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  1. #1
    phunphysio
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    Unhappy Giggle Incontinence

    Cerebral Palsy In Infancy
    I have today recieved a referral for an intelligent 10 y.o.boy diagnosed with giggle incontinence. He looses his whole bladder when he laughs, not just a few drops. I am yet to assess this boy but would appreciate any thoughts or experience in this area. I have treated kids with weak pelvic floor before but giggle incontinence is a new area for me. I am doing some literature searches now and all I have found is ritilin? Looking forward to your thoughts

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  2. #2
    junior_physiotherapist
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    Thumbs up Re: Giggle Incontinence


    Hallo,

    Well, lets determine the cause of incontenence upper or lower motor neurones,social ,psychological,......

    Try Kegel exercises,
    strenghteninging core muscles of trunk,
    biofeedback training,





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    Re: Giggle Incontinence

    phunphysio-

    I hope your treatment is going well with the boy.
    In the meantime.
    I have giggle incontinence, and have had it for now nine years.
    Yes. Nine years.
    God, nine years.
    This "condition" has completely wrecked my life. I have only recently begun seeing a counselor for it, and she told me that I have a lot of anxiety issues. A lot of problems with letting go, in all aspects of my life. I don't trust anyone, I don't like drinking alcohol past a "tipsy" stage, I have problems with sex... the works. While to some this condition may seem laughable, it almost makes me wish I had a life-threatening disease, because people just don't understand. I wish it was something that I could control. But I can't. I am now at the point where I lose control about once a month, but then again, I avoid funny situations like the plague.
    Also recently I have been researching giggle incontinence because I want to learn more about it- maybe find someone else in my situation that I can talk to. So far I have only found a few myths to debunk.
    Evidently some doctors say to go to the bathroom more frequently; to drink less water before a funny event. I'm sorry, but this just does not work. Granted, it helps, of course, but I've had times where I would go to the bathroom (they ran tests and found I can completely empty my bladder) and then five minutes later I would have an "episode". In which all of a sudden my already empty bladder would empty itself again.
    I tried Kegel exercises early on and it never helped. It's not that we cannot control normally, it's that a part in our brains just shuts down. No matter how strong the actual muscle may be, there is no control.
    My best advice to anyone with giggle incontinence is to get on Ritalin and trying it out. I never did, I went on some other drug whose name I do not remember any longer, since I stopped using it about five years ago. Needless to say, it did not work. I am very wary of using Ritalin myself, but I would not bother now- the episodes are too few and far between. But for any child or teenager who pees themselves when laughing-- try it out. And as soon as possible, because of the psychological effects that will occur. Parents, if you're reading this, don't let your kids live with this condition. I wish my parents had made me gone on Ritalin. But it's too late now. Also, if you happen to see your child/teenager washing their pants or underwear, or if you happen to smell urine when you shouldn't, ask them. Because they are going to be far too humiliated to say anything until the last minute. I would know, it happened to me.
    And now before I start crying, I'm going to end this post...


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    Re: Giggle Incontinence

    hello

    first of all am so sorry giggler for the condition u have, n i`m trying to understand how embarrassing is this.. but as we all know that the brain is plastic and can reorganize itself, so i think kegel ex`s, stability ex`s esp. for transverse abdominis. he`s a10 y/o so i think it`s a case with a good prognosis esp. that he`s not complaining from the urine incontinence all the time just when he laughs.

    but i have a Q : how to assess pt. with urine incontinence?


  5. #5
    phunphysio
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    Re: Giggle Incontinence

    This was a long time ago now. We assessed this boy in terms of pelvic floor strength, general TA strength with the boy doing the palpating and talking him through what he was feeling. Luckily he was quite mature here. We went onto Kegel type exercises with modifications for a 10 year old boy with somewhat poor body awareness. We talked about his triggers, type of laughing and practiced being very stupid during therapy to work harder on the actual triggers. We were successful with 7 treatments and I am happy to report the boy continues to do very well.


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    Re: Giggle Incontinence

    Hi im 12 years old male and iv had this all my life and i hate it i cant go out because if i do it will always happen but good luck with the boy


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    Re: Giggle Incontinence

    I'm new to this blogging, but I must add to this in my desperation for help with giggle incontinence. My 18 yr old has had it and it is so bad at this point I don't think she can go off to college. I've taken her to Riley's Childrens Hospital. Tried Ritalin, didn't help. Ditropan didn't help either. Maybe the dosing of the Ritalin was not enough...Ugh...I had this as a child, but not this bad. It is a daily problem for her. Maybe even 4X's if friends are over. She has hid this problem until recently. She has been popular, very smart, and now there are a few mean girls who have found out and make fun of her. I am going to try Sudafed...I've been reading and the Dr had mentioned this to me once. I will post later of our progress. I cried reading your post giggler 88. This is a horrible problem.


