Saturday, May 28, 2011

An uncommonly diagnosed common problem in kids - Helping children with voiding dysfunction!

My child wants to go the toilet repeatedly!
She rushes to the toilet, and sometimes passes urine in her underwear!
This is a fairly common complaint in Pediatric Office Practice.
It is the tendency of the Pediatrician & the parent to blame this on a lazy, inattentive child who is simply too busy to stop whatever they are doing. However this can very easily be a sign of voiding dysfunction. Repeated wetting can lead to lower self esteem in a child, so this condition should not be left undiagnosed and untreated.
I am going to use this forum to provide links to some important and helpful articles that are great learning resources for parents & pediatricians.
This is an excellent primer for pediatricians regarding a common problem that we encounter in our practice, voiding dysfunction. Unfortunately we rarely investigate this thoroughly, beyond the usual urine examination, and do not seek specialist consultation, especially in India. This is due to two reasons, first a lack of awareness of the problem of voiding dysfunction, and secondly, since we lack qualified/ interested Pediatric urologist in our country.
Hopefully these articles will educate us regarding this relatively common condition.
"In a study of 7-year-old Swedish schoolchildren, 20% reported needing to get to a bathroom quickly. Additionally, it was reported that 6% of girls and 3.8% of boys continued to have problems with daytime wetting at this age. Upadhyay et al. (2003) found that half of children with dysfunctional voiding symptoms had a history of urinary tract infections."
(Please note: Both these articles require free registration)
Dysfunctional voiding refers to an abnormality in either the storage or emptying phase of micturition and is associated with urgency, frequency, incontinence, and UTIs. It is important to distinguish dysfunctional voiding from enuresis. With enuresis, there is normal voiding with complete expulsion of urine at a socially less acceptable time or place. Enuresis occurs more frequently at night (nocturnal), can occur during the day (diurnal), and is usually self-limiting.
Recommended Audience - Pediatrician, Pediatric Urologist, and Family Physicians. While parents can read the article, they may find it technically demanding.

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