Care4Kids

Voiding Dysfunction in Children

Ever wonder why your toilet-trained 3-year-old keeps having frequent accidents even after constant reminders to use the potty? Certainly, for some 3 year olds, this is due to simply not being completely toilet trained. For this group, time and continued use of standard toilet training techniques will eventually result in improvement.

However, this scenario is also seen in many children who have mastered the challenge of toileting, and are highly motivated. For a variety of reasons, some kids just don’t or won’t take the time to go to the bathroom. When they do go, they may empty the bladder just enough to relieve the pressure, but not enough to empty all of its contents.

Once habits like these become common, the muscle that allows kids to hold their urine may become overactive, making it even harder for them to completely empty the bladder. This is known as voiding dysfunction. This can be especially frustrating for both parents and children.

SYMPTOMS OF VOIDING DYSFUNCTION

The symptoms a child with voiding dysfunction may experience will depend on his specific type of problem. They may include:

•   Wetting during the day and night

•   Urgent urination

•   Overactive bladder or needing to use the bathroom quite frequently

•   Repeated urinary infections

•   Constipation

•   Pain in the back or lower abdominal area

•   Bladder spasms

•   Incontinence (child may leak urine on the way to the bathroom or may leak without sensation or warning)

The issue of constipation warrants special mention, as this is a problem that is frequently associated with voiding dysfunction. Symptoms of constipation in children are a bit different than symptoms that occur with adults. They can include irregular bowel movements, streak marks on underwear and sometimes even diarrhea.

Constipation often can be improved by increasing the fiber and fluid in a child’s diet. Treating constipation may result in improved voiding. Children who only wet their beds at night usually do not have voiding dysfunction.  Voiding dysfunction should be taken seriously because it can have a significant impact on family and social dynamics, and in severe situations, kidney damage can result.

DIAGNOSIS

To make a diagnosis, your child’s doctor will want to examine your son in order to rule out physical or neurological problems and test his urine for any signs infection. Expect your doctor to ask for a detailed history of your son’s voiding habits and bowel movements.

Other tests, such as an ultrasound or X-ray also may be necessary in order to rule out other medical conditions. Your child may be asked to urinate into a special machine that monitors how much and how fast he urinates.

Some children will require additional bladder tests like a voiding cystourethrogram (VCUG). A VCUG can check for problems in the structure or function of the urinary system. It can evaluate the bladder’s size and shape and look for abnormalities, such as a blockage along the path of the urine. It also can show whether the urine is moving in the right direction.

TREATMENT

Treatment options will vary based on your child’s specific problem or condition. Medication is sometimes used to help with frequent or problematic bladder contractions. Kids with small bladders need to learn to go to the bathroom frequently and not to “hold it” in. This is sometimes referred to as “timed voiding.”

For children with large, stretched-out bladders, teaching them new habits, like sitting down and spending several minutes trying to make sure the bladder is completely empty, is important. As noted above, treating constipation can result in significant improvement.

A regular bathroom routine may help your son develop normal voiding habits. Pay attention to the sound of the urine stream when your child goes to the bathroom. A good urine flow probably means your child is drinking enough fluids and is also able to relax and completely empty his bladder. Kegel exercises that call for the child to contract and then relax the pelvic floor muscles can help strengthen the muscles that release the urine.

If your child has a physical abnormality that is causing his voiding dysfunction, surgery may be necessary.


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