URINARY INCONTINENCE

Voiding dysfunction is a broad term use to describe a voiding (urination) pattern that is abnormal for the child’s age. A normal bladder stretches easily as it fills with urine. It does not contract or increase in pressure as it fills. As the bladder contracts during normal voiding, the external urethral sphincter muscle should completely relax so that the urine released from the bladder flows smoothly, completely, and without interruption. A problem in bladder filling or emptying is called a voiding dysfunction.

WHAT CAUSES VOIDING DYSFUNCTION IN CHILDREN?

Voiding dysfunction can be the result of numerous causes:

  • Behavioral problems or poor habits (eg, infrequent voiding, poor toileting habits, having too much fun or being too busy to break to go to the bathroom, being fearful of urinating due to a past painful urinary tract infection, attention deficit disorder, psychological or emotional stressors)
  • Congenital (born with) problems in the physical anatomy of the urinary tract
  • Acquired problems in the physical anatomy of the urinary tract (such as those caused by tumors or trauma)
  • Central nervous system diseases and conditions that affect the urinary tract (e.g., cerebral palsy, epilepsy, multiple sclerosis, other abnormalities of the brain or spinal cord that affects the nerves that control bladder or urinary sphincter function)
  • Endocrine or kidney diseases that affect the urinary tract (e.g., diabetes, chronic kidney disease)
  • Genetic diseases that affect the urinary tract (e.g., Ochoa syndrome, Williams syndrome)
  • Infections or irritations that affect the urinary tract (e.g., urinary tract infections, urethritis, pinworms, foreign body)
  • Other causes can include stress incontinence (the involuntary loss of urine during activities such a coughing, or sneezing), giggle incontinence (see next page for definition), and delayed nighttime bladder control.

WHAT ARE THE SYMPTOMS OF VOIDING DYSFUNCTION?

Signs and symptoms of voiding dysfunction include:

  • Incontinence (urine leakage) during the day and/or night – often is the first sign noticed by parents that there is a problem
  • Increase in urinary frequency and/or urgency (the need to void immediately)
  • Urinary hesitancy, dribbling, intermittent urine flow and/or straining at urination
  • Pain in the back, flank or abdomen
  • Recurrent urinary tract infections
  • Blood in the urine
  • Infrequent urination – three or fewer voids in a 24-hour period
  • Constipation and fecal soiling

ARE THERE DIFFERENT TYPES OF VOIDING DYSFUNCTION?

Yes. Some of the more common types include:

  • Daytime wetting (also called diurnal enuresis): Daytime wetting can consist of either small urine leaks that spot or dampen underwear to the complete soaking of undergarments. Wetting occurs more commonly in the afternoon, as most children are anxious about wetting in school and work hard to stay dry.
  • Giggle incontinence: This is the complete emptying of the bladder that occurs with vigorous laughter or giggling.
  • Urge syndrome: This is frequent attacks of the need to void (at least seven times a day) countered by hold maneuvers, such as squatting. Urine loss is mild, represented by a dampening of undergarments.
  • Bedwetting (also called nocturnal enuresis): This is when a sleeping child cannot control his/her urination at night. This problem begins to be considered abnormal after the age of five.