the contraction for 10 s and to repeat
the single contraction for 10 times. For each component
was awarded a score according to references tables
(Table 1) and an overall score was calculated, defined as
total PC test. The same medical doctor performed all PC
tests, to avoid bias.
2.2 | Classic exercises
PF classic exercises were represented by a pelvic floor
contraction for 5 s, followed by a relaxation for 10 s.
Exercises were performed in the gynecological modified
position or with the children on the left/right side. In this
way, child was on the side with the hip's flexion at 45°
and a knee's flexion at 90°, a pull was placed between the
legs, to prevent adductors' contraction.
2.3 | Exercises with fitball
Exercises with fitball taught to children and their parents
were two. In the first exercises patient sat down on the
ball reproducing the proper position on the toilet, 5 s of
pelvic floor muscles' contraction, followed by 10 s of
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ET AL.
T A B L E 1 References parameters for the evaluation of the
pelvic floor muscles.
Oxford grading scale modified by Laycock—to evaluate phasic
contraction of pelvic floor8
0 No contraction of PFM
1 Flicker contraction of PFM
2 Weak contraction of PFM
3 Moderate contraction of PFM
4 Good (with lift) contraction of PFM
5 Strong contraction of PFM
Tonic contraction evaluation: the length of time, up to 10 s, that a
maximum contraction can be sustained before the strength is
reduced9
0 Contraction maintained less than 2 s
1 Contraction maintained between 2 and 5 s
2 Contraction maintained between 5 and 9 s
3 Contraction maintained more than 9 s
Endurance evaluation: the number of repetitions (up to 10) of the
specific maximum contraction is recorded.9
0 Less than 2 valid contractions
1 Between 2 and 5 valid contractions
2 Between 5 and 9 valid contractions
3 More than 9 valid contractions
relaxation were requested. In the second exercises, after
the contraction of PF the child must rise up and
maintained the position for 5 s, then he returned at
starting position for the 10 s' relaxation. During the
relaxation time, children could jump on the fitball
(Figures 2 and 3).
2.4 | Parameters evaluated
During the last session were evaluated: continence rate
comparing bladder diaries; PF activity with the external
PC test; adherence at PFE was evaluated asking to
parents and children if they performed exercises at home
and which type.
Finally, satisfaction was evaluated using a Likert‐type
psychometric scale (1 = very unsatisfied, 2 = unsatisfied,
3 = neutral, 4 = satisfied, 5 = very satisfied). We asked to
patients and their parents to evaluate satisfaction with
the treatment.
Data were collected using an Excel worksheet and
analyzed applying student's t‐test, χ2 or Fisher's exact
tests. Declaration of Helsinki has been respected.

SOLLINI ET AL.
F I G U R E 2 (A, B) First exercise with fitball: patient sat down on the ball reproducing the proper position on the toilet, 5 s of pelvic floor
muscles' contraction, followed by 10 s of relaxation
F I G U R E 3 (A, B) Second exercises with fitball: after the
contraction of pelvic floor the child must rise up and maintained
the position for 5 s, then she returned at starting position for the
10 s' relaxation
3 | RESUL TS
Twenty‐six children (average age: 9 ± 3 years), 25 female
and 1 male, affected by diurnal and nocturnal urinary
incontinence, giggle incontinence and urinary retention
were enrolled: 13 in group A and 13 in B. The
composition of 2 groups were similar, no statistically
clinical differences were present, all pathologies are
represented in both A than B. At 4th control urinary
incontinence was reduced by 72.5% in the group A and
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 149
71.4% in group B. Total score of external PC test
increased by 88.50% (+2.3 points) in A, and 64.7%
(+1.7 points) in B, and there was an improvement of all
PC test components: phasic, tonic and endurance in both
groups. All results are showed in Table 2.
Adherence at home was 92% in group A and 62% in
group B. At the end of the treatment four patients of
group A decided to maintain home exercises including
fitball. No patients of group B decided to change
exercises.
Satisfaction with the treatment was 95% in both
groups. Twelve of the 13 patients in each group replied to
be satisfied (4 point) or very—satisfied (5 points) at
Likert‐type psychometric scale.
All differences between group A and group B are not
statistically significant.
4 | DISCUSSION
LUTSs are frequents in children and adolescents.
