Introduction Refractory overactive bladder (OAB) in children can be treated with second line modalities such as as biofeedback, transcutaneous electrical stimulation (TENS), and botulinum toxin. In this study, we aimed to investigate the efficacy of biofeedback‐assisted pelvic floor muscle therapy (PFMT) on symptoms, bladder capacity, uroflowmetry, and pelvic floor muscle activity (PFMA) in children with resistant OAB or dysfunctional voiding (DV) with associated seconder bladder overactivity (DV/SBO). Materials and Methods A total of 24 children with resistant OAB were included in the study. Patients were divided into two groups as: group‐1 pure OAB and group‐2 DV/SBO. Children were evaluated with voiding diary, uroflowmetry‐EMG, PFMA before and after treatment. All patients were treated with PFMT. Results Urgency cured or improved in 12 of 17 (71%) of children in group‐1 and in six of seven (86%) children in group‐2 (P < 0.0001 and 0.031, respectively). Other symptoms cured or improved with 64%‐100% recovery rates in group‐1 and 50%‐80% in group‐2. Maximum voided volume (maxVV) in voiding diary increased from 81.6 to 150.9 mL in group‐1 and from 115.6 to 175.7 mL in group‐2 (P < 0.0001 and 0.063, respectively). Mean work value of PFMA increased and mean rest value of PFMA decreased significantly (P < 0.0001, 0.018 and P = 0.002 and 0.018, respectively). Conclusion The measurement of PFMA in children with refractory OAB or DV/SBO gives information on the strength and endurance of PFMs. In children with refractory OAB or DV/SBO, biofeedback‐assisted PFMT provides symptomatic improvement and increases functional bladder capacity.

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