Non-neurogenic voiding dysfunction occurs when an individual—in this case a child—experience symptoms of urinary incontinence not because there is a complication with the nerves that control the bladder (neurogenic), but due to a disruption in the signals the bladder sends to the brain. The condition may also arise due to behavioral and developmental issues.
Problems with urination, such as bedwetting, are common in young children who are learning to consciously recognize the signals the bladder is sending to the brain, letting it know that it is full and ready to release urine (void). By the age of four, the child should have voluntary control, an increased bladder capacity, and voiding frequency should be reduced. However, when there is a non-neurogenic voiding dysfunction, the child may urinate frequently, find it difficult to hold their urine, or develop recurrent urinary tract infections as a result of not being able to expel urine properly.
How Does Urination Work?
Urination normally occurs through a cycle of events:
- When the bladder if full, it sends a signal of “fullness” to the brain.
- Unless urination happens right away, within 5 to 60 minutes the bladder then sends a signal of “urgency” to the brain.
- Urination occurs when a child purposely relaxes the valve (sphincter) of the bladder that holds in the urine.
- The bladder then contracts on its own to force out the urine.
Normal urination requires coordination between relaxing the sphincter and the bladder contracting. A problem with any step in this cycle can lead to a voiding dysfunction.
When the sphincter and the bladder muscles are not coordinated, the bladder will try to squeeze out urine even though the sphincter is closed. This extra work can cause the bladder to become thicker and more muscular. Once this happens, the bladder may have spasms (involuntary contractions) which cause pain or leakage of urine.
Non-Neurogenic Voiding Dysfunction Causes
Non-neurogenic voiding dysfunction can result when there is a disruption in the signals the bladder sends to the brain, but may be caused by behavioral and developmental issues as well.
- Late signals from the bladder: results in a short time between the bladder feeling full and the urge to urinate.
- No signal from the bladder: causes decreased urination (lazy bladder syndrome).
- False signals from the bladder: leads to spasms of the bladder.
- Perception problems: a child doesn’t notice the signal from the bladder. This may be behavioral or developmental.
- No action or delayed action: sometimes children delay urination because they are “too busy” playing, watching TV, or doing some other activity.
- Frequent action: a child may act on every small signal from the bladder.
- Discoordination of the bladder and sphincter: some children may close the sphincter of the bladder during urination, either voluntarily or subconsciously.
Non-Neurogenic Voiding Dysfunction Symptoms
Non-neurogenic voiding dysfunction is often associated with fecal retention and constipation. Other symptoms include:
- Frequent (every 2 hours) urination
- Urinating without warning (urge incontinence)
- Interrupted flow of urine (staccato urination)
- Incomplete emptying of the bladder
- Bladder spasms
- Delayed urination (lazy bladder)
- Urination while laughing, coughing, or sneezing (giggle incontinence)
- Increased UTIs
Diagnosing Non-Neurogenic Voiding Dysfunction
To diagnose problems with non-neurogenic voiding dysfunction in children, a doctor may perform any of the following:
- Physical examination of the genitalia, spine, neurologic (nerves), and abdomen
- History, including symptoms, presence of UTIs, hygiene care, and family history of similar problems
- Urinalysis and/or urine culture to check for signs of a UTI
- Voiding diary to record urination, including episodes and accidents
- Uroflow machine to measure the pattern of urination, such as whether the stream is broken up
- Electromyelogram (EMG) machine to measure the activity of the bladder sphincter
Non-Neurogenic Voiding Dysfunction Treatment
Depending on the exact cause, treatment for non-neurogenic voiding dysfunction may include educating the child about urination, behavioral therapy, retraining of the bladder, or medications such as bladder relaxants or antibiotics.
References:
Kajiwara M, Inoue K, Usui A, et al. (2004). The micturition habits and prevalence of daytime urinary incontinence in Japanese primary school children. Journal of Urology 171(1):403-407.
Bower WF, Moore KH, Shepherd RB, et al. (1996). The epidemiology of childhood enuresis in Australia. British Journal of Urology 78(4):602-606.
Bloom DA, Seeley WW, Ritchey MI, et al. (1993). Toilet habits and continence in children: An opportunity sampling in search of normal parameters. Journal of Urology 149(5):1087-1090.
