It is not uncommon for children to have voiding (urination) problems. This broadly defined condition may be due to several reasons – from behavioral problems or poor voiding habits to infections and diseases. Some children also are born with or acquire physical problems that lead to voiding dysfunction.
We need to understand the cause to treat the dysfunction. We will document medical and social histories, conduct a physical exam and order lab tests. Once we know the underlying cause, we can recommend treatment options.
Voiding dysfunction means your child is unable to completely empty the bladder. During the normal voiding, the external urethral sphincter muscle should completely relax, so the urine flows smoothly and completely as the bladder empties itself.
An interrupted or erratic urine flow or incomplete emptying cause voiding dysfunction.
- Incontinence (lack of bladder control)
- Urinary tract infection
- Frequent urination
- Urgent urination
- Pain or straining with urination
- Intermittent urine flow
- Pain in the back, side or abdomen
- Blood in the urine
- Neurological problem from a spinal cord or brain abnormality that affects how nerves help control bladder and urinary sphincter function.
- Often a learned problem — Your child may continually hold urine all day because he or she doesn’t want to stop playing to go to the bathroom. Children get into this routine for different reasons:
- Some may be routinely too busy to break for the bathroom
- Others may have experienced a painful urinary tract infection (UTI) and are afraid to urinate
- Sometimes, the problem is related to potty training or constipation.
- A child may have developed abnormal urinating habits from the beginning.
- Medical history
- Review of a voiding diary
- Thorough physical examination
- Urinalysis and urine culture
- Radiologic and urodynamic evaluation (a detailed study of bladder function)
Further evaluation many be required due to the severity and symptoms. We may recommend:
- Blood tests — To establish how well your child’s kidneys are working
- Voiding cystourethrogram (VCUG) — An x-ray to examine your child’s urinary tract. The images will show any reverse urine flow into the ureters and kidneys.
- Radionuclide cystogram — Similar to a VCUG except using a different fluid to highlight your child’s urinary tract.
- Renal ultrasound — Used to determine the size and shape of your child’s kidney, and to identify a mass, kidney stone, cyst or other obstruction or abnormalities
- Intravenous pyelogram — Reveals the rate and path of urine flow through the urinary tract
- A timed voiding schedule — You ask your child to go to the bathroom when he or she wakes up, every two to three hours, and before going to bed at night.
- In some children, medication may be needed to decrease bladder hyperactivity.
- Rarely, extensive reconstructive surgery such as bladder augmentation (adding a piece of the intestine or stomach to the bladder to increase bladder capacity) may be necessary.