Voiding dysfunction is a broad term that is used to describe the condition where there is a poor coordination between the bladder muscle and the urethra. This will result in incomplete relaxation or over-activity of the pelvic floor muscles during voiding.
Types of Voiding Dysfunction and their Symptoms:
- Overactive Bladder (OAB) : Children with OAB may feel an urgent need to urinate even when their bladder may not be full, and may use the bathroom more than 10 times per day or about every hour. Most children with OAB will have urinary tract infections (UTIs) and urinary incontinence, and sometimes these symptoms will be continued even after the UTI is treated. Some children may (unsuccessfully) try to “hold it” by crossing their legs or using other physical maneuvers. OAB is the most common type of voiding dysfunction and occurs in about 22% of children between the ages of 5 - 7 years old.
- Dysfunctional Voiding : With this type of dysfunction, the muscles which control the flow of urine out of the body don’t relax completely, and the bladder never fully empties. This may cause a range of symptoms such as daytime wetting, night wetting, a feeling that the bladder is always full, urgency, and straining to urinate. With severe cases of dysfunctional voiding, children may develop symptoms similar to those of a neurogenic bladder and be at higher risk for complications such as kidney infection and disease.
- Underactive Bladder : Children with an underactive bladder will urinate less than 3 times a day, or will be able to go for more than 12 hours without urinating. These children have to strain to urinate because the bladder muscle itself will be “weak” and doesn’t respond to the brain’s signal that it is time to go. Accidental wetting with underactive bladder is caused by the bladder becoming too full and overflowing.
Void Dysfunction treatment
- Overactive Bladder (OAB) : The first step in treating OAB is to put the child on a schedule where they use the bathroom every 2-3 hours while they are awake. Children are encouraged to urinate before the sense of urgency develops to help “retrain” the bladder. After a few months on the voiding schedule, physicians may prescribe medications that can help them reduce the frequency and feeling of urgency.
- Dysfunctional Voiding : Most treatments for dysfunctional voiding emphasize on retraining the brain and helping the bladder relax. Children are taught that normal urination does not involve squeezing the abdominal muscles, but instead, relaxing muscles in the pelvis and bladder. A timed voiding schedule is the important part of bladder retraining. Biofeedback and Kegel exercises (pelvic floor relaxation and contraction) may also effectively help manage dysfunctional voiding. The physician may also be prescribed medicine that will help the bladder relax.
- Underactive Bladder : Treatment for underactive bladder is primarily behavioral. Children are allowed on a timed bathroom schedule to go whether or not they feel the urge to urinate. Medications that relax the bladder can also be helpful. Children with very large capacity bladders who aren’t able to urinate may need short term catheterization.