Dysfunctional voiding (urinating problems)
Dysfunctional voiding is a condition in which children frequently delay a trip to the bathroom for any number of reasons. As they learn that they can frequently "hold back" the urine by keeping the bladder's sphincter muscle tight, this learned behavior makes it more difficult to fully relax that muscle when it is time to urinate. As a result, the child's bladder may not empty completely, which sets the stage for a urinary infection.
In normal situations, regular urination helps keep the urinary tract sterile by flushing away bacteria, while holding in urine allows bacteria to grow. In fact, holding back the urine again and again may eventually lead to urine obstruction. Although this problem occurs as the child attemps to urinate, a child with dysfunctional voiding often has symptoms such as incontinence.
Signs of dysfunctional voiding
- Frequent urine holding
- Daytime wetting
- Bathroom emergencies
- Constipation
- Urinary tract infections (UTIs) (More here about UTIs »)
- When a female child “curtsies” or crosses the legs and bends from the waist
How is dysfunctional voiding diagnosed?
Dysfunctional voiding is primarily diagnosed through a thorough history with emphasis on toilet habits. Further evaluation involves pre- and post-void ultrasounds to assess for residual urine. Also, a test called a uroflow is done with electromyography, or EMG, to test the electrical activity of muscles. The test may show poor pelvic floor muscle relaxation showing abnormal urine flow such as an intermittent stream.
In addition, an
abdominal x-ray called a KUB may be done to see if the child is experiencing constipation or
stool retention.
Treatment for dysfunctional voiding
Bladder function improvement training (BFIT) involves a multi-pronged approach individualized for each child. The components of treatment include:
- Antibiotics - While dysfunctional voiding is being treated, children with recurrent UTIs are often given low-dose preventive antibiotics. It is helpful to begin an antibiotic during the initiation of a bladder and bowel program in order to break the cycle of UTIs that often causes wetting accidents.
- Bowel program - Constipation is common among children with dysfunctional voiding. Since most children with dysfunctional voiding do not appropriately relax the pelvic floor muscle, typically they are constipated since these are the same muscles that also control the release of stool. More here about stool retention (constipation) as it affects the bladder.
- Behavior modification - This includes:
o Relaxation/repositioning - Perhaps the most important treatment for children with dysfunctional voiding is the ability to release urine in a relaxed and complete manner. Therefore, children should be taught proper toileting positioning and techniques to promote pelvic floor relaxation.
o Timed voiding - Children with dysfunctional voiding may not receive strong messages that signal when the bladder is full and, therefore, need to have a schedule to retrain the bladder.
o Biofeedback - When repositioning does not improve pelvic floor function, biofeedback training is implemented on an age-appropriate level. This essentially means teaching a child how to “read” his or her own body and to understand how the body works. Biofeedback has been shown in many different settings to be key to addressing dysfunctional voiding.
Making appointments
Children referred for treatment are evaluated and managed by experienced urology nurse practitioners. To make an appointment at the hospital or one of our other facilities, call 1.800.543.7362 (1.800.KIDS DOC).