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: Creatinine

What It Is

Creatinine is a waste product that the muscles produce at a steady rate as part of normal daily activity. The bloodstream carries creatinine to the kidneys, which filter it out of the blood, and it is passed out of the body in urine.

A urine creatinine test measures the amount of creatinine in the urine. It can be done on its own or with other tests that determine the relative amounts of other substances being excreted in the urine.

Why It's Done

Healthy kidneys filter the blood to rid it of waste products that the body can't use. Low levels of creatinine in the urine may point to a kidney disease, certain muscular and neuromuscular disorders, or an obstruction of the urinary tract. If test results are abnormal, other tests will be done to make a specific diagnosis.

A creatinine clearance test measures the blood creatinine level as well as how much creatinine is being passed in the urine over several hours. This gives doctors information about how well the kidneys are functioning.

A doctor may order a urine creatinine test in combination with other urine tests even when no kidney dysfunction is suspected. Because creatinine is filtered out at a fairly steady rate, doctors compare the creatinine level with levels of other substances in the urine to determine if they're being excreted at a normal rate.

Preparation

Your child might need to temporarily stop taking certain drugs that affect the urine's creatinine levels and might be asked to not eat large quantities of meat in the day or two before the test.

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.

If you collect the specimen at home, follow any storage and transportation instructions the lab gives you.

For a creatinine clearance test, you'll need to collect all the urine your child passes over a period of several hours (usually 24 hours). This usually involves first getting a special container from the lab in which to collect the urine, plus specific instructions about how to collect and store the timed urine sample.

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

In general, the results of the urine creatinine test are available within a day or two. Your doctor will go over the results with you and explain what they mean. If abnormalities are found, further tests may be needed.

Risks

No risks are associated with taking a urine creatinine test.

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

Collecting the specimen for a urine creatinine test is 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 creatinine test, speak with your doctor.

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