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Pediatric Urology pp 35–51Cite as

Bladder and Bowel Dysfunction

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Abstract

Primary goals in diagnosis and treatment of functional bladder disorders:

  1. 1.

    Stop urinary incontinence.

  2. 2.

    Reduce associated UTI.

A secondary aim is to reduce behavior dysfunction associated with incontinence.

Summary of evidence for these goals:

  • Several studies indicate placebo results in cure or improvement of symptoms in approximately 40 % of children with voiding dysfunction.

  • There is little evidence that biofeedback, AC, or alpha-blockers are more effective than urotherapy or placebo to reduce diurnal incontinence. One trial demonstrated an alarm watch is better than timed voiding.

  • Several small series indicate botulinum A injection in patients with refractory overactive bladder (OAB) stops incontinence in approximately 50 %, with an average response duration of 6 months.

  • Two small series report transcutaneous electrical nerve stimulation (TENS) or Interstim devices improve symptoms in children refractory to other treatments.

  • While urinary symptoms improve during treatment for constipation, one randomized controlled trial (RCT) found no added benefit to polyethylene glycol versus placebo, and another study reported improvement in diurnal incontinence in patients both with and without improved stooling.

  • Our review found no evidence that the voiding dysfunction treatment reduces UTI. Two studies reported recurrent UTI within 1 year in approximately 40 % of females despite various treatments (urotherapy, biofeedback, AC).

  • While children with voiding dysfunction also have increased behavioral problems, our review found only one study that reports impact of therapy, finding decreased problems in those with dysfunctional voiding but not urge syndrome. One case–control study found improved self-esteem in patients after incontinence therapy.

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Authors and Affiliations

  1. Department of Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, 1935 Medical District Drive, MS F4.04, Dallas, TX, 75235, USA

    Nicol C. Bush M.D., M.S.C.S.

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  1. Nicol C. Bush M.D., M.S.C.S.
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Correspondence to Nicol C. Bush M.D., M.S.C.S. .

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Editors and Affiliations

  1. Children’s Medical Center Dallas, Department of Pediatric Urology, University of Texas Southwestern Medical, N/A, Dallas, 75235, Texas, USA

    Warren T. Snodgrass

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Bush, N.C. (2013). Bladder and Bowel Dysfunction. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_3

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  • DOI: https://doi.org/10.1007/978-1-4614-6910-0_3

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