Bladder Bowel Dysfunction in Children

Background

 

Bladder Bowel Dysfunction previously called dysfunctional voiding is common problem affecting 40% of children who are seen by a pediatric urologist. This common problems is often a cause if significant stress for both patients and their family. Bladder bowel dysfunction describes incomplete relaxation or overactivity of the pelvic floor muscles during voiding or stooling. In children, dysfunctional voiding or bladder bowel dysfunction manifests itself often as day or nighttime accidents, recurrent urinaty tract infections, and  urinary frequency, urgency or holding.

 

Children generally are toilet trained between 3-5 years of age. As they learn to hold their urine, the normal voiding pattern is to void 4-7 times daily in absence of any urinary symptoms or infections.

 

 

Causes

 

Bladder bowel dysfunction happens with the normal phases of filling and emptying are not working together.  There are many causes of voiding dysfunction however the majority of children develop voiding dysfunction secondary to infrequent voiding or holding of urine. As a result, the bladder is denied it’s normal cycling of filling and emptying and because it is part of a cycle these problems perpetuate themselves. As a result, children develop problems with leakage, recurrent infections or feelings of urinary frequency and urgency.

 

Rarely, these symptoms are a result of an anatomic or neurologic congenital abnormality. However, greater that 95% patients do not have any anatomic or neurologic cause for this problem

 

 

Diagnosis and Evaluation

 

The majority of patients with bowel bladder dysfunction can be diagnosed by history. However, often ancillary tests are used to rule out anatomic causes and help tailor treatment planning.

 

 

 

 

 

 

Treatment

 

Fortunately the majority (>90%) of patients will respond to conservative treatment of bladder retraining . This is a behavior modification program that involves re-teaching the bladder a normal filling and emptying cycle.  As the bladder needs to re-learn how to fill and emptying this treatment usually will show improvement in bladder symptoms within 6-12 months.

 

Techniques for bladder retraining/behavior include:

 

 

Other medical therapies inlude:

 

 

 

 

 

 

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Author: Dr. J. Mickelson - last edited Oct 2015