Literature showed that 21.7% of children suffer from
urinary incontinence, with a high prevalence in girls. The
prevalence of other LUTSs was also high, with intermit-
tency and straining as the most frequent symptoms.
These conditions are present in “healthy” children, not
only in the “sick” ones.10 Symptoms of LUT may have
significant social consequences for children and their
parents. For this, it is important to learn to manage them,

150 | SOLLINI
TABLE 2 Incontinence's reduction and external PC test results for each group
GROUP A (n = 13)
I session IV session
Incontinence: n of patients (%) 8 (62%) 3 (23%)
“Phasic” PCT (mean points) 1.61 2.77
“Tonic” PCT (mean points) 0.77 1.23
“Endurance” PCT (mean points) 0.23 0.92
PCT Total (mean points) 2.61 4.92
Abbreviation: PC, pubococcygeus.
also with simple home exercises. For experts, urotherapy
is always the first line treatment in children affected by
non‐neurogenic LUTS.1,2 Biofeedback can be use as first
line therapy as part of urotherapy program to improve
results obtained, or as second line treatment if children
are refractory to urotherapy.2,3,11
Urotherapy training in children and adolescents is
different from other patients' age because different
factors changing during time: age, cognitive ability and
interest, adherence. For this reason, the urotherapy
program must be flexible and able to move from a
micturition school to an adult fitness program.
Efficacy of PFE was showed, at first, by Kegel to treat
women with stress urinary incontinence.6 These exercises
have proved successful also to rehabilitate women with
urge incontinence, during pregnancy and postpartum and
also in men.7,12,13 The efficacy of these exercises in children
with LUTS was showed too. Several studies highlighted the
importance of training PF in association with urother-
apy14–16 In a study of Vasconcelos et al.17 efficacy of PFE
and PF biofeedback were compared and results showed the
same efficacy in terms of reduction in episodic urinary
incontinence and UTI. In absence of neurogenic bladder or
anatomical, congenital or acquired, problem, recurrent UTI
are generally caused by functional urinary retention, where
a PF relaxation deficit is common to observe. A muscular
training focusing on muscular relaxation, using biofeedback
or PFE, can help patients empty their bladder correctly and
completely.11
In children the use of biofeedback was introduced in
1979 by Maizels et al. and was followed by the
introduction of animated biofeedback in 1999.18,19 Since
muscle activity is displayed on personal computer screen,
identification of pelvic floor muscles and their functional
state (relaxation/contraction) is facilitated. In addition,
animated program like video games, catch child's
attention who performs the pelvic training program as
a game. It is clear that PFE in addition with PFAB are the
best approach to these pathologies. Maintaining exercises
at home, results can be improved.
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ET AL.
Group B (n = 13)
Difference I session IV session Difference
−72.5% 7 (54%) 2 (15%) −71.42%
+72% 1.54 2.30 +50.3%
+59.7% 0.69 1.23 +78.2%
+300% 0.38 0.77 ++100%
+88.5% 2.61 4.30 +64.7%
Possibility to perform exercises using a fitball was
introduced by Ladi Seyedian et al. that compared efficacy
of a rehabilitative program composed of urotherapy and
PFE using fitball with a simple program represented only
by urotherapy; efficacy of combined approach was
documented.20
Based on these evidence, in our preliminary study, we
compared efficacy of classic Kegel's PFE and PFE using
fitball. All patients improved their symptoms: the urinary
incontinence reduction is the same in both groups. Also
muscles recruitment and selectivity, evaluated with external
PC test, were improved with the treatment and adherence at
home exercises was high in both groups. In our experience,
training to work on pelvic floor, the most important thing
was working in the correct way, regardless of body position,
in accordance with Kegel theory. For that, although the
exercises performed with the fitball could appear to be
different from the classic ones, the results are super-
imposable. Difference wasn't statistically significant between
group A and B but the major home's adherence in group A
could be attributed to parents' control during classic
exercises. This control could help child to better understand
the muscles' position because, if the patient agrees, the
parent could place a hand on pelvic floor and help the child
to work in a correct way. During fitball exercises the parental
control it was more difficult, for the direct contact of PF with
the ball. For that, a major parent's participation could be
translated with a major adherence with home's exercises. For
this reason, fitball is recommended in children more
collaborative and oldest, to avoid the possibility that it will
be understood as a game. Fitball represents an important
proprioceptive stimulus, because the patient can feel the area
to be contracted, corresponding with muscles resting on the
ball. The particular position on the ball can be useful for
training PF selectivity too. To stabilize the lower limb in the
“toilet position,” abductors and adductors are used for the
lower limb activity and they are less required for the PFE.
