Non-neurogenic voiding dysfunction refers to an irregular urination pattern that is not caused by a neurogolical disease, injury, or inherited malformation. Rather, this type of voiding dysfunction results due to a interference in the signals the bladder sends to the brain, or because of behavioral and development issues. The condition typically presents with urinary incontience, but is also associated with fecal retention and constipation.
Urinary incontinence symptoms linked with non-neurogenic voiding dysfunction include difficulty holding urine, frequent urination, or an inability to fully empty the bladder. Treatment options consist of behavioral or motivational therapy, medication, catheterization, and rarely surgery.
Therapy for Non-Neurogenic Voiding Dysfunction
Several methods are used that help children learn to urinate regularly, as well as to become more aware of the signals that indicate when the bladder is full.
For children who have overactive bladders or who respond to small urges to urinate, this may include learning to resist the initial urge without using emergency techniques like squatting to hold in the urine.
Children who have dysfunctional urination—such as an intermittent stream of urine—are taught to relax the pelvic floor muscles and to avoid using their abdominal muscles to force out urine.
Behavioral or motivational therapy can be used to assist in those efforts:
- Education: The first step in behavioral therapy is educating the child about how the urinary system functions and how to properly respond to an urgent need to urinate.
- Urination schedule: Children may be placed on a regular voiding schedule (every two to three hours). This may also include avoiding certain beverages that can stimulate the need to urinate, such as caffeinated, highly acidic, or carbonated fluids.
- Biofeedback: This type of therapy uses electrical sensors (placed on the lower abdomen) to receive information regarding how the bladder is contracting and expanding. This information is then transmitted to a computer that can be seen by the child. By having a visual of the bladder muscles and pelvic floor, he or she can focus on controlling them. Over time, the idea is that the child will be able to obtain a normal voiding pattern on their own.
Medication for Non-Neurogenic Voiding Dysfunction
Several medications are available to help children with non-neurogenic voiding dysfunction. Not all of these drugs are approved specifically for that use, and some are still being studied for use in children.
Anticholinergic agents— Currently, these are the only drugs approved for children with overactive bladder or urgent urination, and may include oxybutynin (Ditropan), tolterodine (Detrol), and trospium chloride (Sanctura).
The main purpose of anticholinergic agents is to increase the capacity of the bladder and decrease the activity of the bladder muscles. This helps children wait longer between urinating, which also increases the amount that they urinate.
Side effects of anticholinergic agents are common and include:
- Flushing of the face
- Dry mouth
- Constipation
Alpha-blockers— These drugs are not specifically approved to treat this condition in children. There are also limited studies on the effectiveness of these drugs in children. However, doctors may still prescribe them for children with a dysfunctional bladder neck. The goal of alpha-blockers, such as doxazosin mesylate (Cardura)and terazosin hydrochloride, are to relax the muscles that control the exit from the bladder to allow urine to flow more smoothly.
The main side-effects include:
- Dizziness
- Fatigue<
- Headache
Antibiotics— Children with non-neurogenic voiding dysfunction are more likely to have urinary tract infections (UTIs). Doctors may prescribe antibiotics to treat these infections.
Additional Treatments for Non-Neurogenic Voiding Dysfunction
Surgery— Bladder augmentation surgery is rarely used to treat voiding dysfunction in children whose nerves are not a factor. If indicated, the procedure involves increasing the size and capacity of the bladder, while also decreasing pressure inside the bladder. This may allow children to wait longer before urinating.
Constipation treatment— Children with voiding dysfunction also have an increased risk of constipation. Treatment for this symptom includes similar methods that are used for voiding dysfunction, such as a schedule for bowel movements and changes to the diet. Laxatives and enemas may also be utilized.
Catheterization— Occassionally, a tube may be inserted into the urethra and guided up to the bladder so that it can be drained of urine. This can lessen the child's risk of developing a urinary tract infection.
References
Ellsworth P, Caldamone A. (2008). Pediatric Voiding Dysfunction: Current Evaluation and Management. Urologic Nursing 28(4):249-257.
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.
