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The Mars Clinic is committed to excellence in the management of children’s bladder and bowel conditions. We participate heavily in research projects to validate our assessment and treatment techniques. We continue to provide education to parents, teachers, carers and medical professionals regarding the current evidence for treatment of children’s bladder and bowel disorders.

Treatment for Complex Bowel Presentations

Long-term outcomes of physiotherapy-led continence clinic treatment of children with complex bowel presentations.

Hardy S(1), Burgess C(2), Samuels A(1), Fitzgerald J(1), Connor F(2).
(1) Mars Clinic – Children’s Continence Clinic, South Brisbane.
(2) Lady Cilento Children’s Hospital, South Brisbane.

To investigate the long term outcomes of treatment, levels of symptom regression and patient reported satisfaction in paediatric patients who present to a children’s continence clinic with a persistent bowel presentation. An increased understanding of these factors would play a significant role in the modelling of appropriate health care services to meet this community need.

Results & Conclusions: There are positive outcomes of treatment in children with complex bowel presentations when treatment is conducted in a children’s continence setting.  In this abstract, almost two-thirds of the complex bowel presentation patient group reported long-term sustained treatment benefits more than four months after the completion of treatment.  Regardless of treatment outcomes and the level of symptom improvement, 100% of patients reported a high level of satisfaction with the services provided within a physiotherapy-led children’s continence clinic setting.

Abstract Presentations: Accepted for presentation at the National Conference on Incontinence, Sydney, November 2017.

Interactive computer game-based biofeedback in childhood functional outlet obstruction.

Burgess C2, Bradley T2, Hardy S1, Hart S1, Connor F2

1Mars Clinic - Children's Continence Clinic, South Brisbane.

2Lady Cilento Children’s Hospital. South Brisbane.

 Purpose:  Is physiotherapy-directed use of a computer game-based biofeedback system a useful adjunct in the treatment of functional outlet obstruction (dyssynergic defecation)?

Results & Conclusions:  Statistically significant (p < 0.05) improvements were observed in episodes of soiling, voiding pattern flow rates and quality of life scores when comparing pre-treatment and post-treatment subjective and objective measures. Physiotherapy-directed use of a computer game-based biofeedback system is demonstrated to be a useful adjunct to standard therapy in the management of functional outlet obstruction.

 Abstract Presentations: Presented at the Australian Physiotherapy Association National Conference, Gold Coast, October 2015.


Treatment Options for Rural and Regional Clients

Providing treatment options for rural and regional clients with dysfunctional voiding: Case study on paediatric intensive animated biofeedback.
Authors: Diggles, A., Hardy, S. & Fitzgerald, J.
Authors' Institution: The Mars Clinic for Children's Continence, South Brisbane.

To investigate whether an effective program of physiotherapy-led non-invasive urotherapy and animated biofeedback-based pelvic floor muscle retraining can be provided in a hsort, but intensive dosage.
Results & Conclusions: 
An intensive program is effective in improving dysfunctional voiding. These outcomes are promising and, by reducing the burden of both travel and hospitalisation, may increase the accessibility of dysfunctional voiding treatment options for rural and regional patients.

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International Children’s Continence Society Update

The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardisation Committee of the International Children’s Continence Society.
Austin, P., Bauer, S., Bower, W., Chase, J., Franco, I., Hoebeke, P., Rittig, S., Vande, J., Walle, J., von Gontart, A., Wright, A., Yang, A., & Neveus, T. Journal of Urology (Volume 191, pg. 1863-1865): June 2014.

The impact of the original International Children’s Continence Society terminology document on lower urinary tract function resulted in the global establishment of uniformity and clarity in the characterization of lower urinary tract function and dysfunction in children across multiple health care disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric lower urinary tract function. 
Results & Conclusions: 
The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of lower urinary tract function in children. For the complete document visit

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Childhood Constipation

Animated Biofeedback in Childhood Constipation.
Burgess C, Hardy S and Connor F.
Multi-Centre Research: Currently being performed and due for completion in 2015.

Dysfunctional Voiding

Physiotherapy treatment of children with dysfunctional voiding. An audit study of an innovative computer games-based biofeedback system.
Hardy SJ, Winkle D and Fitzgerald JP.
Mars Clinic Abstract: August 2011
Purpose: We conducted an audit to assess the outcomes of physiotherapy-directed use of the UrostymTM biofeedback system in the treatment of dysfunctional voiding.
Methods: A prospective study of 24 children between January 2009 and May 2010. Medical practitioner referrals for all patients presenting with symptoms of dysfunctional voiding were examined. Weekly intervention of ‘standard therapy’, UrostymTM biofeedback and Urostym UroflowTM was performed. UrostymTM biofeedback uses surface electromyography to facilitate visualisation and control of pelvic floor muscle activity through a computer game. Urostym UroflowTM Bluetooth technology enables simultaneous recording of surface electromyography and urine flow, with visual display of electromyography activity, flow rate and volume.
Quantitative data comparisons are made between initial and final treatment voiding pattern flow rates and pelvic floor activity. Qualitative data comparisons are made to assess perceived severity of incontinence and impact of incontinence on quality of life, measured via visual analogue scales. Results: Mean patient age was 8.4 years (range 5 - 14). The average number of 30 minute treatment sessions was 8.5 (range 5 - 17). Twenty subjects (83%) demonstrated improvement in voiding pattern. Statistically significant (p < 0.001) improvements were observed in pelvic floor activity and visual analogue scale scores.
Conclusions: Physiotherapy-directed use of the UrostymTM biofeedback system is demonstrated to be a useful adjunct to standard therapy in the management of dysfunctional voiding. The Mars Clinic for Children’s Continence, a strategic partnership between paediatric urology and physiotherapy, produces outcomes which improve patient compliance, quality of life and understanding of pelvic floor control.

International Children’s Continence Society

The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Report from the Standardisation Committee of the International Children’s Continence Society.
Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, Jørgensen TM, Rittig S, Walle J, Yeung CK and Djurhuus JC
Journal of Urology (Volume 176, pg. 314-324): July 2006
Purpose: We updated the terminology in the field of pediatric lower urinary tract function. Materials & Methods: Discussions were held of the board of the International Children’s Continence Society and an extensive reviewing process was done involving all members of the International Children’s Continence Society as well as other experts in the field.
Results & Conclusions: New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results.
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