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Evaluation and diagnosis of bladder dysfunction in children

Kenneth G Nepple, MD
Christopher S Cooper, MD, FACS, FAAP
Section Editor
Laurence S Baskin, MD, FAAP
Deputy Editor
Melanie S Kim, MD


Bladder dysfunction, also referred to as voiding dysfunction, is a general term to describe abnormalities in either the filling and/or emptying of the bladder. It is a common problem in children and constitutes up to 40 percent of pediatric urology clinic visits [1]. In some children, bladder dysfunction is a component of bowel and bladder dysfunction, previously referred to as dysfunctional elimination, which involves abnormalities in both bladder and bowel emptying.

Daytime urinary incontinence, a common feature of bladder dysfunction, can cause major stress in school-age children [2,3], and negatively impact a child's self-esteem [4]. Thus, it is desirable to identify and treat affected school-age children as early as possible.

The evaluation of non-neurologic bladder dysfunction in children will be reviewed here. The etiology and clinical features of bladder dysfunction in children are discussed separately. The clinical features, evaluation, and management of children with bladder dysfunction due to myelomeningocele also are discussed separately. (See "Etiology and clinical features of bladder dysfunction in children" and "Management of bladder dysfunction in children" and "Urinary tract complications of myelomeningocele (spina bifida)".)


The goals of the evaluation for suspected bladder dysfunction in children are to:

Determine whether the child has an abnormality in either filling and/or emptying of the bladder.


