How does voiding dysfunction contribute to pediatric urinary tract infection (UTI)?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Prolonged retention of urine may permit incubation of bacteria in the bladder. Voiding dysfunction is not usually encountered in a child without neurogenic or anatomic abnormality of the bladder until the child is in the process of achieving daytime urinary control.

A child with uninhibited detrusor contractions may attempt to prevent incontinence during a detrusor contraction by increasing outlet resistance. This may be achieved by using various posturing maneuvers, such as tightening of the pelvic-floor muscles, applying direct pressure to the urethra with the hands, or performing the Vincent curtsy, which consists squatting on the floor and pressing the heel of one foot against the urethra. As a result, bacteria-laden urine in the distal urethra may be milked back into the urinary bladder (urethrovesical reflux).

Constipation, with the rectum chronically dilated by feces, is an important cause of voiding dysfunction. Neurogenic or anatomic abnormalities of the urinary bladder may also cause voiding dysfunction.

Voiding dysfunction should be evaluated and managed appropriately. Surgical correction of underlying anatomic disorders may be indicated in select cases. For more information, see Pediatric Vesicoureteral Reflux.


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