50 - Non-neuropathic bladder–sphincter dysfunction

Summary

Background

Bladder dysfunction and nocturnal enuresis are the most common urological disorders in children. The development of continence and voluntary voiding requires maturation of the neural system and the establishment of sound micturition habits. While the conscious sensation of bladder fullness is usually gained during the second year of life, the ability to void and also to inhibit voiding develops 1–2 years later. Consequently, most healthy children become dry during this period of life. By 4 years of age 75% of all children have attained bladder control and can consciously start, postpone or interrupt voiding. Nocturnal dryness is generally achieved later than daytime bladder control.

Healthy schoolchildren void 3–7 times/day, and most of them empty their bladders completely, without residual urine. There is, however, a substantial minority of at least 20% of 7-year old children who have signs of incomplete bladder control, i.e., symptoms of either “non-neuropathic bladder–sphincter dysfunction” or nocturnal enuresis.

When taking a history in incontinent children over 5 years of age, the severity, frequency and timing of wetting episodes should be described, as well as whether the accidents are preceded by urgency or associated with holding maneuvers. Bowel function should also be assessed. The use of a bladder diary is strongly recommended, since it is the only method of recording incontinent episodes as well as times of micturition, voided volumes, pad usage as well as fluid intake, the degree of urgency and the degree of incontinence.