Introduction
Going to the bathroom several times may seem like a general thing, but eventually, it can lead to a series of complications, which may signal that the bladder may have some problems. If any of these problems can affect the child, they may face difficulty holding their urine (urinary incontinence). If a child over four has urinary incontinence, and doctors can find specific anatomical or neurological causes, they may diagnose the child with voiding dysfunction.
The cause of voiding dysfunction is still unknown, but the condition can impact children physically, socially, and psychologically. If voiding dysfunction is left untreated, it can result in vesicoureteral reflux (VUR) and long-term kidney damage.
What Is Voiding Dysfunction?
The lower urinary tract involves the bladder and urethra, which allows for storage and timely voiding of urine. Voiding dysfunction is a broad term that means a condition where there is weak coordination between the bladder muscle and the urethra. This results in incomplete relaxation or over-activity of the pelvic floor muscles during voiding. Voiding symptoms represent lower urinary tract symptoms (LUTS).
The lower urinary tract symptoms (LUTS) can occur during bladder filling (storage), emptying (voiding), post urination, or any combination. Storage symptoms are irritating and may include urgency, frequent nighttime urination, frequent urination, or involuntary loss of urine. In men, voiding symptoms can be related to obstructive causes like difficulty emptying the bladder or straining, urinary hesitancy, weak stream, or urinary dribbling.
What Are the Causes of Voiding Dysfunction?
In men, the significant causes of voiding dysfunction are obstructive symptoms, including an enlarged prostate due to benign prostatic hyperplasia (BPH) and prostatitis. Some other common causes are urethral stricture (scar tissue), bladder tumors, or bladder stones. Pelvic floor hyperactivity is also found in men. Irritative symptoms can result from similar etiology and other causes, including bladder infection, bladder stone, or tumor.
What Are the Types of Voiding Dysfunction and Associated Symptoms?
The following are the symptoms and their associated symptoms -
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Overactive Bladder (OAB) - Patients with overactive bladder may have the urge to urinate even when their bladder is not full or even empty. Most children with overactive bladder will have urinary incontinence and urinary tract infections (UTIs), and sometimes these symptoms continue even after these problems are taken care of. Some children may try to hold it by crossing their legs or using other physical activities. OAB is seen in 22 % of children between the ages of five and seven.
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Dysfunctional Voiding - In dysfunctional voiding, the major muscles that control the urine flow out of the body do not relax completely, and the bladder does not get empty. This problem can lead to issues like daytime wetting, night wetting, a feeling that the bladder is always full, urgency, and straining to urinate. In serious cases of dysfunctional voiding, a patient may have symptoms similar to those of a neurogenic bladder and be at higher risk for complications such as kidney infection and other diseases.
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Underactive Bladder - Patients with an underactive bladder tend to urinate less than normal. These patients are pressured to urinate because the bladder gets weak and does not respond to the brain’s signal at times. Accidental wetting with an underactive bladder is caused by the bladder becoming too full or overflowing.
How to Diagnose Voiding Dysfunction?
By age 4, most children can stay dry during the day. Voiding dysfunction can not be diagnosed until a child is older than four and has had no daytime incidence for at least six months after toilet training completes. First, the child will undergo a physical exam to check for anatomical or medical reasons that could be causing daytime wetting.
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Urinalysis: The child’s urine will be examined for a urinary tract infection.
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Kidney and Bladder Ultrasound: This is an imaging technology that shows how well the child is able to empty their bladder.
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Uroflow EMG (Electromyogram): This test shows how well the bladder gets signals from the brain.
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KUB (Abdominal X-Ray): X-rays are used to see if constipation may be causing urinary incontinence.
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Urodynamic Testing: A catheter is introduced into the urethra, and the bladder is filled with saline water to help physicians strengthen the bladder.
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VCUG (Voiding Cystourethrogram): This test examines how well the child's bladder works. VCUG is done in combination with urodynamic testing.
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Magnetic Resonance Imaging (MRI): If the doctor thinks the child may have neurogenic bladder issues, they may ask for a spine MRI.
How Is Voiding Dysfunction Treated?
Depending on the type of voiding dysfunction, all conditions can be treated with medicine, training of the bladder, and others.
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Overactive Bladder: For treating OAB, parents set a schedule to use the bathroom every two to three hours while the child is awake. Children are asked to urinate before they feel the urge to urinate. After a few months on the voiding schedule, doctors may prescribe medications that can help reduce the frequency and feeling of urgency.
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Dysfunctional Voiding: The treatment for dysfunctional voiding mainly focus on reframing the brain and helping the bladder to relax. Doctors and parents explain to the child that in the process of urination, they do not need to squeeze the abdominal muscles, but they can settle the powers of the pelvis and the bladder. A timed voiding schedule is an essential part of bladder retraining. Biofeedback and Kegel exercises can also effectively help manage dysfunctional voiding. The doctor may also be prescribed medicine according to the condition.
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Underactive Bladder: Underactive bladder can be treated by changing some primary behavior of a child. Parents can schedule the bathroom time for their child to detect whether the child is urinating or just have the urge to urinate. Medications can also help the child to relax the bladder. Children with large-capacity bladders who cannot urinate may require short-term catheterization. Transcutaneous electrical nerve stimulation (TENS) has also been shown to help these children.
Conclusion
Problems with urination related to poor coordination between bladder muscles and the tube that carries urine out of the body (urethra) are broadly described as voiding dysfunctions. Some voiding dysfunctions go away with little or no treatment, as is often the case with urine control issues related to pregnancy or a minor infection. Bladder control problems not caused by structural issues or underlying medical conditions are sometimes manageable or avoidable with pelvic floor exercises.
