Pediatric Urological Surgery

Childhood Problems with Urinary Control

• What Symptoms Are Associated With VoidingProblems in Children?
• Loss of Urinary Control (Enuresis)
• Frequent Urination
• Urinary Urgency
• Squarring/Squeezing to Prevent Urination
• Recurrent Urinary Tract Infections
• Tendency Towards Constipation

How Common are these problems?

About 15 percent of all 5 year old children, 5 percent of all 10 year old children, and 1 percent of all 15 year old children occasionally wet themselves. Therefore, this represents a common childhood problem. Not every child is ready for complete urinary control by 5 years of age, and it is difficult to predict their ability to gain this control. It would seem to be a continuous developmental situation with most problems resolving as the child grows older. Often, it seems to be a family trait with a parent, brother or sister late in developing complete urinary control.

How can your initial physician evaluation help?

The office evaluation should include a complete history and physical examination, with a urine specimen obtained for urinalysis and urine culture. This allows identification of 3 subgroups of incontinent children:

1. Children who wet only at night, without evidence of abnormalities on physical exam, a urinary tract infection, or daytime voiding symptoms.

2. Children with daytime urinary symptoms such as frequency, urgency, damp underwear, and squatting or squeezing to avoid wetting. They may have a tendency towards constipation, urinary tract infections and night bedwetting, too.

3. Children with obvious abnormalities (such as spina bifida) on physical exam, or continuous day and night wetting despite an otherwise normal voiding pattern (suggests an ectopic ureter). Fortunately, only a very small minority of children fall into this subgroup.

What is the cause of incontinence?

The majority of children with this problem (in subgroups 1 and 2) have a degree of maturational delay in their ability to store and empty urine from their bladder. Recent studies have demonstrated bedwetting children (in subgroup 1) may produce more urine at night than other children. A truly serious problem that causes urinary incontinence is unusual and exists in only a small minority of these children (in subgroup 3).

Many children feel frustrated and embarrassed by this problem and this can certainly be emotionally stressful. However, in an otherwise emotionally healthy child this does not represent an underlying psychological problem (they don't need a psychiatrist!).

Whar tests are necessary?

1. Urinalysis and urine culture.

2. X-rays are not always indicated, unless an abnormality is noted on the initial physicians evaluation or there is a history of urinary tract infection.

3. A sonogram is a safe, non-invasive test to screen children with persistent problems for significant urinary tract abnormalities. This often proves reassuring for the parents and child.

4. Cystoscopic examination under anesthesia is very rarely indicated and urethral dilation (stretching) is not helpful.

What treatment may be helpful?

1. For children who wet only at night and void normally during the daytime (subgroup 1) patience and understanding are most important. A common sense approach includes: voiding just before bed- time, limiting fluid intake about 2 hours before going to sleep, and encouraging success with a positive reinforcement (reward) program. The use of punishment for wetting should always be avoided. The older (usually >8) more mature child may find therapy helpful. Treatment options that have proven to be effective include: the enuretic alarm system and DDAVP Nasal Spray, (we can provide additional information on these therapeutic options).

2. Children with wetting and daytime urinary symptoms (subgroup 2) often respond to medication, bladder anti-spasmodics. Many have a tendency towards constipation and this should be treated vigorously with high fiber diets, stool softeners, laxatives, suppositories and even enemas if necessary. Encourage regular bladder emptying. voiding by the clock every 3-4 hours during the day. For recurring urinary tract infections, antibiotic therapy is essential. Occasionally, for severe problems, bladder emptying may be improved by intermittent catheterizations or behavior modification therapy.

3. Children with anatomic abnormalities of their urinary tract (subgroup 3) may require surgery for correction. Those children with neurologic dysfunction of their lower urinary tract (spina bifida, spinal cord trauma) often need a combination of medications, intermittent catheterization SS and surgery.

[ top ]