For many children, frequent urinary tract infections and urinary accidents signal a more subtle health problem known as voiding dysfunction—a condition used to describe urinary habits that are unhealthy.
Along with urinary accidents during the day or night and/or recurrent urinary tract infections, children with voiding dysfunctions may have other symptoms, including:
- Constipation
- Painful urination
- Blood in urine
- Slow, straining or dribbling urination
- A frequent (or infrequent) urge to pee
- Pain in the back or abdomen
- An urgent, severe urge to pee with inability to hold
Problems with voiding can be linked to children’s anatomy, physiology or bathroom habits. Whatever the cause, proper diagnosis and treatment can resolve even the most serious voiding dysfunctions.
Possible physical and anatomical causes for voiding dysfunction are:
- An abnormality in urinary tract anatomy, such as vesicoureteral reflux
- Spina bifida, multiple sclerosis, cerebral palsy, epilepsy and other brain or spinal cord conditions that influence the way nerves interact with the bladder or urinary tract
- Chronic kidney disease or diabetes
- Tumors or other trauma
Possible behavioral causes for voiding dysfunctions are:
- Not going to the bathroom often enough
- Rushing in and out of the bathroom too quickly
- Not emptying the bladder completely
- Ineffective voiding postures, such as little girls’ failure to spread their legs widely
- Constipation
- Past experience with painful urination
- Psychological or emotional stress
- Attention deficit disorder
The Children's Continence Program at Riley at IU Health specializes in evaluating children for voiding dysfunctions. Our pediatric urologists and nurse practitioners are expertly trained to find and treat the root of your child’s recurring incontinence and urinary tract infections. Many families are referred to Riley at IU Health after other treatments have not worked—otherwise known as refractory dysfunctional voiding.
Pediatric Enuresis Education Sessions (PEES)
Riley Pediatric Urology now offers specialized interactive virtual group appointments for children with day and nighttime incontinence. The sessions are offered up to twice per month at no cost to the family and with no referral required. We focus on providing patients and families with the educational materials and resources needed to jump-start treatment of incontinence, without a formal office visit. Families will receive evidence-based education and a behavior modification plan for their child, as well as information about identifying any other urologic problems that might need further evaluation. Join to share experiences, ask questions from experts, and learn from others. If you are interested in attending, please call (317) 944-8896 to enroll.
Diagnosing Voiding Dysfunctions
Our specialists gather a medical history to better understand your child’s overall health, voiding habits and bowel function. We also collect a social history to gain insight about your child, including eating and drinking habits. Your child will also have a physical exam and lab tests, including urinalysis, urine culture and possibly blood work.
Based on your child’s evaluation, your physician may recommend additional tests that are appropriate for making an accurate diagnosis. These may include:
- Uroflow. This test uses a special toilet to measure how much and how fast urine flows.
- Renal ultrasound. A renal ultrasound is a painless, noninvasive exam, which uses high-frequency sound waves to diagnose problems with a child’s kidneys, ureters or bladder.
- Kidney, ureter or bladder x-ray (KUB). KUB x-rays are taken for many reasons, but in children they often reveal constipation, which can contribute to urinary incontinence, or help locate possible kidney stones. Physicians may use KUBs to confirm an intestinal blockage or foreign objects in the stomach.
- Voiding cystourethrogram (VCUG). A voiding cystourethrogram is x-ray examination of the bladder and urinary tract.
- Urodynamics. Urodynamic tests reveal how the lower urinary tract functions.
Your child will be in expert, compassionate hands while being diagnosed and treated for a possible voiding dysfunction.
Treatments
Treatments
Diagnosis and treatment for incontinence relieves a great burden for many families. Low self-esteem and emotional stress often affect children who cannot hold their pee. Understandably, parents may find their child’s incontinence and suffering equally distressing.
Fortunately many children with voiding dysfunctions respond to modest treatments, including behavioral modification and training to help them acquire healthier voiding habits. Our specialists help families apply simple techniques that may resolve incontinence or other voiding dysfunctions.
Children can improve voiding by:
- Scheduling a time to pee (every hour or two) regardless of urge
- Avoiding dietary irritants: chocolate, citrus, carbonation, red dye and caffeine
- Taking more time in the bathroom
- Changing their posture or position during voiding
- Emptying the bladder twice to make sure it empties completely
- Eating a high fiber diet
- Increasing water consumption
- Consuming fluids well before bedtime to avoid bedwetting
These behavioral changes may be supported by medication, physical therapy or biofeedback to educate the muscles of the pelvic floor. Medication can be useful for calming muscles that stimulate an overactive bladder. Since incontinence often goes hand-in-hand with constipation, we may also treat constipation, which can further irritate the bladder. Some families use bed alarms for nighttime bedwetting and bathroom timers as reminders that it is time to go to the bathroom.
If incontinence is linked to a child’s anatomy, surgery may be an inevitable part of treatment. Pediatric urologists at Riley at IU Health rank among the top providers in the U.S. for treatment of voiding dysfunctions related to body structure, including vesicoureteral reflux—a condition that causes urine to flow backwards in the body. This can cause frequent urinary tract infections with high fevers that can damage kidney function.
Riley at IU Health also serves a small population of children with voiding dysfunctions that do not respond to standard treatment or conservative therapy. For these children, we offer a specialized form of therapy called sacral neuromodulation. This treatment stimulates nerves in the bladder, improving bowel and bladder continence.
The procedure works by placing a device under the skin in the lower back to stimulate a specific nerve that controls bladder and bowel function. The device delivers electrical impulses to the nerves, telling the bladder or bowels when to contract. After families explore all other options without success, sacral neuromodulation can provide much needed relief and is successful in approximately 75 percent of these difficult cases.
Key Points to Remember
Key Points to Remember
- Frequent urinary tract infections can conceal underlying anatomical problems that cause incontinence in children.
- Voiding dysfunctions may stem from physical, neurogenic (originating with nerves), behavioral or psychological problems.
- Many children outgrow voiding dysfunctions with simple changes in their daily habits.
- If your child’s voiding dysfunction has a behavioral cause, specialists in pediatric urology can often help them learn healthy habits that eliminate or improve incontinence.
- Medication can help many children control the urge to urinate.
- In rare cases, surgery is necessary to repair a physical problem responsible for a child’s voiding dysfunction.
Support Services & Resources
Support Services & Resources
We offer a broad range of supportive services to make life better for families who choose us for their children's care.
This institute is part of the U.S. Department of Health and Human Services. It supports medical research through universities and medical institutions in the U.S. and provides health information about diabetes, digestive and kidney disease.
Learn more about which foods to avoid on an elimination diet.
Learn about proper toilet positioning.
Recommended daily fluid intake for children.
Guidelines for establishing regular bowel movements.