Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Overactive Bladder in Children Clinical Presentation

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

History

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.

Next

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.

Previous
Next

Comorbidities

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.

Previous
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002. 21(2):167-78. [Medline].

  2. Franco I. Overactive bladder in children. Part 1: Pathophysiology. J Urol. 2007 Sep. 178(3 Pt 1):761-8; discussion 768. [Medline].

  3. Fitzgerald MP, Thom DH, Wassel-Fyr C, et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol. 2006 Mar. 175(3 Pt 1):989-93. [Medline]. [Full Text].

  4. Dator DP, Hatchett L, Dyro FM, Shefner JM, Bauer SB. Urodynamic dysfunction in walking myelodysplastic children. J Urol. 1992 Aug. 148(2 Pt 1):362-5. [Medline].

  5. Peters CA, Bolkier M, Bauer SB, Hendren WH, Colodny AH, Mandell J, et al. The urodynamic consequences of posterior urethral valves. J Urol. 1990 Jul. 144(1):122-6. [Medline].

  6. Chung JM, Lee SD, Kang DI, et al. Prevalence and associated factors of overactive bladder in Korean children 5-13 years old: a nationwide multicenter study. Urology. 2009 Jan. 73(1):63-7; discussion 68-9. [Medline].

  7. Bloom DA, Seeley WW, Ritchey ML, McGuire EJ. Toilet habits and continence in children: an opportunity sampling in search of normal parameters. J Urol. 1993 May. 149(5):1087-90. [Medline].

  8. Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. 1999 Aug. 53(8):453-8. [Medline].

  9. Sureshkumar P, Craig JC, Roy LP, Knight JF. Daytime urinary incontinence in primary school children: a population-based survey. J Pediatr. 2000 Dec. 137(6):814-8. [Medline].

  10. Järvelin MR, Vikeväinen-Tervonen L, Moilanen I, Huttunen NP. Enuresis in seven-year-old children. Acta Paediatr Scand. 1988 Jan. 77(1):148-53. [Medline].

  11. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child. 1974 Apr. 49(4):259-63. [Medline].

  12. Himsl KK, Hurwitz RS. Pediatric urinary incontinence. Urol Clin North Am. 1991 May. 18(2):283-93. [Medline].

  13. Hellstrom AL, Hanson E, Hansson S, Hjalmas K, Jodal U. Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. 1990 Mar. 149(6):434-7. [Medline].

  14. Curran MJ, Kaefer M, Peters C, Logigian E, Bauer SB. The overactive bladder in childhood: long-term results with conservative management. J Urol. 2000 Feb. 163(2):574-7. [Medline].

  15. van Gool JD, de Jonge GA. Urge syndrome and urge incontinence. Arch Dis Child. 1989 Nov. 64(11):1629-34. [Medline].

  16. Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga MA. Functional Defecation Disorders in Children with Lower Urinary Tract Symptoms. J Urol. 2012 Oct 30. [Medline].

  17. Lettgen B, von Gontard A, Olbing H, Heiken-Lowenau C, Gaebel E, Schmitz I. Urge incontinence and voiding postponement in children: somatic and psychosocial factors. Acta Paediatr. 2002. 91(9):978-84; discussion 895-6. [Medline].

  18. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006 Apr. 130(5):1527-37. [Medline].

  19. Riegler G, Esposito I. Bristol scale stool form. A still valid help in medical practice and clinical research. Tech Coloproctol. 2001 Dec. 5(3):163-4. [Medline].

  20. van den Bosch M, Graafmans D, Nievelstein R, Beek E. Systematic assessment of constipation on plain abdominal radiographs in children. Pediatr Radiol. 2006 Mar. 36(3):224-6. [Medline].

  21. Koh H, Lee MJ, Kim MJ, Shin JI, Chung KS. Simple diagnostic approach to childhood fecal retention using the Leech score and Bristol stool form scale in medical practice. J Gastroenterol Hepatol. 2010 Feb. 25(2):334-8. [Medline].

  22. Cvitkovic-Kuzmic A, Brkljacic B, Ivankovic D, Grga A. Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction. Eur Urol. 2002 Feb. 41(2):214-8; discussion 218-9. [Medline].