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Literature review current through: Sep 2016. | This topic last updated: May 18, 2016.
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  1. Farhat W, Bägli DJ, Capolicchio G, et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 2000; 164:1011.
  2. Anderson GE, Jimerson SR, Whipple AD. Student Ratings of Stressful Experiences at Home and School: Loss of a Parent and Grade Retention as Superlative Stressors. Journal of Applied School Psychology 2005; 21:1.
  3. Ollendick TH, King NJ, Frary RB. Fears in children and adolescents: reliability and generalizability across gender, age and nationality. Behav Res Ther 1989; 27:19.
  4. Hägglöf B, Andrén O, Bergström E, et al. Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. Eur Urol 1998; 33 Suppl 3:16.
  5. Akbal C, Genc Y, Burgu B, et al. Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol 2005; 173:969.
  6. Nelson CP, Park JM, Bloom DA, et al. Incontinence Symptom Index-Pediatric: development and initial validation of a urinary incontinence instrument for the older pediatric population. J Urol 2007; 178:1763.
  7. Schneider D, Yamamoto A, Barone JG. Evaluation of consistency between physician clinical impression and 3 validated survey instruments for measuring lower urinary tract symptoms in children. J Urol 2011; 186:261.
  8. Burgers RE, Mugie SM, Chase J, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children's Continence Society. J Urol 2013; 190:29.
  9. von Gontard A, Lettgen B, Olbing H, et al. Behavioural problems in children with urge incontinence and voiding postponement: a comparison of a paediatric and child psychiatric sample. Br J Urol 1998; 81 Suppl 3:100.
  10. Duel BP, Steinberg-Epstein R, Hill M, Lerner M. A survey of voiding dysfunction in children with attention deficit-hyperactivity disorder. J Urol 2003; 170:1521.
  11. Robson WL, Jackson HP, Blackhurst D, Leung AK. Enuresis in children with attention-deficit hyperactivity disorder. South Med J 1997; 90:503.
  12. von Gontard A, Baeyens D, Van Hoecke E, et al. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 2011; 185:1432.
  13. Wolfe-Christensen C, Veenstra AL, Kovacevic L, et al. Psychosocial difficulties in children referred to pediatric urology: a closer look. Urology 2012; 80:907.
  14. Wolfe-Christensen C, Guy WC, Mancini M, et al. Evidence of Need to Use Self-Report Measures of Psychosocial Functioning in Older Children and Adolescents with Voiding Dysfunction. J Urol 2016; 195:1570.
  15. Wolfe-Christensen C, Manolis A, Guy WC, et al. Bladder and bowel dysfunction: evidence for multidisciplinary care. J Urol 2013; 190:1864.
  16. Hoebeke P, Van Laecke E, Raes A, et al. Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction. BJU Int 1999; 83:294.
  17. Ellsworth PI, Merguerian PA, Copening ME. Sexual abuse: another causative factor in dysfunctional voiding. J Urol 1995; 153:773.
  18. Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006; 176:314.
  19. Chang SJ, Yang SS. Variability, related factors and normal reference value of post-void residual urine in healthy kindergarteners. J Urol 2009; 182:1933.
  20. Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society. J Urol 2014; 191:1863.
  21. Jequier S, Rousseau O. Sonographic measurements of the normal bladder wall in children. AJR Am J Roentgenol 1987; 149:563.
  22. Yeung CK, Sreedhar B, Leung YF, Sit KY. Correlation between ultrasonographic bladder measurements and urodynamic findings in children with recurrent urinary tract infection. BJU Int 2007; 99:651.
  23. Allen HA, Austin JC, Boyt MA, et al. Evaluation of constipation by abdominal radiographs correlated with treatment outcome in children with dysfunctional elimination. Urology 2007; 69:966.
  24. Arikan N, Soygür T, Selçuki M, et al. Role of magnetic resonance imaging in children with voiding dysfunction: retrospective analysis of 81 patients. Urology 1999; 54:157.
  25. Wraige E, Borzyskowski M. Investigation of daytime wetting: when is spinal cord imaging indicated? Arch Dis Child 2002; 87:151.
  26. Van Arendonk KJ, Austin JC, Boyt MA, Cooper CS. Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder. Urology 2006; 67:1049.
  27. Nelson JD, Cooper CS, Boyt MA, et al. Improved uroflow parameters and post-void residual following biofeedback therapy in pediatric patients with dysfunctional voiding does not correspond to outcome. J Urol 2004; 172:1653.
  28. Allen HA, Austin JC, Boyt MA, et al. Initial trial of timed voiding is warranted for all children with daytime incontinence. Urology 2007; 69:962.
  29. Yamanishi T, Yasuda K, Murayama N, et al. Biofeedback training for detrusor overactivity in children. J Urol 2000; 164:1686.
  30. Van Arendonk KJ, Knudson MJ, Austin JC, Cooper CS. Improved efficacy of extended release oxybutynin in children with persistent daytime urinary incontinence converted from regular oxybutynin. Urology 2006; 68:862.
  31. Kaufman MR, DeMarco RT, Pope JC 4th, et al. High yield of urodynamics performed for refractory nonneurogenic dysfunctional voiding in the pediatric population. J Urol 2006; 176:1835.
  32. Bael A, Lax H, de Jong TP, et al. The relevance of urodynamic studies for Urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J Urol 2008; 180:1486.
  33. Herndon CD, Decambre M, McKenna PH. Interactive computer games for treatment of pelvic floor dysfunction. J Urol 2001; 166:1893.
  34. Wen JG, Tong EC. Cystometry in infants and children with no apparent voiding symptoms. Br J Urol 1998; 81:468.
  35. Chandra M, Maddix H, McVicar M. Transient urodynamic dysfunction of infancy: relationship to urinary tract infections and vesicoureteral reflux. J Urol 1996; 155:673.
  36. Schulman SL, Quinn CK, Plachter N, Kodman-Jones C. Comprehensive management of dysfunctional voiding. Pediatrics 1999; 103:E31.
  37. Hoebeke P, Van Laecke E, Van Camp C, et al. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001; 87:575.
  38. Yeung CK, Godley ML, Duffy PG, Ransley PG. Natural filling cystometry in infants and children. Br J Urol 1995; 75:531.
  39. Nijman RJ. Classification and treatment of functional incontinence in children. BJU Int 2000; 85 Suppl 3:37.