How is overactive bladder (OAB) treated in children?

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Initial management of overactive bladder (OAB) involves a behavioral and cognitive approach. The child and caregiver must be educated on normal bladder and sphincter function. Dietary changes are helpful in some children, particularly those who drink caffeinated or acidic fluids and those with increased fluid intake.

Pharmacologic treatment is initiated if behavioral therapy fails or symptoms are severe. Surgical treatment may be considered if behavioral therapy and pharmacologic therapy fail.

As with adults, older children often institute various coping strategies, including defensive voiding, toilet mapping, and restriction of fluid intake. Thus, the management of OAB must consider not only the detrusor overactivity but also the responses to it. [25] The volume and types of fluids should be assessed and modifications made to encourage normal fluid intake as well as avoidance of potential bladder irritants and diuretics such as caffeine.

Constipation, if present, must be treated. Studies demonstrate improvement in OAB symptoms simply by treating constipation, if present, even without OAB therapy. [26, 27]

Urinary tract infections (UTIs) should be treated and, depending on the child’s age and whether the UTIs have been febrile or nonfebrile, investigated further with renal ultrasonography and voiding cystourethrography (VCUG). In children with recurrent UTIs, antibiotic prophylaxis may be helpful in decreasing the number of infections while voiding and bowel habits are being managed. Nitrofurantoin or trimethoprim-sulfamethoxazole, at one third to one half of the normal treatment dose administered once per day, is the typical choice for prophylaxis.

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