Brief Answer:
Thorough evaluation required

Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day

Dear Ms,

Being a Pediatric Surgeon, I come across several such cases.
Lets analyze the symptoms:

Feeling of need to go within 1 hour of passing Urine, failure to do so result in spontaneously passing out urine: It suggest Urgency , with Urge Incontinence.
Urinary bladder is unlikely to get filled within 1 hour , so itt is not overflow incontinence.
Urgency could be due to mainy factors
1. Urinary tract infection
2. Constipation: Constipation could be associated spasm of muscle of pelvic floor-- This causes stimulation of Detrussor(muscle of Urinary bladder) to contract leading to frequent urge to pass urine and if there is delay causing incontinence.
3. Spontaneous Detrussor muscle over activity.

Oxybutinine is a anti-muscuranic drug which suppresses the contraction of detrussor muscle. Imipramine is a Tric-cyclic antidepressant which because of its anti-muscuranic activity is helpful in detrussor muscle over activity.

I would not recommend the use of it without appropriate Urodynamic Study(UDS).


Had she been my patient I would have managed her in the following way

1. Detailed examination Of Perineum:

a) Examination of genitals to look for two seperate opening for Urethra and Vagina ( this will rule out Urogenital sinus in which there is single opening)

b) To rule out fungal infection of the surrounding area

c) Examination of anal opeing followed by digital rectal examination: Anal fissure could be cause of constipation, visual inspection will rule out the possibility . Digital rectal examination will assess the severity of constipation

2. Investigations:

a. X ray of Lumbo-sacral spine: To rule out any spine abnormality
b . Urine Examination: To ru;e out urinary tract infection
c. Ultrasound abdomen

Having accessed the severity of constipation. It can be managed in following way

1. Ensuring consumption of good quantity of water:
Follow rule of 1: 1 glass of water 1 hour before every meal and 1 hour after every meal will ensure adequate intake of water.
Decreased consumption of water is one of the factor for constipation
2. Laxative like Lactulose
3. High fiber diet
4. Toilet training: Inculcate habit of passing urine every 2 hours. Also make her sit for potty at fixed times twice a day for 20 minutes each. Children usually do not spend sufficient time, this leads to incomplete evacuation of stools and further worsening constipation.
5. Retention Enema : This will help in evacuation of loaded colon and rectum ,therby decreased the pelvic muscle spasm

6. Hot seitz bath: To a tub of lukewarm water add handful of common table salt. Make the baby sit in it for 15-20 minutes. This will relax the muscle. This can be carried out before bathing the child

7. Double voiding at night: Habit of making her pass urine twice, let her pass urine and again make her pass urine after 5 minutes. This can be done daily before she goes to bed


This will require patience, but will definitely work. If there is no improvement in symptoms after 2 months, would suggest you to get revaulation with Ultrasound abdomen and Urodynamic Study which will document flow and pressure in urinary Bladder.

Discuss it with treating physician and I am quite sure things should work out fine.

Do get back to me for any further assistance, will be glad to assist you.

Take Care

Best Regards
Dr Deepak Kishore
MBBS,MS,MCH
Consultant Ped Surgeon

---

Brief Answer:
Consult Pediatric Surgeon

Detailed Answer:
Hi
Greetings,

Dear Ms,

I understand your problem. I would suggest you to consult either Pediatric Urologist or Pediatric Surgeon for further assessment and management.

Take Care
Wishing you and your family a very happy and healthy life.

Regards
Deepak

---