Thursday, January 14, 2010

Pediatric Voiding Dysfunction: Current Evaluation and Management

From Urologic Nursing

Pamela Ellsworth, MD, FAAP, FACS; Anthony Caldamone, MD, FAAP, FAC

Voiding dysfunction and urinary incontinence in children is common. Both are associated with significant effects on quality of life and co-morbidities, including urinary tract infections (UTIs) and constipation. A thorough history, physical examination, and non-invasive evaluation are essential in determining the etiology. Interventions, such as behavioral therapy/biofeedback and pharmacologic therapies, are primary treatments. Prevalence rates, current evaluation, and management techniques are discussed in this article.


The prevalence of pediatric voiding dysfunction and daytime incontinence is difficult to determine due to varying definitions of urinary incontinence (UI) and different study designs. Furthermore, few studies have evaluated the prevalence of the different types of voiding dysfunction in children.
The prevalence of daytime wetting varies with age and gender. Overall rates vary from 1% to 10%. In 6 to 7-year-old children, the rate is between 2% to 4%, with a rapid decrease in subsequent years (Bloom, Seeley, Ritchey, & McGuire, 1993; Bower, Moore, Shepherd, & Adams, 1996).

Management Of Bowel Symptoms
Critical to the management of pediatric voiding dysfunction is the management of any underlying bowel dysfunction. It is important to identify those children with bowel dysfunction during the initial evaluation by asking questions regarding bowel habits (see Table 2 ). As with voiding dysfunction, a behavioral approach to the management of bowel dysfunction is important. Bowel regimens consisting of timed attempts at having a bowel movement are important. Children are encouraged to try to have a bowel movement after meals, taking advantage of the gastrocolic reflex. It is important that the child has enough fiber in his or her diet and is drinking enough fluids. Those children who fail to improve with simple dietary and behavioral measures will benefit from the addition of laxatives, such as polyethylene glycol 3350 (Miralax®).

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