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Overactive Bladder in Children Clinical Presentation

  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
Updated: Nov 18, 2015


The clinical presentation of overactive bladder (OAB) in children is similar to that in adults. The clinical features include urgency, urinary frequency, urinary urge incontinence, and nocturia or nocturnal enuresis. Many of the signs and symptoms of OAB are due to faulty perceptions of bladder signals and habitual nonphysiologic responses to these signals.[15]

A careful voiding and bowel history, as well as a review of fluid intake (including type of fluid), is important to note. In girls, voiding habits should be reviewed to ensure proper positioning during voiding to eliminate vaginal reflux voiding as a source of incontinence.

Children often exhibit various behaviors to prevent urinary leakage, including squatting behaviors and the Vincent curtsy sign.


Physical Examination

Physical examination findings are usually normal in children who have idiopathic OAB. Some children with urinary incontinence have perineal excoriation.

A focused neurologic examination should be performed to rule out an underlying neurologic etiology. The examination includes an assessment of perineal sensation, assessment of the perineal reflexes supplied by sacral segments S1-S4 (standing on toes, bulbocavernosus reflex), evaluation of anal sphincter tone, and evaluation of the buttocks, legs, and feet for signs of occult neurospinal dysraphisms of the lumbosacral area.

The position and caliber of the urethral meatus should be inspected. The abdominal examination should include assessment for a distended bladder and a full sigmoid/descending colon (suggestive of constipation). The sacrum should be palpated to ensure that it is present and the presacral area inspected for dimples, abnormal gluteal clefts, hairy patches, and other signs of possible neurologic lesions.



Some of the consequences of OAB result from the child’s voluntary attempts to maintain continence during the involuntary detrusor contractions. These coping mechanisms, including forceful contractions of the external sphincter and squatting maneuvers to produce perineal compression, may lead to functional and morphologic changes in the bladder, which can increase the child’s risk of urinary tract infections (UTIs) and vesicoureteral reflux.

Frequent voluntary contractions of the pelvic floor muscles may also lead to postponement of defecation. Constipation and fecal soiling are often identified in children with OAB. Greater than 50% of children with lower urinary tract symptoms evaluated in a tertiary referral center fulfilled diagnostic criteria for functional defecation disorders.[16]

In addition, symptoms of pediatric OAB and urinary incontinence may lead to embarrassment in the child. The child may be inappropriately labeled as having a psychological problem. Children with OAB may refrain from social activities, in fear of wetting and of letting others know how frequently they void. Difficulties may develop between the child and the child’s peers, parents, or both.

Contributor Information and Disclosures

Pamela I Ellsworth, MD Professor of Urology, University of Massachusetts Medical School; Chief, Division of Pediatric Urology, Department of Urology, UMassMemorial Medical Center

Pamela I Ellsworth, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Urological Association, Phi Beta Kappa, Society of University Urologists, Society for Fetal Urology

Disclosure: Nothing to disclose.


Katherine M Callaghan University of Massachusetts Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American Urogynecologic Society, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received grant/research funds from Uroplasty for none; Partner received honoraria from Allergan for speaking and teaching.

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Urodynamic study demonstrating detrusor overactivity.
Differential diagnosis of overactive bladder (OAB).
Uroflow and electromyography (EMG) study demonstrating dysfunctional voiding: staccato flow pattern and failure to relax sphincter during voiding.
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