Tackling Voiding Dysfunction in Childhood

Voiding dysfunction is a broader term used to describe poor coordination between the bladder muscles and urethra.

Voiding Dysfunction in Childhood

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Voiding dysfunction is a broader term used to describe poor coordination between the bladder muscles and urethra. Children with voiding dysfunction do not empty their bladder normally and frequently develop urinary tract infections. Although the exact cause is unknown, adverse childhood experiences and neuropsychiatric disorders increase risk of developing voiding dysfunction. Studies show that children with Attention Deficit Hyperactivity Disorder (ADHD) also have a higher incidence of voiding disorders. Other symptoms include constipation, bowel episodes, painful urination, frequent urge to pee, blood in urine and back pain.

Voiding dysfunction is classified into three main types: overactive bladder, dysfunctional voiding, and underactive bladder.

Children with overactive bladder develop a sense of urgency to empty the bladder even when it is not full. They take over 10 or more loo breaks daily or hourly loo breaks during the day. Around 22% children between ages 5-7 years suffer from overactive bladder.

In dysfunctional voiding, the sphincter muscles don’t relax completely, and the bladder is never completely empty. It occurs with other symptoms like daytime wetting, nocturnal wetting, urgency, etc. Severe dysfunctional voiding increases risk of kidney disease.

Children with underactive bladders urinate under three times a day, sometimes even 12 hours apart. Urination is often strenuous as the bladder muscles are weak and don’t respond normally to brain signals.

Management Of Voiding Dysfunction

Timely management is key to a successful outcome of voiding dysfunction. Overactive bladder can be treated by having a loo break schedule, wherein children take bathroom breaks every 2 -3 hours before the sense of urgency develops. After a few months of training, medicines can be prescribed to avoid urgency.

Children with dysfunctional voiding are taught that normal urination does not need contraction of muscles. Rather it requires relaxation of sphincter muscles. Biofeedback and Kegel exercises along with medicines may be prescribed to relax the bladder. Surgery may be required in rare cases. Some children may require short term catheterisation. Apart from specific treatments, treating accompanying symptoms like constipation is also helpful.

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When diagnosed accurately, voiding dysfunction is treatable. Children should never be punished or ridiculed for bed wetting. It is an involuntary condition and irresponsible behaviour of elders can have an ill effect on the psychology of the child who is already undergoing tough times.