Voiding dysfunction means that the child is unable to completely empty his or her bladder and has an abnormal voiding pattern i.e. interrupted or intermittent flow of urine.
Sometimes, the disruption of the voiding cycle may be the result of a neurological problem. This could be the result of an abnormality of the spinal cord or brain that affects how nerves help control the function of the bladder and urinary sphincter ie Neurogenic bladder.
However, it’s more often a problem of toilet training ie Non neurogenic. For example, the child may continually hold his urine in all day because he doesn’t want to stop playing to go to the bathroom.
Children get into this routine for different reasons:
Whatever the reason, some children get into a pattern of not relaxing their external urethral sphincters. Their bladders can tolerate this for months and in some cases years, depending on how hard the child works to avoid urinating.
Eventually the bladder muscle, which has to continually work against this voluntary blockage, will become so strong and thick that it will overcome the blockage and periodically empty on its own, whether the child is sitting in a classroom or out on the soccer field.
Incontinence during the day and night may be the first sign that there is a problem.
Other symptoms include:
A detailed history of the child's voiding patterns and a voiding diary made by the parents, help in making a diagnosis.
This is followed by a thorough physical examination, urinalysis and urine culture. Radiologic and urodynamic evaluation (a detailed study of bladder function) may be used to both confirm the diagnosis of a dysfunctional voiding pattern and to document its aftereffects.
Further evaluation of the urinary tract is dictated by the severity and character of the child’s symptoms. Some additional test may be required like -:
Most treatment begins with a timed voiding schedule where the child is asked to go to the bathroom right when he wakes up, every two to three hours thereafter, and upon going to bed at night.
It’s also important to make child completely relax while urinating. These simple changes are often enough to help the child work through the problem.
In some children, however, medication may be necessary 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.
It’s essential to prevent urinary tract infections and make sure that any other associated problems, such as vesicoureteral reflux, bladder dysfunction, or kidney problems, etc are being appropriately controlled.
The key with voiding dysfunction is to identify it early on, treat it, and limit the possible negative effects it can have on the child’s urinary system.