Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Abstract

Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment.In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

Non-Neurogenic Bladder Dysfunction in Children: Diagnosis and Procedure.

“…3,4,7 The main principle in establishing the diagnosis of non-neurogenic dysfunction is to exclude neurogenic and structural causes in patients.2 In addition, routine urine recording is strongly recommended to recognize the amount volume), pattern, and urinary frequency of children. 1,7 Recording of urine volume may help estimate the maximum urine volume compared with estimated bladder capacity. Urinary disorders are often accompanied by digestive problems such as constipation or alvi incontinence so that it needs to be evaluated.…”

“…Voiding cystourethrogram (VCUG) is recommended in cases of recurrent ISK fever to exclude vesicoureter reflux, especially if ultrasound results indicate upper urinary tract abnormalities and / or bladder wall thickness or trabeculation found, associated with obstructive symptoms, particularly the posterior urethral valve in male patients -laki. 1 Spinal MRI examination is recommended to exclude neurogenic causes, such as tethered cord syndrome or neurologic abnormalities or skin or bone abnormalities in the spine.…”

“…1,3,7 The terminology uses child age limits above 5 years according to DSM-5 and ICD criteria -10 for urinary incontinence disorder. Clinical symptoms are summarized in Table 1.…”

“…[1][2][3]8 As many as 22% of school-aged children in America have at least one complaints of bladder dysfunction, the most common are holding maneuvers (19.1%), and urgency syndrome (13.7% ).3 Overactive Bladder is the most common ISSN: 2320-5407 Int. J. Adv.…”

“…3,8,12 Non-neurogenic bladder dysfunction affects the quality of the child's life both physically and psychosocially. [1][2][3]6 Physical effects include anatomical damage and renal function and urinary tract, either due to secondary infection in the form of renal scarring, vesicoureter reflux, or obstruction leads to chronic kidney disease. Psychosocial effects include impaired concentration or learning disorders, decreased self-confidence, and mental / emotional disturbance due to urinary problems.…”