  23. Müller L, Bergström T, Hellström M, Svensson E, Jacobsson B. Standardized ultrasound method for assessing detrusor muscle thickness in children. J Urol. 2000 Jul. 164(1):134-8. [Medline].

  24. Franco I. Overactive bladder in children. Part 2: Management. J Urol. 2007 Sep. 178(3 Pt 1):769-74; discussion 774. [Medline].

  25. Hohenfellner M, Dahms SE, Matzel K, Thüroff JW. Sacral neuromodulation for treatment of lower urinary tract dysfunction. BJU Int. 2000 May. 85 Suppl 3:10-9; discussion 22-3. [Medline].

  26. Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000 Nov 1. 56(5):766-71. [Medline].

  27. Barroso U Jr, Carvalho MT, Veiga ML, Moraes MM, Cunha CC, Lordêlo P. Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children. Int Braz J Urol. 2015 Jul-Aug. 41 (4):739-43. [Medline].

  28. Patidar N, Mittal V, Kumar M, Sureka SK, Arora S, Ansari MS. Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report. J Pediatr Urol. 2015 Jul 29. [Medline].

  29. Gurocak S, Konac E, Ure I, Senol C, Onen IH, Sozen S, et al. The Impact of Gene Polymorphisms on the Success of Anticholinergic Treatment in Children with Overactive Bladder. Dis Markers. 2015. 2015:732686. [Medline].

  30. Kim JH, Lee JH, Jung AY, Lee JW. The prevalence and therapeutic effect of constipation in pediatric overactive bladder. Int Neurourol J. 2011 Dec. 15(4):206-10. [Medline]. [Full Text].

  31. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997 Aug. 100(2 Pt 1):228-32. [Medline].

  32. Kjølseth D, Madsen B, Knudsen LM, Nørgaard JP, Djurhuus JC. Biofeedback treatment of children and adults with idiopathic detrusor instability. Scand J Urol Nephrol. 1994 Sep. 28(3):243-7. [Medline].

  33. Sureshkumar P, Bower W, Craig JC, Knight JF. Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials. J Urol. 2003 Jul. 170(1):196-200; discussion 200. [Medline].

  34. Youdim K, Kogan BA. Preliminary study of the safety and efficacy of extended-release oxybutynin in children. Urology. 2002 Mar. 59(3):428-32. [Medline].

  35. Palmer LS, Zebold K, Firlit CF, Kaplan WE. Complications of intravesical oxybutynin chloride therapy in the pediatric myelomeningocele population. J Urol. 1997 Feb. 157(2):638-40. [Medline].

  36. Ferrara P, D'Aleo CM, Tarquini E, Salvatore S, Salvaggio E. Side-effects of oral or intravesical oxybutynin chloride in children with spina bifida. BJU Int. 2001 May. 87(7):674-8. [Medline].

  37. Hjälmås K, Hellström AL, Mogren K, Läckgren G, Stenberg A. The overactive bladder in children: a potential future indication for tolterodine. BJU Int. 2001 Apr. 87(6):569-74. [Medline].

  38. Lopez Pereira P, Miguelez C, Caffarati J, Estornell F, Anguera A. Trospium chloride for the treatment of detrusor instability in children. J Urol. 2003 Nov. 170(5):1978-81. [Medline].

  39. Bolduc S, Moore K, Nadeau G, Lebel S, Lamontagne P, Hamel M. Prospective open label study of solifenacin for overactive bladder in children. J Urol. 2010 Oct. 184(4 Suppl):1668-73. [Medline].

  40. Hoebeke P, De Pooter J, De Caestecker K, et al. Solifenacin for therapy resistant overactive bladder. J Urol. 2009 Oct. 182(4 Suppl):2040-4. [Medline].

  41. Malhotra B, El-Tahtawy A, Wang EQ, et al. Dose-escalating study of the pharmacokinetics and tolerability of fesoterodine in children with overactive bladder. J Pediatr Urol. 2012 Aug. 8(4):336-42. [Medline].

  42. Kuo HC. Effect of botulinum a toxin in the treatment of voiding dysfunction due to detrusor underactivity. Urology. 2003 Mar. 61(3):550-4. [Medline].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.