Pediatric Voiding Dysfunction

Pediatric Voiding Dysfunction Symptoms 

Pediatric voiding dysfunction can cause a range of symptoms including: 

• Persistent nighttime wetting 

• Daytime wetting 

• Incontinence 

• Urinary frequency 

• Urinary urgency 

• Recurrent urinary tract infections (UTIs) 

• Infrequent voiding 

• Straining to urinate or the need to “push” to urinate 

• Constipation 

• Hematuria, or blood in the urine 

• Weak or interrupted stream 

Causes & Risk Factors for Pediatric Voiding Dysfunction 

There are many causes for why children may experience voiding dysfunction. These include: 

• Urinary tract infections (UTIs) 

• Constipation 

• Emotional or physical stress (at home, school, etc.) 

• Behavioral influences (i.e., holding in urine, rushing in the bathroom, etc.) 

Some specific conditions that may cause pediatric voiding dysfunction include: 

• Congenital or acquired spinal cord abnormalities 

• Neurologic disorders 

• Mechanical blockages like urethral valves 

• Bladder instability 

• Abnormal pelvic floor activity for unknown reasons 

The most severe risk is degradation of kidney function from abnormally high bladder pressure and/or recurrent urinary tract infections. Degradation of quality of life is an extremely critical component in treating voiding dysfunction in children. 

Prevention Strategies for Pediatric Voiding Dysfunction 

While pediatric voiding dysfunction is not always preventable if caused by other conditions, some ways to decrease the risk include: 

• Establishing bathroom schedules 

• Ensuring the bladder is completely empty 

• Avoiding bladder irritants especially before bedtime 

Evaluation and Treatment for Pediatric Voiding Dysfunction 

A number of tests are performed to do a comprehensive urodynamics assessment, which determines the status of the kidneys, bladder and urethra. These tests provide valuable information about bladder capacity, voiding and bladder pressure. 

• Uroflow with and without electromyography (EMG): A non-invasive study evaluating the volume and rate of urine flow per second. After completion, an ultrasound of the bladder is performed to determine if the child is fully emptying their bladder. This test evaluates: 

o   Stability of the bladder 

o   Peak urinary flow 

o   Bladder capacity 

o   Ability to empty the bladder 

• Simple Urodynamics: A study evaluating what the uroflow evaluates as well as: 

o   How much pressure builds in the bladder as it fills 

o   Whether the bladder is having involuntary contractions or is contracting normally 

o   How full the bladder is when there is an urge to void 

• Videourodynamics: A study that integrates imaging technology with simple urodynamics to determine if there are any anatomic abnormalities in the bladder and urethra. This study adds contrast fluid to the fluid filling the bladder to image the shape of the bladder and urethra while the bladder is filling, having contractions and voiding. This study can also help determine if there are any other anatomic considerations like vesicoureteral reflux (VUR) or diverticula. 

If the evaluation indicates a pediatric voiding dysfunction, patients may be first managed with non-surgical treatment options. If those treatments are ineffective, surgical intervention may be required. 

Non-surgical treatment options include: 

• Biofeedback: A non-invasive technique to that teaches children how to control, relax and contract the pelvic floor muscles 

• Behavior modifications: Techniques such as bladder retraining, pelvic floor therapy, or dietary restrictions  

 Surgical treatment options include: 

• Ureteral reimplant surgery 

• Bladder augmentation surgery 

• A combination of the above procedures 

Would you like an appointment? 

To request an appointment or learn more about our program, please call our office at (212) 746-5337. Our phone staff is available Monday through Friday, 9 AM to 5PM (EST). 

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