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    Re: Giggle Incontinence

    Hi im new to this.
    I have suffered this since i can remember and as a child i was in and out of hospital numerous times and they found nothing wrong and put it down to me just being lazy.Now i am 20 years old and have 2 kids so need to see a physiotherapist and i confided in her which i have never done before about my problem and she told me i may have giggle incontinence.She has checked my pelvic muscles and they are very strong so that wasnt the problem.Kegel excercises dont help,neither does drinking less.Im pretty much on the same boat as the person below and giggler88.I dont know what to do anymore,i have no life and in fear everyday incase i have an accident.Im getting transfered to another hospital so we will see what happens.Im just thankfull that i am not alone in this and that im not the only person that has this which i thought i was up until now.I just need someone to talk to that knows what i am going through.x


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    Re: Giggle Incontinence

    Quote Originally Posted by phunphysio View Post
    I have today recieved a referral for an intelligent 10 y.o.boy diagnosed with giggle incontinence. He looses his whole bladder when he laughs, not just a few drops. I am yet to assess this boy but would appreciate any thoughts or experience in this area. I have treated kids with weak pelvic floor before but giggle incontinence is a new area for me. I am doing some literature searches now and all I have found is ritilin? Looking forward to your thoughts
    In the UK there seems to be even less understood about Giggle Incontinence (bad name - should be belly laugh incontinence...). My 12 year old daughter has struggled through the last few years voiding at least once a day at school, (unless her friends are away - she doesn't laugh hard then). Pads can't cope with total voiding. Her muscles are fine (she can stop when she has an urge - stop/start on the loo etc.) but she experiences complete and uncontrollable voiding when she laughs hard. According to one consultant we saw, she should avoid laughter... Yeah right - he'd be offering electric shock therapy next.

    Through research and pestering consultants I found a specialist in the UK who had successfully treated children with Ritilin. We saw her 5 days ago, she concurred with the conclusion that it was Giggle Incontinence which is a cataplexy and so to do with brain function rather than a stress incontinence which has physical roots. We picked up a prescription for Ritilin. Thank God. I had not dared hope that this would solve everything, but it really has.

    If Giggle Incontinence was a physical problem that could be solved with kegel exercises Ritilin would have no effect. Yes, trying to make sure a child voids frequently so that the bladder is always as empty as possible can mitigate the problem, but is no solution. Ritilin does not 'cure' her - if she stops the Ritilin, the problem would be back - but heavens does it improve her quality of life. So far, no side effects - other than an extremely happy daughter and an absence of odour...

    Any doctors reading this please be aware that there is significant evidence that true Giggle Incontinence is a cataplexy and please treat it as such so that more children like mine can lead normal lives and not suffer the emotional damage that several contributors to this column have experienced. Education, education, education.


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    Re: Giggle Incontinence

    I also have, and still do suffer from this.....and as the rest of you know-its hell to put it nicely. (excuse my language)
    I have had it my entire life, and now as a 14 yr old girl, I still have not just "grown out of it" as I was always told i would. Nonetheless, I didn't get my hopes up then either. My mom has it too. And now my younger brother. So yes, I would confirm the theory it is hereditary. But what makes me mad is that there is still no cure, no treatment that works for everybody. Why? The so-called-experts on the subject don't have any idea what is truly going on, they simply make assumptions, give prescriptions, and send you on your merry way only to find 6 years later that it was all only wishful thinking. I have tried every ADD pill out there, I have tried ditropan, which actually did help to a point, and I have tried various combinations of these two forms of "treatment." Kegal exercises are no help, as it is not the issue. I believe that unless the specialist or "expert" on the topic has it themselves, they are not qualified to take patients with the condition. Because only we can understand what we all go through. I'm sorry, but I will never sit in a cold, sickly purple, doctors office and be told to my face:

    "There is nothing I can do for you. Just deal with it. There are people out there dying of diseases, you really don't have it that bad"

    No offense to those who know someone with a fatal disease or have one themselves. But I see no difference. Sure I may not die from it directly. But becuase of it at 12 years old I considered suicide. Aside from the fact that I practically have no life anyway. We can't have fun for fear we may laugh. We cannot enjoy the time we have on this earth becuase of the personal consequences for us. We have no hope for treatment. For a cure. And yet there are people spending great sums of money on things that will mean nothing once they are gone. Plastic surgery for example.....

    Those of us with the condition know how hard it is.....to have friends, to be social at all,....and especially to have a boyfriend, girlfriend, or spouse. I "live" each day in fear that its only a matter of time until they all know my secret....only a matter of time until it happens while I'm with a guy, just hanging out, and never be able to face him again. Its torture seeing other people laugh and have fun, and knowing that could never be me. Will never be my younger brother. Was never my mom.

    However, I will remind us that although its hell, we have a special quality not many people have. We will never judge another person for their petty faults. We are not as shallow as the majority of people in todays society. We learn to be accepting and show humility. We tend to be more humble and care less about material things because we see how valuable true joy really is. Ironically, that is my middle name.

    <3 to all my fellow (non)gigglers out there. together we will win this battle.....


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    Re: Giggle Incontinence

    im sorry but i love how you seem to completely disregard the fact that we've all "been there, done that" and that your suggestions are of no help as they are no different from anything else we've already been told-which didn't work anyway. So I would ask that everyone would please stop giving the same suggestions to people with this condition. It is cruel in a way to make us think we may have a chance at life, only to find that there is no cure or treatment.

    thanks but no thanks


  16. #12
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    Re: Giggle Incontinence

    dear everyone,

    I have been following this discussion since it started. Have never reacted because of my lack of knowledge on the subject.
    Thank you all for sharing your thoughts and deepest feelings. It must be something terrible to have.
    Nearly all the people reacting are from the general public, not many are colleague health professionals.

    I have often thought it a shame that none of us reacted. The reason probably being that it is not a disorder we physiotherapists see often.
    Because this problem is one that is affecting you so much ...... I will try.
    I have never come across a child with this disorder... so pardon my ignorance.

    Thought I would do my share of looking for information.... most probably things you already know but... I will give it a try...
    And I do think it is important that we professionals know more about this condition as well.

    The official description is enuresis risoria.
    In the pediatric population, giggle incontinence usually refers to urine leakage associated with laughter. A detailed history often reveals some degree or history of urgency and dampness at other times as well. In these cases, there is usually some underlying bladder instability and treatment with an anticholinergic may be of benefit (Chandra, Saharia, Shi, & Hill, 2002). An entity rare in children, giggle micturition, or enuresis risoria, refers to the complete loss of urine associated with laughter, rather than just leakage. History is usually negative for urgency or dampness at any other time. Anticholinergics are generally ineffective, but some benefit has been derived from methylphenidate (Ritalin®), based on the suggestion that the condition is central in nature and related to cataplexy (Sher & Reinberg, 1996).

    A little more on the subject below:
    I could only read the abstracts

    Treatment of enuresis risoria in children by self-... [Br J Urol. 1995] - PubMed - NCBI

    Elsevier

    http://www.ncbi.nlm.nih.gov/pubmed/8683753


    This is the only recent and free viewable document I found:
    http://www.ncbi.nlm.nih.gov/pmc/arti...00027-0123.pdf

    Now that I am looking into this I am pretty shocked to find that most of the literature is very OLD and there is not much out there at all!

    I will ask my colleagues in Holland that are specialized in treating children with bladder & colon disorders (working in a specialized team) what they know about
    this subject.
    Please allow a little time...

    I promise to get back to you as soon as I know more.

    kind regards

    Esther


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    Re: Giggle Incontinence

    Hello everyone!
    I am quite excited to join up as I have had giggle incontinence for as long as I can really remember. I have always avoided speaking about my problem with anyone where possible and I have never been able 2 talk 2 any other sufferers!
    I would like 2 say to nongigglers unite that it really is possible 2 have good relationships despite ur condition. I might have been lucky but I am 26 and have been dating the same man for 7years. At first I was so embarrassed and tried my best 2 hide it but I'm sure you will all know it's very difficult! Anyway I spent so long worrying about it but when he found out 2 my surprise he wasn't disgusted (like I expected) he was impressed with how I was dealing with such a big problem and still carrying on my life.
    I think the hardest thing about giggle incontinence is the affect it has on ur social life, the one doctor I've ever seen about it told me 2 avoid "high risk" situations and I try 2 do this but it's not very practical is it? Does anyone know whether Ritalin is a viable treatment for young adults or only children? To everyone - keep ur heads up, xx


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    Re: Giggle Incontinence

    I'm a 50 year old woman, college educated and faced this problem as a child. The problem disappeared when i was around 28 and then reappeared when I hit my mid-40s. It's to the point that I avoided groups without realizing this was the reason why.

    I also have incontinence (some of the time) when I sneeze or cough. Those are minor, but when I laugh hard, I lose all control. Like Giggler, I can go to the bathroom a few minutes before, and still have this issue.
    I'd love to be able to enjoy being with people again in a fun setting, but don't want to have to wear adult diapers to do so. By the way, I do not have medical insurance, our free medical clinic cannot assist, and we don't have money for medical appointments. Yes, I've tried kegel exercises, which don't help.

    Any suggestions? Is there a potential that there is something that can be done medically?



 

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