Voiding dysfunction is a term used by doctors and nurses that means a person does not empty their bladder normally. This term means many different things. It may mean that the person waits too long to urinate, or urinates too frequently, or even tries to urinate when the muscles keeping the urine in the bladder (the sphincter muscles) are clamped down. The problems and symptoms a child with voiding dysfunction has will depend on his or her type of voiding dysfunction. These problems and symptoms may include wetting during the day and night, frequent and urgent urination, urinary tract infections, or sometimes kidney damage. Wetting only at night (nocturnal enuresis) is not considered a voiding dysfunction. A lot of children with voiding dysfunction also have problems with their bowels. With treatment, most children will improve. The best type of treatment depends on the kind of voiding dysfunction.
Urine Voiding Dysfunction is most common in Girls:
These are quite common in children esp. girls. In the first few years of life, voiding is often incomplete due to urinary bladder muscles and the controlling valve or sphincter dyssynergia or lack of coordination. Approximately 10% of 7-year-old children suffer from daytime incontinence and/or nighttime incontinence or nocturnal enuresis. Daytime incontinence is usually due to detrusor or bladder muscles hyperactivity.
Signs and Symptoms associated with Urine Voiding Dysfunction in Children:
The symptoms may be leakage of urine, frequency or urgency.
Constantly wet undergarments or bed wetting may be noticed.
Stress incontinence or leakage, while they were playing, may be noticed. The children are constantly embarrassed by this situation and may lose self-esteem in bigger children. Urinary tract infections and constipation may also be there simultaneously. This is a problem situation where there is “Bowel – Bladder Dysfunction”.
Is your child suffering from a Lazy Bladder?
Nowadays, many children chronically neglect to go for voiding on a regular basis whenever an urge occurs like while watching television, playing mobile games, sheer immersion in games or even situations where they may not be wanting to go to a dirty toilet at school or in public places. They develop lazy bladders. In “Lazy Bladders” there are no detrusor contractions.
In such children, the urinary tract should be thoroughly investigated to rule out organic causes. Phimosis or tight preputial skin, narrow urethral opening, urethral obstruction problems, ectopic (misplaced ureteral openings), vesicoureteral reflux (VUR) needs to be ruled out. Investigations like urine examination, ultrasonography, cystourethrogram, urodynamic study, and cystoscopy will help in identifying the culprit lesion.
These children may be helped with medicines like antispasmodics, tricyclic derivatives or even antibiotics to treat infections. Toilet training activities, behavioural therapy, and rarely CIC or clean intermittent catheterization may be needed. Endoscopic injection therapy for VUR is definitive. Associated constipation requires attention.