About Satisfaction with the treatment, 95% of patients
and their families defined the rehabilitative program
satisfactory, and were pleased to learn a simple way to treat

SOLLINI ET AL.
LUTS and their social implications. If PFE were taught in the
correct way, the use of fitball can be a valid alternative to
classic way. For children Kegel's exercises were bored and
often they leave the program during the time. Possibility to
have an economic and fun method to continue the training
must be proposed, for the importance to continue exercises
during the time, to maintain results. This was highlight by
the four children that decided to change from classic
exercises to fitball exercises.
The most important limit of the study was the small
number of participants. It is a preliminary study that we're
hoping to expand, also evaluating other parameters.
5 | CONCLUSIONS
One of the main concerns in urotherapy effectiveness, as
for other treatment, is adherence. Adherence is a critical
point especially in adolescents, and the risk of LUTS relapse
during time is always to consider not for lack of efficacy but
for not adherence to the treatment, where hospitalization or
medicalization could be refused during time.
The efficacy of PF training it is certain but it is important
to study and to show new methods to performed exercises at
home, to help children and families that haven't specialistic
clinics available. Furthermore, the use of fitball can be a
valid alternative to classic ones and it is a valid resource to
catch children attention and participation. In this way it is
possible to continue exercises during the time, with higher
probability that results are maintained during the time.
More studies could be useful to confirm the results of
our preliminary experience, verifying the effectiveness in
the different form of LUTS.
AUTHOR CONTRIBUTIONS
Maria Laura Sollini, Maria Luisa Capitanucci, and
Giovanni Mosiello have given substantial contributions
to the conception or the design of the manuscript, to
acquisition, analysis and interpretation of the data. Maria
Laura Sollini, Maria Luisa Capitanucci, and Giovanni
Mosiello have participated to drafting the manuscript,
authors Calogero Foti, Ugo Nocentini, and Enrico
Castelli revised it critically. All authors read and
approved the final version of the manuscript. All authors
contributed equally to the manuscript and read and
approved the final version of the manuscript.
ACKNOWLEDGMENT
Open access funding provided by BIBLIOSAN.
CONFLI CT OF I NTER EST
The authors declare no conflict of interest.
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 151
DATA AVAILABILITY STATEMENT
This is a retrospective study, data of patients are owned
by the authors and available upon request.
ETHICS STATEMENT
Declaration of Helsinki has been respected.
ORC ID
Maria Laura Sollini https://orcid.org/0000-0002-
9092-915X
Maria Luisa Capitanucci http://orcid.org/0000-0002-
0934-8631
Calogero Foti http://orcid.org/0000-0003-2246-348X
Ugo Nocentini https://orcid.org/0000-0001-7445-4441
Enrico Castelli https://orcid.org/0000-0003-1685-8936
Giovanni Mosiello http://orcid.org/0000-0002-
9626-9519
REFER ENCES
1. Kaya C, Radmayr C. Clinical evaluation: History taking and
urological, gynaecological and neurological evaluation. In:
Mosiello G, Del Popolo G, Wen J, De Gennaro M, eds. Clinical
Urodynamics in Childhood and Adolescence. Urodynamics,
Neurourology and Pelvic Floor Dysfunctions, 2018; pp. 11–20.
Springer International Publishing.
2. Chang SJ, Van Laecke E, Bauer SB, et al. Treatment of
daytime urinary incontinence: a standardization document
from the International Children's Continence Society.
Neurourol Urodyn. 2017;36(1):43‐50.
3. Nieuwhof‐Leppink AJ, Hussong J, Chase J, et al. Definitions,
indications and practice of urotherapy in children and
adolescents: a standardization document of the International
Children's Continence Society (ICCS). J Pediatr Urol.
2021;17(2):172‐181.
4. Schulman SL, Von Zuben FC, Plachter N, Kodman‐Jones C.
Biofeedback methodology: does it matter how we teach
children how to relax the pelvic floor during voiding? J Urol.
