Voiding Dysfunction - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Voiding dysfunction is a general phrase that describes situations where the bladder muscle and urethra's coordination is off inside the urinary canal. This causes the pelvic floor muscles to either not relax completely or contract excessively during urination (urination). The organs that retain and discharge urine from the body are part of the urinary tract. These are the ureters, bladder, urethra, and kidneys. Urine can be stored and released through the lower urinary system, consisting of the bladder and urethra; when there are irregularities in the filling, storing, and emptying of urine, voiding dysfunction results.

What Are the Causes of Voiding Dysfunction?

The common causes of voiding dysfunction are

• Overactive Muscles - Overactive pelvic floor muscles.

• Urethral Obstruction - Obstructions in the tube that remove urine from the body and nerve issues that influence how the bladder muscles contract.

• Tumors - Malignant and non-cancerous tumors.

• Stones - Bladder stones.

• Interstitial Cystitis - A long-standing painful bladder condition.

• Urinary Incontinence - Loss of bladder control.

• Neurological Disorders - Neurological Disorders might come from a spinal cord or brain anomaly that alters how nerves help regulate the bladder and urine sphincter operation.

What Are the Types of Voiding Dysfunction?

The types of voiding dysfunction are

• Overactive Bladder (OAB) - Children with OAB may urinate more frequently than ten times a day or roughly once every hour, even though their bladders are incomplete. Urinary incontinence and urinary tract infections (UTIs) are common in children with OAB, and occasionally these symptoms persist long after the UTI has been treated. Some kids may attempt to "hold it" by crossing their legs or making other bodily gestures but fail.

• Dysfunctional Voiding - This malfunction prevents the bladder from emptying because the muscles that regulate the urine that flows out of the body do not relax. A variety of symptoms are brought on by this, including nighttime and daytime urination, urgency, and straining to urinate. Children who experience severe dysfunctional voiding may experience symptoms resembling those of a neurogenic bladder (a bladder that does not operate due to an underlying neurological cause) and are more likely to experience problems, including kidney disease and infection.

• Underactive Bladder - Less than three urinations per day or the ability to go more than 12 hours between urinations are signs of an underactive bladder in children. Due to the bladder muscle's inherent "weakness" and inability to respond to the brain's indication that it is time to urinate, these youngsters must exert extra effort to perform. The bladder overflows when it becomes excessively full, leading to unintentional wetting when it is inactive.

What Are the Symptoms of Voiding Dysfunction?

The symptoms of voiding dysfunction are:

• Lack of voluntary control during urination day and night.

• Increased urinary frequency.

• Pain during urination.

• Constipation.

• Urinating urgently.

• Discomfort or difficulty urinating.

• Hesitancy.

• Dribbling.

• Irregular urination.

• Back, flank, or abdominal pain.

• Urine with blood in it.

How Is Voiding Dysfunction Diagnosed?

The urologist may request a voiding diary, and they will most likely take a history of the child's voiding habits. Identifying a defective voiding pattern accurately depends mainly on this, arguably its most crucial aspect. Urinalysis, urine culture, and a comprehensive physical examination are typically performed afterward. A defective voiding pattern can be diagnosed, and its consequences can be documented using radiologic and urodynamic evaluation (a thorough review of bladder function).

The doctor prescribes the following non-invasive tests if the examination reveals no problems:

• Urinalysis: The urine will be examined for a urinary tract infection, which can result in urgency and incontinence.

• Ultrasound of the Kidney and Bladder: This imaging technique can demonstrate how effectively the youngster can void their bladder. The test is also performed to assess the kidney's size and shape and to look for obstructions such as masses, kidney stones, cysts, and other abnormalities.

• The Uroflow EMG (Electromyogram) test reveals the efficiency with which the bladder receives messages from the brain.

• KUB (Abdominal X-Ray): This sort of X-ray is used to determine whether urine incontinence may be caused by constipation.

Doctors may advise these tests if the child has complicated symptoms or symptoms that don't go away after treatment:

• Urodynamic Testing: To determine the bladder's strength, a catheter is put into the urethra (the opening through which urine exits the body). Saline solution is then injected into the bladder.

• VCUG (Voiding Cystourethrogram): This test determines how effectively the child's bladder functions. Urodynamic testing may be combined with VCUG.

• Magnetic Resonance Imaging (MRI): Doctors may also advise an MRI of the spine if they suspect the child has a neurogenic bladder. Despite being non-invasive, most kids will need anesthetic for this operation.

• Radionuclide Cystogram (RNC): An RNC is identical to a VCUG, except a different fluid is administered to show the urinary tract clearly.

• Intravenous Pyelogram (IVP): An IVP shows urine's direction and flow rate via the urinary system.

How Is Voiding Dysfunction Treated?

The goal of voiding dysfunction treatment is to teach patients how to relax the bladder opening when voiding. Some of the methods used to treat voiding dysfunction are:

• Urotherapy: Any non-pharmacological, non-surgical treatments that can improve lower urinary tract function are referred to as urotherapy. Many studies have shown that urotherapy can help pediatric patients with vesicoureteral reflux, constipation, and urinary tract infections. The several urotherapy components can be mixed with pharmacotherapy, and they are not all required to be used together. Urotherapy must be a continuous procedure. The series of steps involved in urotherapy is

  • First Step Initial assessment, management, and education are the first steps.

  • The second step involves a series of biofeedback sessions, including showing the child a uroflow curve and instructing them on recognizing and contracting or relaxing the pelvic floor muscles.

  • The Third Step is maintaining good bowel habits, creating a voiding diary, and performing pelvic floor exercises.

  • Final Step - The last phase is to identify persisting behavioral and psychological problems.

• Biofeedback Behavioral Therapy: The foundation of behavioral treatment is the assumption that the condition is taught and possibly changeable. Incontinence and recurring urine infections will decrease for up to 80 % of youngsters, who will also show improvement. It takes several sessions and repeated practice. It is more likely that biofeedback will improve leftover urine when used in urotherapy. The two general biofeedback techniques are

  • Visual feedback of the uroflow curve.

  • Perineal muscle identification instruction using EMG electrodes.

  • Typically, the first option is faster. Cyclical uroflow sessions, voice feedback, charts, or animation may be employed. Moreover, biofeedback may help some children with voiding dysfunction with paradoxical pelvic floor movement. This finding, present in 30 % of healthy children, is not yet known to have clinical implications.

• Alpha-Blockers - To enhance voiding in those with DV, a disorder that impacts the striated sphincter instead of the bladder neck. Symptomatic relief has been demonstrated with alpha-blockers in small series. Both children and adults tolerate the treatment well.

• Botulinum Toxin - Injection of botulinum toxin showed a sizable decrease in post-void residue and a rise in voided volume but no change in uroflow rates.

• Neuromodulation - A neurostimulation device is used in neuromodulation to trigger a normal biological reaction. The nerves are activated by placing electrodes on the spinal cord, peripheral nerves, or brain. A minimally invasive approach can be used to apply electrodes to the skin or right to the nerves.

Conclusion

Preventing urinary tract infections is crucial, as is ensuring that any other issues like vesicoureteral reflux, bladder dysfunction, or kidney issues are well managed. The key to voiding dysfunction is early detection, treatment, and limiting any potential harm it may do to the urinary system.