Overactive bladder in children: symptoms, treatment (video)

In fact, one of the most common nephrological problems in children is overactive bladder , or OAB . Its main symptom is urinary incontinence . But until 5-6 years of age, even with obvious signs of incontinence, doctors do not diagnose OAB. Of course, for a growing body, incontinence both at night and during the day is acceptable, but parents should carefully monitor their child in order to correctly tell the doctor about the symptoms and make the correct diagnosis in time.
IMPORTANT! When you don’t trigger a disease, you give the body a better chance of getting rid of it!

Introduction

According to the International Society of Childhood, overactive bladder is “urinary urgency, usually accompanied by frequency and nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathology.” The problem associated with incontinence negatively affects self-esteem and impairs the development of children. Children with an overactive bladder need to urinate more often than usual because the bladder muscles spasm uncontrollably. Sometimes the problem affects the muscles surrounding the urethra, through which urine passes. They are designed to prevent urine from leaving the body, but can be "overridden" if the organ undergoes severe contraction. Incontinence in children under 3 years of age is very common. Most babies learn to control their bowel movements after age three, but this can still change. The condition is often not diagnosed until the child is 5 or 6 years old. By age 5, more than 90 percent of children can control their urine throughout the day. A urologist cannot diagnose bedwetting until your child is 7 years old. Wetting the bed occurs when a child is unable to control their urination at night. This is a type of dysfunction that can accompany but is not usually associated with an overactive bladder. Enuresis is considered normal when it occurs in children under 5 years of age. In older children, this condition is called dysfunctional voiding if it is accompanied by constipation and fecal accidents.

Advice from experienced parents

Alevtina, son Georgy (7 years old), daughter Anastasia (3 years old)

Of course, our history is the same. We are military people and move often. And our son turned out to have a tender psyche . And so, as usual, we started packing our bags, and then we started having problems with bedwetting . And it started just when he was already 5 years old. Even taking into account the fact that she constantly got up to visit her daughter, that she put her son on the potty at night, he still constantly peed in his sleep. After the move things got worse. We searched for a long time for the reason, until one of our most experienced pediatricians suggested contacting a psychologist . As it turned out later, changing friends, kindergarten and home became incredibly stressful . We dealt with this problem in literally six months. But now we are trying to move very carefully.

Zoya, Catherine's grandmother (8 years old)

Our mother went to work in the capital, and we stayed with our granddaughter in the city . Everything was fine, the granddaughter was brave and constantly called her mother. But the mother was at work and could not indulge the child with conversations all the time. Of course, in our case, within a month problems began, immediately with urinary incontinence both day and night. A little at a time at first. And then it gets worse. Now a year has passed and the granddaughter seems to have adapted, but as the psychologist told us, we need to monitor and look very carefully at her psychological health . After all, it was stress, and then my too strict conditions that I could call once every two days, that became the decisive factors for the occurrence of such a problem as an overactive bladder .

Classification of pathology

According to WHO, there are several grouping criteria depending on the type of disease. According to the nature of abnormal changes, the bladder can be:

hyperreflex: urine is not retained, but is immediately excreted, since there is no accumulation phase;
hyporeflex: slow filling of the organ to abnormal sizes with rare urges;
areflex form: the process of giving a signal for emptying is disrupted.

Three degrees of severity of neurogenic dysfunction:

Mild form: frequent urination in small quantities during the day, enuresis occurs with excitement and at night.
Moderate (moderate): urine does not accumulate in the urinary cavity, but is immediately excreted. The child constantly experiences frequent and strong urges to write.
Severe: Ochoa and Hinman syndromes, daytime and nocturnal enuresis, persistent UTIs, high risk of renal failure.

How does cystitis manifest in children?

Manifestations of the disease depend on the age of the child.

Symptoms of cystitis in babies in the first year of life:

restlessness, crying, sleep disturbances and loss of appetite;
darkening of urine;
increased frequency of urination (can be observed if the child is left without a diaper).

