Voiding Dysfunction

About Voiding Dysfunction

Enuresis (involuntary peeing that is abnormal for a child’s age) is one of the most common types of voiding dysfunction, and includes both nighttime wetting (nocturnal enuresis) and daytime wetting (diurnal enuresis).

Children often exhibit posturing behaviors, (pee-pee dance, cross their legs, squat). Although it is normal for very young children to do this as they are learning to toilet train, sometimes these symptoms can continue even as the child grows older.

Voiding dysfunction may cause a child to run to the bathroom frequently. Children may have to urinate every 10-30 minutes or in less severe cases, every 1-3 hours. They will often urinate small volumes or feel the urge to urinate again soon after voiding.

 
What causes voiding dysfunction?

The bladder is a muscle that stores urine, and it empties by contracting the muscle. A normally functioning bladder only contracts when it is at full capacity (the normal amount of urine that it can hold comfortably) and it is time to void.

When the bladder is irritable or overactive, it tends to contract at will, regardless of how much urine it is holding. It’s important for you to know that what your child is feeling is real and they do not have conscious control over it.

Constipation often contributes to these symptoms of voiding dysfunction. Your child may have mild to moderate constipation without complaining and the rectum and colon can stretch to accommodate the stool. This causes pushing on the bladder resulting in urgency/frequency, a decrease in capacity, and incomplete emptying.

 
How is voiding dysfunction diagnosed and treated?
In diagnosing overactive bladder, your Nemours pediatric urology team will do few things to rule out infection, or any serious, but rare, disorder:
  • thorough health history
  • physical exam
  • urinalysis and urine culture
  • renal and bladder ultrasound to check for bladder and kidney abnormalities
  • urine flow study (which uses a special toilet to measure your child’s voiding pattern)
  • post void residual (similar to the ultrasound, this is done after voiding to make sure your child is able to empty his or her bladder completely)

We will also ask you to keep a Voiding/Bowel Diary (PDF). This diary provides invaluable information that helps our Nemours pediatric urologists assess your child’s exact voiding problem. It will tell us how frequently your child is voiding, how much their bladder is letting them hold, if there is wetting and when this wetting occurs in relation to voiding. It will also allow us to better assess their stooling pattern and assure there is no constipation.

Most children will outgrow the symptoms of overactive bladder on their own without intervention, if there is no abnormality present. Your Nemours urologist may recommend some medications to relax the bladder depending on your preference and the age of your child.

Addressing your child’s symptoms of overactive bladder and wetting can dramatically improve your child’s quality of life. We often see children’s nighttime bedwetting improve after their daytime symptoms are addressed.

Ultrasound: Renal (Kidneys, Ureters, Bladder)

What It Is

A renal ultrasound is a safe and painless test that uses sound waves to make images of the kidneys, ureters, and bladder.

The kidneys are a pair of bean-shaped organs located toward the back of the abdominal cavity, just above the waist. They remove waste products from the blood and produce urine. The ureters are thin tubes that carry the urine from the kidneys to the bladder.

During the examination, an ultrasound machine sends sound waves into the kidney area and images are recorded on a computer. The black-and-white images show the internal structure of the kidneys and related organs.

Why It's Done

Doctors order renal ultrasounds when there's a concern about certain types of kidney or bladder problems. Renal ultrasound tests can show:

  • the size of the kidneys
  • signs of injury to the kidneys
  • abnormalities present since birth
  • the presence of blockages or kidney stones
  • complications of a urinary tract infection (UTI)
  • cysts or tumors

Preparation

Usually, you don't have to do anything special to prepare for a renal ultrasound, although the doctor may ask that your child not eat or drink anything for several hours before the test.

You should tell the technician about any medications your child is taking before the test begins.

Procedure

The renal ultrasound will be done in the radiology department of a hospital or in a radiology center. Parents are usually able to accompany their child to provide reassurance and support. Your child will be asked to change into a cloth gown and lie on a table. The room is usually dark so the images can be seen clearly on the computer screen.

A technician (sonographer) trained in ultrasound imaging will spread a clear, warm gel on your child's abdomen over the kidney area. This gel helps with the transmission of the sound waves. The technician will then move a small wand (transducer) over the gel. The transducer emits high-frequency sound waves and a computer measures how the sound waves bounce back from the body. The computer changes those sound waves into images to be analyzed.

Sometimes a doctor will come in at the end of the test to meet your child and take a few more pictures. The procedure usually takes less than 30 minutes.

closeUp_ultrasound_illustration

What to Expect

The renal ultrasound test is painless. Your child may feel a slight pressure on the abdomen as the transducer is moved over it. You'll need to tell your child to lie still during the procedure so the sound waves can reach the area effectively. The technician may ask your child to lie in different positions or hold his or her breath briefly.

Babies might cry in the ultrasound room, especially if they're restrained, but this won't interfere with the procedure.

ultrasound_illustration

Getting the Results

A radiologist (a doctor who is specially trained in reading and interpreting X-ray and ultrasound images) will interpret the ultrasound results and then give the information to the doctor. You and your doctor will go over the results. If the test results appear abnormal, your doctor may order further tests.

In an emergency, the results of an ultrasound can be available within a short period of time. Otherwise, results are usually ready in 1-2 days. In most cases, results can't be given directly to the patient or family at the time of the test.

Risks

No risks are associated with a renal ultrasound. Unlike X-rays, radiation isn't involved with this test.

Helping Your Child

Some younger children may be afraid of the machinery used for the ultrasound test. Explaining in simple terms how the renal ultrasound test will be conducted and why it's being done can help ease your child's fears. You can tell your child that the equipment takes pictures of his or her kidneys.

Encourage your child to ask the technician questions and to try to relax during the procedure, as tense muscles can make it more difficult to get accurate results.

If You Have Questions

If you have questions about the renal ultrasound, speak with your doctor. You can also talk to the technician before the exam.

Reviewed by: Yamini Durani, MD
Date reviewed: March 2012