2001;166(6):2423‐2426.
5. Ladi‐Seyedian S, Kajbafzadeh AM, Sharifi‐Rad L, Shadgan B,
Fan E. Management of non‐neuropathic underactive bladder in
children with voiding dysfunction by animated biofeedback: a
randomized clinical trial. Urology. 2015;85(1):205‐210.
6. Kegel AH. Progressive resistance exercises in the functional
restoration of the muscles. Am J Obstet Gynecol. 1948;56:238‐248.
7. Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in
the elderly. Ann Intern Med. 1985;104:507‐515.
8. Laycock J. Clinical evaluation of the pelvic floor. In:
Schussler B, Laycock J, Norton P, Stanton SL, eds. Pelvic
Floor Re‐education. Springer‐Verlag; 1994:42‐48.
9. Società Interdisciplinare del Pavimento Pelvico. Guida alla
Cartella Clinica Pelviperineologica‐Evoluzione della cartella clin-
ica informatica e del sistema IPGH. Rivista Italiana di Colon‐
Proctologia. 2009. https://www.pelviperineologia.it/cartella_pelvi_
perineologica/guida_cartella_pelvi_perineologica.html
10. Linde JM, Nijman RJM, Trzpis M, Broens PMA. Prevalence of
urinary incontinence and other lower urinary tract symptoms

152 | SOLLINI
in children in the Netherlands. J Pediatr Urol. 2019;15(2):
164.e1‐164.e7.
11. Tekgul S, Stein R, Bogaert G, et al. EAU‐ESPU guidelines
recommendations for daytime lower urinary tract conditions
in children. Eur J Pediatr. 2020;179(7):1069‐1077.
12. Kahyaoglu Sut H, Balkanli Kaplan P. Effect of pelvic floor
muscle exercise on pelvic floor muscle activity and voiding
functions during pregnancy and the postpartum period.
Neurourol Urodyn. 2016;35(3):417‐422.
13. Strączyńska A, Weber‐Rajek M, Strojek K, et al. The impact of
pelvic floor muscle training on urinary incontinence in men
after radical prostatectomy (RP)—a systematic review. Clin
Interv Aging. 2019;14:1997‐2005.
14. De Paepe H, Renson C, Hoebeke P, Raes A, Van Laecke E,
Vande Walle J. The role of pelvic‐floor therapy in the
treatment of lower urinary tract dysfunctions in children.
Scand J Urol Nephrol. 2002;36(4):260‐267.
15. Hoebeke P, Vande Walle J, Theunis M, De Paepe H,
Oosterlinck W, Renson C. Outpatient pelvic‐floor therapy in
girls with daytime incontinence and dysfunctional voiding.
Urology. 1996;48(6):923‐927.
16. Schneider MS, King LR, Surwit RS. Kegel exercises and
childhood incontinence: a new role for an old treatment.
J Pediatr. 1994;124(1):91‐92.
15206777, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25060 by Cochrane Netherlands, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ET AL.
17. Vasconcelos M, Lima E, Caiafa L, et al. Voiding dysfunction in
children. Pelvic‐floor exercises or biofeedback therapy: a
randomized study. Pediatr Nephrol. 2006;21(12):1858‐1864.
18. Maizels M, King LR, Firlit CF. Urodynamic biofeedback: a
new approach to treat vesical sphincter dyssynergia. J Urol.
1979;122:205‐208.
19. McKenna PH, Herndon CD, Connery S, Ferrer FA. Pelvic floor
muscle retraining for pediatric voiding dysfunction using
interactive computer games. J Urol. 1999;162(3 pt 2):1056‐1063.
20. Ladi Seyedian SS, Sharifi‐Rad L, Ebadi M, Kajbafzadeh AM.
Combined functional pelvic floor muscle exercises with Swiss
ball and urotherapy for management of dysfunctional voiding
in children: a randomized clinical trial. Eur J Pediatr. 2014;
173(10):1347‐1353.
How to cite this article: Sollini ML, Capitanucci
ML, Foti C, Nocentini U, Castelli E, Mosiello G.
Home pelvic floor exercises in children with
non‐neurogenic Lower Urinary Tract Symptoms: Is
fitball an alternative to classic exercises? Neurourol
Urodyn. 2023;42:146‐152. doi:10.1002/nau.25060