Management of bladder dysfunction in children
- Kenneth G Nepple, MD, FACS
Kenneth G Nepple, MD, FACS
- Associate Professor of Urology
- University of Iowa College of Medicine
- Christopher S Cooper, MD, FACS, FAAP
Christopher S Cooper, MD, FACS, FAAP
- Professor of Urology
- University of Iowa College of Medicine
- Section Editors
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr, MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
Bladder dysfunction, previously 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 . In some children, bladder dysfunction is a component of bowel and bladder dysfunction, previously referred to as the dysfunctional elimination syndrome, which involves abnormalities in both bladder and bowel function.
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 . Thus, it is desirable to identify and treat these children as early as possible.
The management of bladder dysfunction in children will be reviewed here. The etiology, clinical features, evaluation, and diagnosis of bladder dysfunction and management of nocturnal enuresis in children are discussed separately. (See "Etiology and clinical features of bladder dysfunction in children" and "Evaluation and diagnosis of bladder dysfunction in children" and "Nocturnal enuresis in children: Management".)
The management of a child with bladder dysfunction is primarily directed at improving symptoms and avoiding renal damage. Therapeutic considerations include the underlying cause of bladder dysfunction including behavioral and neurodevelopment etiologies, the age of the patient, symptom duration and severity, the motivation and attention span of the patient and family, and the presence of potential risk factors for renal injury such as recurrent urinary tract infections or vesicoureteral reflux. (See "Etiology and clinical features of bladder dysfunction in children", section on 'Dysfunctional voiding'.)
Data on effective treatment of bladder dysfunction in children are limited because of the following flaws in study design:
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- Our approach
- CONSERVATIVE MANAGEMENT
- Voiding behavior modification
- Treatment of constipation
- Other measures
- DIRECTED THERAPY
- PHARMACOLOGIC THERAPY
- Anticholinergic agents
- - Oxybutynin
- Side effects
- - Other anticholinergic agents
- - Our approach
- Beta3-adrenoceptor agonists
- Alpha adrenergic receptor antagonists
- OTHER TREATMENTS
- Biofeedback and pelvic floor muscle training
- - Indications
- Electrical stimulation therapy (neuromodulation)
- - Indications
- Botulinum toxin
- LONG-TERM PROGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS