voiding disorder

The voiding dysfunction (disorder), which we encounter quite frequently in our urology practice, defines urinary incontinence problems in children after it has been shown that there is no possible urinary system or neurogenic disease. It is a condition that can manifest itself with sudden urgency to urinate, urinary incontinence, weak urine flow, and recurrent urinary tract infections. In recent years, its frequency has been increasing gradually, probably due to the fact that both families and physicians have focused more on this issue. With the modern lifestyle, changes in toilet training and toilet habits are held responsible for this frequency.

For a healthy urinary system, adequate relaxation of the sphincter complex, which provides urine retention during voiding, along with a normal bladder storage and emptying function is necessary. Associated with the complex integration of sympathetic, parasympathetic and somatic innervations, a complex interaction between the spinal cord, brainstem, midbrain and higher cortical structures provides control. Normal daytime control of bladder function matures between 2-3 years of age, while nighttime control is normally achieved between 3-7 years of age. While the detrusor may be overactive in filling phase disorders (overactive bladder or urgency syndrome), there is sphincter and pelvic floor mismatch during the contraction of the detrusor in voiding phase disorders. Complaints such as weak voiding, intermittent voiding, urinary incontinence, and dripping occur. Mostly, intestinal disorders such as constipation, fecal incontinence, and anatomical changes such as trabeculation, diverticulum, and vesicoureteral reflux are observed. Detailed history, examination, urinalysis, urine flow rate (uroflowmetry), ultrasound and voiding diary are important in diagnosis.

In the examination, the genital area is examined, the back of the child is examined and a neurological examination is also performed. Videourodynamics is performed in cases that are resistant to treatment. Psychological evaluation and the psychosocial status of the family must be evaluated. The age at which voiding training is given is also important. Treatment of voiding disorder mostly consists of biofeedback and behavioral bladder therapy. Urotherapy is the non-surgical treatment of urinary tract function. Regular voiding habits, healthy voiding posture and avoidance of urinary retention are important. In addition to standard treatments such as fluid intake and prevention of constipation, voiding diary, double scheme, specific treatments such as physiotherapy and pharmacotherapy are also important.

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