urinary system

What is voiding dysfunction in children?

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

Are there different types of voiding dysfunction that occur in children?

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.

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 in children?

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 or three or fewer voids in a 24-hour period
  • Constipation and fecal soiling

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