Bladder and Bowel Dysfunction- Causes, Symptoms, Diagnosis, and Treatment

What Is Bladder and Bowel Dysfunction in General Pediatric Patients?

There are many conditions in children related to bladder and bowel control. Bladder and bowel dysfunction is a disorder related to the involuntary movement of the organs that includes constipation, enuresis, or urgent need to use the bathroom. It is commonly seen that both disorders are often seen together owing to the same nerves sharing the bladder and bowel in the body. Bowel and bladder dysfunction is often found related to vesicoureteral reflux and other infections related to the urinary tract and bowel. The severity of the condition can lead to kidney failure and renal scarring.

There are nerve endings in every organ to receive the impulses for voluntary movements. When the nerve ending located at the bladder or bowel receives impulses, the nerves in the spinal cord send messages to the brain to alert muscles for relaxation and contraction movement. There are internal and external sphincter muscles that control the bladder and rectum. Moreover, the bladder and bowel have anatomical and functional connections where the pressure created in the bowel can directly affect bladder function. The symptoms of this disorder develop with the voluntary hold of the bladder or bowel function for a prolonged period in children.

What Are the Causes of Bladder and Bowel Dysfunction in General Pediatric Patients?

There are many conditions that cause the involuntary movement of the bladder and bowel, such as:

• Damage to the nervous system.

• Damage to the nerve ending located at the sphincter muscles.

• Avoiding the urge to urinate or defecate for a longer period of time can damage the function.

• A condition such as diarrhea.

• Urinary tract infection.

• Constipation.

• Vaginal childbirth.

• Rectal prolapse (when the rectum expands into the anus).

• Rectocele (rectum pushing into the vagina and creating pressure).

• Ulcerative colitis (an inflammatory disease that affects the bowel, where ulcers are seen in the digestive tract).

• Drug’s adverse effects.

• Stroke.

• Multiple sclerosis (a chronic disease where nerves and brain sheath are damaged, causing impairment or numbness of nerve endings). Due to this, the muscular voluntary movements are affected.

• Alzheimer's disease (a progressive neurological disorder where brain cells die, causing a decrease in the size of the brain). As a result, the behavior and day-to-day physical functions are affected.

• Mental stress.

• Diabetes.

• Infections that affect the brain and spinal cord.

• Post-surgical side effects.

What Are the Signs and Symptoms of Bladder and Bowel Dysfunction in General Pediatric Patients?

• Frequent urination or defecation urges.

• Loss of bladder and bowel control.

• Urinary tract infection.

• Irregular bathroom schedule.

• Constipation.

• Lack of bowel movements.

What Are the Diagnostic Procedures Used for Bladder and Bowel Dysfunction in General Pediatric Patients?

• History: It is the very first line of any successful treatment. When a child is presented with the condition, the doctor should take a detailed case history to know any underlying cause behind the bowel and bladder dysfunction.

• Physical Examination: Secondly, the doctor examines the child for any other symptoms or physical changes related to the condition.

• Voiding and Bowel Diary: The parents are asked to keep an eye on the bathroom use of the child for a period of seven to 14 days. The details about frequency, volume or any other abnormality during the bathroom visits are documented for detailed analysis.

• Urinalysis: This mode of diagnosis is used to check for any infection related to the urinary tract.

• Blood Test: It is done to evaluate any deficiency or abnormalities in the bloodstream and the body.

• Cystoscopy: It is the diagnostic method where a thin and hollow tube is inserted into the urethra of the bladder to check for the abnormality related to the lining of the bladder.

• Ultrasound: The high-frequency sound waves are used to take images of the kidney and bladder. Any structural abnormalities are looked for during this imaging.

• Urodynamic Testing: It is the diagnostic method used to check and analyze the sphincters, urine output, or urination.

How to Treat Bladder and Bowel Dysfunction in General Pediatric Patients?

There are following options available for treatment:

• Change in the Diet: Children should be given a balanced diet that includes whole grains, fibrous food, and vegetables. They should be hydrated with proper and measured fluid intake.

• Medicine: When the condition is very severe, the doctor may prescribe drugs to aid the contraction of muscles and urgency. The medications are prescribed according to the symptoms such as loss of urge to urinate or defecate, frequent use of the bathroom, less frequency in using the bathroom, increase in the storage capacity of the bladder or requiring help to empty the bladder and bowel fully.

• Maintaining a Bathroom Schedule: During this treatment, parents train the child’s bladder and bowel for regular movements. Ideally, a child should use the bathroom every three to four hours daily while they are not sleeping. During this training, the children are asked to use the bathroom before the urgency begins, and this helps to restrain the bladder and bowel. Although, after a few months, a doctor may prescribe the medication to control the urgency of using the bathroom frequently.

• Surgery: To manage or improve bladder or bowel control, doctors perform surgeries such as bladder or bowel reconstruction, creating an artificial sphincter, bypassing the bladder or bowel, increasing the bladder size, or resecting the weak part of the sphincter.

• Electrical Stimulation: When lifestyle changes and drug therapy are not effective, this mode of treatment is used. There is sacral neuromodulation therapy (SNS) and percutaneous tibial nerve stimulation therapy (PTNS). During both therapies, the battery-operated device is connected to the nerve endings to generate electronic impulses to control the bladder.

• Clean Intermittent Catheterization (CIC): This is also suggested depending on the severity and age of the patient. During this treatment, the healthcare provider inserts a thin tube into the bladder a few times daily to empty the bladder.

• Continuous Catheterization: This mode of treatment is suggested according to age. During this treatment, a healthcare professional inserts a catheter into the urethra or abdominal wall to continuously empty the bladder.

• Anal Irrigation: It is a new conservative therapy to control or improve bowel function. During which, a catheter is inserted into the rectum, and with the help of an inflatable balloon, the fluid is inserted through it. It usually reduces constipation.

• Biofeedback Therapy: During this treatment, the patients are asked to use a machine to perform exercises to improve bowel control and muscle strength.

• Education: It is the last but not the least treatment option. When parents visit the doctor with the child having this problem, the very first thing a doctor can do is properly educate the parents or caregivers about the condition. Moreover, the doctor should properly guide them with the diet and bathroom schedules and encourage them about the follow-up visit during this condition.

Conclusion:

Bladder and bowel dysfunction disturbs children’s daily routine and social and personal life. It affects not only physical functions but also affects psychological health throughout their life. The parents or caregivers should be encouraged to manage their schedules, diet, and exercise, including regular follow-up visits. And with the help of medicine, surgical therapy, and physical training, the condition can be managed or improved.