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Voiding Dysfunction

Voiding dysfunction is a general term that comprises abnormal voiding in childhood without underlying neurologic causes. Voiding dysfunction can take many forms such as wetting, poor bladder emptying, high bladder capacity, or high bladder pressures. Daytime and/or nighttime wetting is common in children and may occur with and without infections. Nighttime wetting (nocturnal enuresis) is defined as involuntary bedwetting while asleep in a child over 5 years of age, two or more times a month. Nighttime wetting occurs in up to 20 percent of children at 5 years of age. About 15 percent of this group gain control each year, leaving one to two percent of adolescents with this problem. Secondary enuresis starts after the child was apparently toilet trained, dry during the night for at least 6 months, and comprises 25 percent of the nighttime wetting group. Daytime and nighttime wetting occurs in another 15 percent of children with nighttime wetting. Daytime wetters have uncontrolled daytime wetting accidents that are often embarrassing especially if the child is in school or daycare.

The HAWK (Help Awaiting Wet Kids) Center for voiding dysfunction attends to the special needs of children with wetting issues and other forms of abnormal urination. Voiding dysfunction causes a great deal of anxiety for patients and parents. These children are often excluded from social events such as sleep-overs and summer camps.

At Georgia Pediatric Urology, two highly-trained and experienced nurse practitioners specialize in the evaluation and treatment of children with voiding dysfunction. After thorough history taking, physical causes for voiding dysfunction are ruled out such as phimosis, meatal stenosis, constipation, or spinal abnormalities. Diagnostic tools include ultrasound, videourodynamic studies, and urine tests. Behavioral (e.g., timed voiding, double voiding), dietary (e.g., minimizing intake of fluids, sodas, caffeine), and pharmacologic management as well as the use of bed-wetting alarms are discussed. Biofeedback teaches children in a video game-like setting to relax the pelvic floor and urinary sphincter in order to facilitate complete bladder emptying.