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Overactive Bladder in Children Differential Diagnoses

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

Diagnostic Considerations

The diagnosis of idiopathic overactive bladder (OAB) requires that a focused history and physical examination, as well as appropriate investigative studies (see Workup), be performed to rule out conditions that may mimic or cause OAB. Failure to identify an underlying neurologic condition may lead to persistent symptoms. Differential diagnoses for OAB include dysfunctional voiding and voiding postponement (see the image below).

Differential diagnosis of overactive bladder (OAB) Differential diagnosis of overactive bladder (OAB).

Dysfunctional voiding refers to an inability to relax the urinary sphincter or pelvic floor muscles fully during voiding. Unlike people with detrusor-sphincter dyssynergia, people with dysfunctional voiding do not have an underlying neurologic abnormality. Children with dysfunctional voiding typically present with a history of urinary incontinence, recurrent urinary tract infections (UTIs), and constipation.

Although thought to be primarily a voiding phase disorder, dysfunctional voiding may develop in some children with OAB because of overactivity of the pelvic floor muscles in response to attempts to control uninhibited detrusor contractions. In most children, however, it is believed to be a learned condition that occurs during the toilet-training years. It may develop after episodes of dysuria, UTIs, constipation, or prior sexual abuse.

These children typically have either a staccato voiding pattern characterized by periodic bursts of pelvic floor muscle activity during voiding and a prolonged voiding time or an interrupted voiding pattern characterized by incomplete and infrequent voiding with micturition in separate fractions (see the image below).

Uroflow and electromyography (EMG) study demonstra Uroflow and electromyography (EMG) study demonstrating dysfunctional voiding: staccato flow pattern and failure to relax sphincter during voiding.

The term voiding postponement is a new classification of voiding dysfunction proposed by Lettgen et al.[17] In this condition, children postpone urination until overwhelmed by urgency. Urgency forces them to rush to the toilet, and leakage often occurs along the way. Initially, this disorder was attributed to detrusor overactivity. However, clinically significant behavioral symptoms were found to be more common in children with voiding postponement, suggesting more of a behavioral etiology.

These children tend to relax their pelvic floor muscles when voiding; thus, most of these children have a normal uroflow pattern, and only 20% have a staccato pattern.[17]

Differential Diagnoses

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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