For older children, the following signs of cystitis are typical:

increased urination;
a small amount of urine excreted;
pain in the lower abdomen, rectum or perineum;
sharp pain and burning during urination;
cloudy color and unpleasant odor of urine.

Attention! An increase in body temperature and deterioration in well-being with cystitis is an alarming symptom. This is how the inflammatory process in the kidneys can begin.

Chronic cystitis often occurs latently and is detected only during exacerbations.

Symptoms

The most common symptom of OAB in children is the need to go to the toilet more often than usual. On average, a child should visit about four to five times a day. The condition can cause the bladder to shrink and make you feel like you need to pee even if it's not full. The child cannot directly tell you that he constantly has the urge to pee. Look for signs such as squirming in your seat, dancing, jumping from one foot to the other, or holding your genitals with your hands. Other signs may include:

visiting the toilet more than 8 times a day;
desire to urinate without urine;
frequent urinary tract infections;
forced urination associated with cramps of the lower extremities;
spastic paralysis of the lower limbs;
blood in urine;
temperature;
involuntary description.

Less commonly, a child may experience leakage, especially when they are active or sneezing.

Causes of the problem

Overactive neurogenic bladder in children is almost always caused by spinal cord abnormalities, both congenital and acquired. The most common cause of bladder dysfunction in children is abnormal development of the spinal canal, and in the spinal cord, neural tube defects. Genetic and environmental factors play an important pathophysiological role. Main reasons:

spinal cord injury;
tumors of the central nervous system and pelvis;
Urinary tract infections almost always cause increased urgency of urination, as the urinary tract becomes inflamed and uncomfortable;
some neurological conditions;
pollakiuria (frequent urination). Children with this diagnosis may urinate every five to ten minutes, 10 to 30 times a day. This condition is most common between the ages of 3 and 8 and is present only during waking hours. There are no other symptoms. Doctors believe that pollakiuria is associated with stress. It usually does not require treatment and goes away in two to three weeks.
infrequent urination (holding urine for too long a period of time);
small bladder capacity;
myelodysplasia;
hypertemia;
structural abnormalities in the bladder or urethra;

Symptoms of cystitis in a child

Before treating the disease, a correct diagnosis should be made - the symptoms of the pathology, which are considered characteristic of cystitis, can help with this.

Symptoms of inflammation:

high and persistent body temperature in a child;
cry;
anxiety;
disturbed sleep;
frequent trips to the toilet;
change in the color of urine and the appearance of turbidity;
nervous excitement and irritability;
lethargy;
loss of appetite.

These symptoms occur in every second child, which indicates the presence of a developing infection in the body. Young children often experience urinary retention, which occurs due to sphincter spasms. The disease can be detected when a child sits on the potty - he immediately begins to cry and hold his stomach.

In children over 10 years of age, cramps, false urges, and urinary incontinence are observed. Over time, the symptoms of the disease may disappear, but you should not rejoice, since after 5-7 days the signs disappear, and the pathology becomes advanced.

Complications

These include:

Decreased quality of life with social isolation and embarrassment. Children at any age are very cruel and it is enough to pee yourself in front of their peers and the child will be bullied all the time.
Risk of urinary tract infection and urolithiasis.
A large volume of urine puts pressure on the vesicoureteral junction, causing hydronephrosis with vesicoureteral reflux, and in severe cases, nephropathy.
The occurrence of autonomic dysreflexia in children with severe spinal cord lesions. The pathology can be caused by acute bloating of the bladder (due to urinary retention) or distension of the intestines (due to constipation).
Oncology.

Visit doctor

You should make an appointment with your pediatrician for evaluation if your child has signs of OAB after age 7. Your doctor will perform a physical examination and ask you questions about your incontinence symptoms. Basic examinations to identify the exact cause of the disease:

urine analysis;
Ultrasound;
daily diuresis;
blood chemistry.

Diagnosis of OAB in children

In order to clarify the cause of the symptoms listed above, the doctor will prescribe several tests.

Here are some of them:

Urine test for infection . This is a bacteriological culture of urine, which will help identify bacteria causing the infection if they are found there and select an effective antibiotic.
Nechiporenko test . Test for detecting urine volume.
Blood analysis . It is prescribed to exclude diabetes and check the general condition of the baby.
Ultrasound , if necessary, CT examination or MRI.
Biochemical and general examination of urine.

Frequent urination or wetting before the age of three should not be a concern for adults.

Treatment for overactive bladder

The goal of treatment is to try to replicate as much as possible the functions of a normal bladder, including:

filling and storing urine at low urinary pressure;
Maximize emptying to reduce urinary problems, particularly infections;
making trips to the toilet at regular intervals.

In most cases, children outgrow the problem. It is necessary to teach the baby to respond to signals in a more timely manner in order to avoid wet panties. In addition, if punished or inadequately responded to the problem, the child will urinate even more. Train your child's organs together. There are exercises to strengthen and coordinate the muscles of the urethra and bladder to control bowel movements. This will teach your baby to prevent urination when away from the toilet and to anticipate the urge to urinate. Additional methods to help combat the problem include:

avoid caffeine or other ingredients that may stimulate the urge to pee;
try to stick to a schedule, for example, emptying every hour;
mandatory visit to a psychologist.

If the cause of hyperactivity lies in infection of the genitourinary system, then comprehensive treatment with antibiotics is necessary. Children are often prescribed medications that relax the bladder: oxybutynin, driptan, novitropan. They may cause side effects such as dry mouth and constipation, but are safe and effective.

What causes cystitis?

The most common cause of cystitis is a bacterial infection. The main causative agents of cystitis in children: Escherichia coli, streptococci, staphylococci and chlamydia. Other causes of cystitis include vaginitis, taking certain medications (for example, sulfonamides), and pinworms.

Predisposing factors to the development of cystitis are:

improper or irregular toileting of the external genitalia;
wearing tight and thick clothes, tights, underwear for a long period of time;
local hypothermia;
decreased immunity;
foci of chronic infection (tonsillitis and others);
congenital anomalies of the genitourinary system.

Prevention and prevention

Appropriate family planning and counseling, access to appropriate prenatal care and screening, and adherence to nutritional guidelines before and during pregnancy can significantly reduce the rate of children born with neural tube defects or other congenital anomalies. Monitoring your child during play and rest prevents spinal cord injuries. A balanced diet will help the body get all the vitamins and microelements and prevent vitamin deficiency. Children do not know how to control the amount of fluid they consume and parents need to monitor this. You should drink at least a liter of clean water per day. Make sure you do not experience urinary retention. Having played too much, the baby may forget to go to the toilet, which is fraught with consequences.

Main questions

Does the neurogenic bladder affect the intestines? Yes, most patients with neurogenic bladder have concurrent cases of neurogenic bowel.
Is the condition curable? Yes. With timely treatment, the disease is 100% curable.
Is it necessary to take medications? Doctors all over the world are debating whether to prescribe medication to the baby. Some argue that this is a necessity, others that this is a last resort. Each case is individual and the decision is made by the urologist only after a thorough study of all examinations.

Video: Overactive Bladder

How is cystitis diagnosed?

If your child has a change in the color or clarity of urine, pain in the lower abdomen, or increased frequency of urination, you should immediately consult a doctor.

The examination plan for a child with suspected cystitis includes:

general urine analysis;
urine culture for the pathogen and sensitivity to antibiotics;
Ultrasound of the bladder and kidneys;
cystoscopy (for chronic cystitis).

The reliability of the analysis is largely determined by the quality and correctness of urine collection. To do this you should:

carry out thorough hygiene of the genital organs: the girl is washed from front to back, the boy’s preputial sac is washed;
collect the average morning portion: the child urinates first in the potty, then in a sterile container for analysis, then again in the potty;
deliver urine to the laboratory within 1 hour; If this is not possible, it should be stored in the refrigerator, but no more than a day.