My mentor in Urologic training frequently advised us to never become expert in something that you can’t operate on. It is clear that I didn’t heed this sage advice. Though Pediatric Urology is a surgical discipline, 10% of our 14000 office visits last year were for management of children with wetting problems. Diurnal enuresis, voiding dysfunction(VD), lower urinary tract symptoms (LUTS), overactive bladder (OAB), dysfunctional elimination syndrome (DES) and daytime wetting are all terms used the describe the symptoms of a type of patient inundating offices of Pediatric Practioners throughout world. Bladder and Bowel Dysfunction (BBD) is currently the preferred term to characterize those patients who present with voiding symptoms, a variable history of urinary tract infection (UTI) and all too often poorly recognized bowel issues.1 These patients ultimately end up in the Pediatric Urologists office for evaluation of UTI’s (with or without fever) which will recur with monotonous regularity until the underlying issues with wetting and soiling are addressed. Though UTI’s are often the focus of the medical providers, the families are more often concerned about the wet underwear and furniture, the odors, and the social stigma accompanying the child who can’t control bladder and bowel function in the school setting or on the fields of play. “Help us!” is their plaintive plea. Frustratingly, the help that we provide is often not effective in correcting the problems. At the end of the day, the most successful programs require significant family commitment to become good observers as they change dietary habits and behaviors while investing significant time for their children’s benefit. With the hectic pace of family life and the buzz of our modern world, the overwhelmed parents often are not up to the challenge and many prefer to choose medication to take care of the problem. But pharmacologic management is a slippery slope in that no matter the medication, there are well-recognized side effects. Still we can’t give up on the children; we need to be patient and continually strive to work with the families to find the most effective program to benefit their children. Such efforts in childhood may have benefits in adulthood as well as it has been show that childhood bladder problems persist into adulthood with attendant negative effect on quality of life.2
All primary practioners are familiar with these patients. This manual represents our collective experience over the years in trying to understand the basics of bladder and bowel control so as to be able to favorably impact the clinical circumstances of children with BBD. We have come a long way since the days when every wet child received a prescription for an anticholinergic. Now we rarely resort to medication in managing these problems and instead rely heavily on behavioral interventions and Physical Therapy. No doubt in the future we will have different management options. From my view the greatest advances need to be in the area of effectively influencing families to change behavior so as to benefit their children.
- Austin PF, bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, Von Gontard A, Wright A, Yang S, and Neveus T: The Standardization of Terminology of Lower Urinary Tract Function in children and Adolescents: Update Report from the Standardization Committee of the International Children’s Continence Society. J Urol, 191: 1863, 2014
- Bower W, Yip S, and Yeung CK; Dysfunctional Elimination Symptoms in Childhood and Adulthood. J Urol 174: 1623, 2005.
