Pediatric Voiding Dysfunction Program FAQs
What should I expect at our first appointment?
During the first visit, a provider will perform a thorough history and physical exam. Any medications or medical conditions that may relate to voiding dysfunction will be discussed.
In addition, we will ask about your child’s voiding habits including how often they go to the bathroom, how often they have accidents, whether they have urinary tract infections, and how often they have bowel movements. We will discuss any diagnostic tests that may be needed and treatment recommendations as well as follow up plan.
What tests are commonly ordered?
Depending on your child’s history and exam we may recommend one or more of the following tests after the first visit or in subsequent visit:
- Renal bladder ultrasound – a painless test that uses sound waves to look for abnormalities of the kidney and bladder.
- Urine analysis – a test that looks for signs of infection in the urine. Results are available during your visit.
- Uroflow – a non-invasive test that studies your child’s bladder function. Your child will be asked to urinate on a special seat. The rate and amount of urine flow as well as the pattern of flow will be recorded. An ultrasound will be used to see how much urine is left in the bladder, this is called the post void residual (PVR).
- X-ray of the abdomen – this test is sometimes used to evaluate for constipation. We have found that even in children with seemingly regular bowel movements can be constipated or have stool retention. If constipation or stool retention is present and treated, the voiding dysfunction can improve dramatically.
- Video urodynamic study
- Voiding cystourethrogram (VCUG) – this test is usually reserved for children with recurrent urinary tract infections or those with abnormalities on renal bladder ultrasound. A small catheter is placed into the bladder, the bladder is filled with a contrast liquid, and pictures are taken of the bladder during filling and voiding. Conditions that contribute to urinary tract infections such as vesicoureteral reflux (VUR) can be detected.
- MRI of the spine – in some children with concerning symptoms or findings on initial tests or who are refractory to initial management plan, we may recommend evaluation of the spinal cord to ensure that the nerves to the bladder from the spinal cord are normal. There are rare conditions such as tethered cord that can cause voiding dysfunction symptoms.
What are the treatment options?
Depending on the results of our evaluation, we may recommend some of the following treatments:
- Modification of voiding habits – this treatment is the most common treatment recommended initially and is effective in the majority of children. Typically this involves urinating on a schedule, attempting to urinate again after finishing (called double voiding), modifications of posture during voiding, and taking time in the bathroom.
- Treatment of constipation or stool retention – This is recommended at the same time as modification of voiding habits. Because constipation or stool retention is such a common cause of voiding dysfunction, we want to ensure that it is adequately treated. Therefore, we recommend dietary changes and stool softeners to ensure your child has one to two daily soft bowel movements.
- Biofeedback – The goal of biofeedback to for your child to learn how to relax their pelvic muscles and empty their bladder completely. Biofeedback consists of up to 6 weekly session with a specially trained nurse. During each session, sticker-like electrodes are placed over the pelvic floor muscles. Using a computer program that is like a game, your child will learn how to contract and relax the pelvic floor muscles on command so they can relax during urination. How well your child urinates and empties may be followed with uroflow tests as well. Biofeedback is often successful is teaching your child how to control their pelvic muscles, relax during urination, and completely empty the bladder. This reduced complaints of wetting, urgency, and even urinary tract infections.
- Medication - We use medications occasionally to treat children with refractory wetting or frequency due to overactive bladder. The goal is not to have the child on medication for the rest of their life, but to control the symptoms while they are working on voiding habits and/or constipation.