Voiding dysfunction

Voiding dysfunction is a condition where there is inconsistent coordination within the urinary tract between the bladder muscle and the urethra. This results in incomplete relaxation or overactivity of the pelvic floor muscles during voiding (urination).

The urinary tract consists of kidneys, ureters, bladder, and urethra. These organs collect and store urine and release it from the body. The bladder and the urethra are in the lower urinary tract, allows for storage and timely expulsion of urine. Voiding dysfunction arises when there are any abnormalities in the filling, storage, and emptying of the urine.

Voiding dysfunction symptoms are described when there are

• Frequent urinating -more than 8 times per day,
• Urgency (strong need to urinate),
• Urine retention (unable to empty your bladder),
• Urinary tract infection,
• Intermittent urine flow,
• Urinary hesitancy.

This dysfunction can affect both women, men, and children.

Voiding dysfunction may cause due to nerve dysfunction, non-relaxing pelvic floor muscles, and under activity of the bladder.

Sometimes children hold as they don't want to stop playing, holding when you are too busy to take a break, and the problem could arise due to potty training.

In men, it could be because of an enlarged prostate, due to benign prostate hyperplasia or prostatitis, bladder stone, or bladder tumor, bladder infection, symptoms may occur due to neuro-sensory dysregulation within the bladder, inappropriate bladder contractions, or poor bladder compliance.

Urinary incontinence is more common in girls than in boys. Children who have voiding dysfunction may experience bedwetting and other bowel accidents.

The urologist will perform a physical exam as a first step to see if there are anatomical or medical reasons.

Tests conducted are - Urinalysis, Kidney and Bladder Ultrasound, