Voiding disorders in children

What is it?

There are many problems with urination. One of the most common is enuresis – an involuntary and unconscious loss of urine during sleep. Most children are able to stay dry by the age of 3. Up to 4 years of age, enuresis is still considered normal, but if it occurs at the age of 5 or older, then it is time to solve the problem.

Causes and risk factors

Enuresis affects 15-20% of 5-year-olds, 5% of 10-year-olds, and 1% of 15-year-olds.

Usually in the same family you can find a person who suffered from enuresis in the past, but a direct genetic transmission of the disease has not been proven.

There are many causes of urinary disorders:

·      urinary tract infections, which are the most common cause of urinary disorders in general;

·      minor anatomical abnormalities of the bladder or urethra, such as congenital narrowings of the urethra called posterior urethral valves;

·      “immaturity” in the functioning of the sphincters of the bladder and urethra;

·      stones, especially in older children.

A frequent cause of enuresis is immaturity of the bladder, which empties uncontrollably. In a large percentage of children, enuresis is a manifestation of urological pathology.

It is often feared that enuresis is an expression of some psychological problem that the child cannot talk about. In fact, it has been found that it is not a possible psychological problem that is the cause, but rather the opposite: it is enuresis that generates psychological resentment related to the anxiety the child feels toward his or her peers.

It has also been found that eliminating this disorder leads to the resolution of these problems.

Which are the symptoms?

Other urinary disorders that a child may complain of are as follows:

·      unspecified difficulty urinating (dysuria);

·      pain when urinating (stranguria);

·      sudden and strong urge to urinate, without being able to hold it until reaching the toilet, followed by involuntary loss of urine (imperative urination);

·      frequent urge to urinate with little urine output (pollakiuria).

How is it diagnosed?

In the presence of a urination disorder, a visit to a pediatric urologist can assess the presence of the disorder and determine its severity.

It is then necessary to perform

·      urinalysis with urine culture: to assess the actual presence of bacteria in the urine, the number and type of bacteria detected;

·      ultrasound examination of the urinary tract to check for anatomical abnormalities;

·      in addition, urinary cystourethrography should be performed in selected cases. This examination involves inserting a catheter into the bladder, filling the bladder with contrast agent, and taking several x-rays while the bladder is filling and emptying. It is performed on an outpatient basis and allows you to study the anatomy and function of the bladder and urethra. It is the first examination to be performed when bladder reflux, immature bladder function or congenital narrowing of the urethra is suspected.

Suggested exams

How is it treated?

Treatment of various urinary disorders depends on the pathology that caused the disorder.

In the case of:

·         anatomical anomalies - surgical correction of the anomaly is performed;

·         urinary tract infections - medical treatment is based on the use of medications to “relax” the bladder or reduce the amount of urine excreted during the night;

·         stones - treatment consists mainly of water therapy at home: by drinking heavily, the child can remove the stone spontaneously. If the stone cannot be removed, lithotripsy can be used. Results vary and depend on the size of the stone. Repeated treatment may be necessary.

In the case of enuresis, some spontaneous resolution may occur as the child grows older: between the ages of 5 and 9, 14 out of 100 children spontaneously recover in each year of life.

Suggested procedures

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