Overactive Bladder in Children Clinical Presentation

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Presentation

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. [17]

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.

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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 the following:

  • Perineal sensation
  • Perineal reflexes supplied by sacral segments S1-S4 (standing on toes, bulbocavernosus reflex)
  • Anal sphincter tone
  • Possible signs of occult lumbosacral neurospinal dysraphisms in the buttocks, legs, and feet 

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.

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