urinary system

What is voiding dysfunction?

Voiding dysfunction is a term that means your child’s bladder is not emptying — he or she is not urinating — normally or fully.

What causes voiding dysfunction in children?

Voiding dysfunction can be caused by:

  • Behavioral problems or poor habits (infrequent urination, poor toileting habits, having too much fun or being too busy to break to go to the bathroom, being afraid of urinating due to a past painful urinary tract infection, attention deficit disorder, psychological or emotional stress)
  • Congenital (born with) urinary tract problems
  • Acquired problems of the urinary tract (such as those caused by tumors or trauma)
  • Central nervous system diseases and conditions that affect the urinary tract (such as 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 (diabetes, chronic kidney disease)
  • Genetic diseases that affect the urinary tract (Ochoa syndrome, Williams syndrome)
  • Infections or irritations that affect the urinary tract (such as urinary tract infections, urethritis, pinworms, foreign body)

Other causes can include stress incontinence (the involuntary loss of urine during actions such as 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 go immediately)
  • Urinary hesitancy, dribbling, intermittent urine flow and/or straining at urination
  • Pain in the back, lower side, or abdomen
  • Returning 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 their complete soaking. 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: 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 slight wetting of underwear.
  • 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.

What is the difference between voiding dysfunction and overactive bladder?

Overactive bladder is a condition in which the large bladder muscle (detrusor) contracts involuntarily, causing symptoms including urinary frequency, urgency and or/or urge incontinence. Urinary incontinence is the involuntary leakage of urine. Urinary incontinence can range from the occasional leakage of urine to a complete inability to hold any urine and can be one symptom of overactive bladder.

How is voiding dysfunction diagnosed?

If your child is experiencing a voiding problem, he or she will be referred to pediatric urology. Other members of the team might include behavioral psychologists, pediatricians, family practice physicians, and nurse practitioners.

Medical and social histories. The provider will take a history of your child's urination patterns and may ask you to create a voiding diary (to track frequency and volume). In addition, the doctor will ask about your child's bowel function (frequency, volume, caliber, staining, abdominal pain).

Physical and neurology exam. The provider will then conduct a thorough physical exam, including examination of the back, rectum and genitalia (for anatomic abnormalities). The neurologic exam will include careful attention to the lower extremities, including tone, strength, sensation, and reflexes.

Lab tests. A urinalysis, urine culture, and blood test (i.e., serum creatinine level) are conducted to gain an initial view of kidney function.

Other specialized tests. Certain radiologic and urodynamic tests (a test that provides details of bladder storage and emptying functions) may be ordered to help confirm the diagnosis and to document treatment effects. Other tests that may be ordered include:

  • Renal and bladder ultrasound: Identifies obstructions in the urinary pathway and the capacity of the bladder
  • Magnetic resonance image (MRI) of the lower spine: Identifies any spinal cord abnormalities
  • Voiding cystourethrogram (VCUG): Special type of X-ray evaluates possible vesicoureteral reflux (the backward flow of urine from the bladder to the kidneys). This test is most often conducted in children with a history of urinary tract infections that are accompanied by a fever.
  • Uroflow: Your child urinates into a special toilet that is used to get more information about the bladder and how he or she urinates.

How is voiding dysfunction treated?

Treatment options are based on the underlying cause of the voiding dysfunction, severity of symptoms, and findings from the physical, laboratory, and medical test results. Treatment may consist of one or more of the following approaches. Your providers will discuss which specific method(s) will be tried with your child.

  • Managing constipation
  • Eliminating bladder irritants
  • Treating urinary tract infections (UTI)
  • Incorporating behavioral interventions: Behavioral interventions are tools and techniques children and their parents can use to gain control over voiding dysfunction. The goals of behavioral interventions are to help your child remain dry and empty the bladder effectively.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit Cleveland Clinic: Health or Cleveland Clinic Florida. This document was last reviewed on: 5/27/2016