Primer: Diagnosis and Management of Uncomplicated Daytime Wetting in Children

Vijaya M Vemulakonda; Eric A Jones

Disclosures

Nat Clin Pract Urol. 2006;3(10):551-559. 

In This Article

Conditions Associated With Urinary Tract Dysfunction

Constipation has been implicated as an etiology for urinary tract dysfunction in children. In a study of 234 children with chronic constipation and urinary incontinence, Loening-Baucke found that, after their constipation was treated, 89% of children had resolution of their daytime wetting and all children with chronic urinary tract infections and anatomically normal urinary tracts had resolution of their infections.[12] The mechanism by which constipation affects urinary continence and urinary tract infection is not clear. Physical displacement of the bladder by stool accumulated in the rectum can directly affect bladder capacity, and could promote bladder instability.[13,14] Parasympathetic efferent nerve fibers from the distended colon might affect bladder sensation and contractility by a mechanism that is yet to be determined.[15]

The association between urinary tract infection and daytime incontinence has been studied extensively, although the reason for the link remains elusive. The incidence of recurrent urinary tract infection is between 50% and 90% in children with functional incontinence, with girls affected more often than boys.[16,17] Incomplete bladder emptying might facilitate the transition from bacterial colonization to development of urinary tract infection.[18] The presence of urinary tract infection exacerbates the urgency and frequency symptoms that are associated with daytime incontinence, by causing inflammation of the bladder wall.[19] There is an association between urinary tract infection and detrusor-sphincter dyssynergia and, therefore, children with recurrent urinary tract infections and incontinence should be evaluated for dysfunctional voiding. Likewise, it is important to evaluate all children with incontinence for urinary tract infections.

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