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.

Urine Test: Calcium

What It Is

A urine calcium test is done to determine how much of the mineral calcium is being excreted in the urine by the kidneys.

Why It's Done

A urine test for calcium is often done to:

  • help determine the cause of kidney stones and other kidney diseases
  • detect overactivity or underactivity in the parathyroid glands (glands in the neck that produce hormones that help control the level of calcium in the blood)
  • monitor disorders of the kidney and diseases of calcium metabolism

Results may also point to digestive disorders that interfere with the small intestine's ability to absorb nutrients. The urine calcium test is usually used in combination with other tests to make a specific diagnosis.

Preparation

The doctor might prescribe a special diet with high or low levels of calcium for a few days before the test. Your child might need to temporarily stop taking specific drugs, such as antacids, that affect calcium levels in the urine.

The Procedure

Collecting the specimen should only take a few minutes. Your child will be asked to urinate into a clean sample cup in the doctor's office. If your child isn't potty trained and can't urinate into a cup, a small catheter may need to be inserted into the bladder to obtain the urine specimen.

Alternatively, a urine collection bag with adhesive tape on one end may be used to collect a sample from an infant. You'll clean your baby's genital area and then arrange the bag around the urinary opening. Once the bag is in place, secure it with the attached tape. You can then put a diaper on your baby. Check your baby's collection bag and remove it after your child has urinated, usually within an hour.

After you bring the sample to the lab, technicians will analyze it for calcium content.

What to Expect

Because the test involves normal urination, there shouldn't be any discomfort as long as your child can provide a urine specimen.

Getting the Results

The results of the urine calcium test are usually available in 1-2 days. Your doctor will go over the results with you and explain what they mean. If abnormalities are found, your doctor may may want to do further tests to make a specific diagnosis.

Risks

Infants may occasionally experience skin irritation from the adhesive tape on the collection bag. If a catheter is used to obtain the urine, it may cause temporary discomfort. If you have any questions or concerns about this procedure, talk to your doctor.

Helping Your Child

Urine collections are usually painless. Explaining how the test will be conducted and why it's being done can help ease any fear. Make sure your child understands that there should be no foreign matter, such as toilet paper or hair, in the sample.

If You Have Questions

If you have questions about the urine calcium test, speak with your doctor.

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