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Child has trouble urinating, leaking urine. Monitoring bowel movements did not help. Can you advise?

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Posted on Sat, 30 Jun 2012
Question: My 10 year old daughter has been having a problem, and she's had this on and off for a couple of years. At times she has to go to the bathroom every few minutes, though only a few drops come out, and she also complains that her underwears get wet from urine leaking, only little bit, but it still bothers her. The urologist we went to did alll the tests, and said maybe she needs to monitor her bowel movements better, asthat might be causing the oproblem, however, we did not find that to be true. Can u give me advice how I can help her.
doctor
Answered by Dr. Hema Yadav (6 hours later)
Hello ,
Thanks for posting your query.
Yes, your daughter does seem to have an urge incontinence or a stress urinary incontinence which may be due to a genitourinary infection, or a habbit disorder due to chronic constipation and straining.
Since you have been to a urologist, I assume you have done the following tests.
1.Ultrasound abdomenand pelvis.
2.Urine routine and cultures with antibiotic sensitivity.
3 Any urodynamic studies if done .
4 Cbc, Renal profile etc
If yes kindly let me know the reports of the same whether normal or any findings positive.
Also do try to find out if she has any associated complaints like itching in genitalia, burning urination, white discharge on undergarments etc
I assume she has no other medical problems, no anxiety or stress and is not under any medications .

Please help me in providing a specefic and better advice by furnishing the above details.
Awaiting your response,
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Hema Yadav (14 hours later)
Yes, she had all the tests done 2 years ago when she was having these issues. Everything was normal. She has a very carefree personality and does not stress so easily. She sometimes complains of itching in the urinary area, but not burning, and no white discharge. She has no other medical problems. She has not suffered from constipation since she was 4 yrs old. However, from birth until then her constipation was very severe, and she was extremely difficult to feed, once I switched her to solid foods. Also, I was told that she had Rena pelvis dilation when I was pregnant with her, but then right before birth, it was normal.
Could her problem now be related to her straining during bowel movement as a small child? What can I do to help her?
Thank you so much for all your help.
doctor
Answered by Dr. Hema Yadav (6 hours later)
Hello,
Thanks for the details.
Your daughter most probably has an overactive bladder.
Overactive bladder is a form of urinary incontinence, which is the involuntary release of urine. Children as well as adults can have this problem.
A child with an overactive bladder will need to urinate frequently, and at times the need may be urgent. She may not make it to the toilet before the urine begins to flow.
Common causes for overactive bladder in children include:
1.Urinary infection
2.consumption of caffeine, which increases urine output and can cause spasms in the bladder muscle
3.consumption of ingredients that a child may be allergic to
4.events that cause anxiety
5.infrequent urination (holding urine for too long a period of time)
small bladder capacity
6.structural abnormalities in the bladder or urethra
7.constipation
Since all others have been ruled out the more likely cause in her case could be the effect of constipation for a long time during early childhood.
Her symptoms might improve over time on it's own or with simple measures as follows.
If she does not outgrow the condition, treatments can include bladder training and medication. In bladder training, the child uses exercises to strengthen and coordinate the urethra and bladder muscles to control urination. Such exercises teach the child to prevent urinating when away from the toilet and to anticipate the urge to urinate. Additional techniques to help overactive bladder
include:
1.avoiding caffeine or other ingredients that may encourage overactive bladder
2.using timed voiding, or urinating on a schedule -- for example, every two hours
3.adopting healthy urination habits, such as taking enough time to urinate and relaxing muscles during urination.
The medication oxybutynin is used to control such problems as urgent, uncontrolled, or frequent urination and other conditions that affect the bladder muscles. Oxybutynin works by relaxing the bladder muscles to prevent urinary problems. However, there are newer drugs available that may have fewer side effects.
So if the problem persists so much as to disrupt her daily life then please consult her doctor and discuss regarding starting medications or bladder exercises.
Hope that answers your query.
Regards








Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Hema Yadav (19 hours later)
Thank you for your detailed answer. I will try to pay more attention to what triggers these episodes for her, since they seem to come and go, and are not daily, persistent issues. However, when they do happen, it bothers her a lot, and I don't want her to feel ashamed of herself because of this.
When you say outgrow the condition, by what age, do you mean. Also, if not treated now, might these issues affect her abilities to have children, later on in life, or cause problems when she gets her period?
I appreciate all the information and advice that you have been providing me. Thank you so much.
doctor
Answered by Dr. Hema Yadav (6 hours later)
Hello ,
Thanks for the follow up.
There is no specefic age group and the time period varies with each individual however the problem should not be persistent after she attains puberty.
As such this problem won't affect her future fertility or menstruation.
However if untreated there is a risk of recurrent genitourinary infections and backpressure effects on upper urinary tract hence it's best to get her reevaluated if the problem worsens.
Please do not let this affect her and reassure her that it can happen to anyone and she should never feel ashamed of it.The more positively she deals with it the sooner it will resolve.
Sometimes simple kegel exercises (pelvic muscle or bladder exercises) may itself cause relief even before medications are indicated.
Wishing her a speedy recovery & good health forever.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Hema Yadav

Pediatrician, Infectious Diseases

Practicing since :2005

Answered : 1528 Questions

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Child has trouble urinating, leaking urine. Monitoring bowel movements did not help. Can you advise?

Hello ,
Thanks for posting your query.
Yes, your daughter does seem to have an urge incontinence or a stress urinary incontinence which may be due to a genitourinary infection, or a habbit disorder due to chronic constipation and straining.
Since you have been to a urologist, I assume you have done the following tests.
1.Ultrasound abdomenand pelvis.
2.Urine routine and cultures with antibiotic sensitivity.
3 Any urodynamic studies if done .
4 Cbc, Renal profile etc
If yes kindly let me know the reports of the same whether normal or any findings positive.
Also do try to find out if she has any associated complaints like itching in genitalia, burning urination, white discharge on undergarments etc
I assume she has no other medical problems, no anxiety or stress and is not under any medications .

Please help me in providing a specefic and better advice by furnishing the above details.
Awaiting your response,
Regards.