Overactive Bladder in Children Clinical Presentation
- Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS more...
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.
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 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.
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.
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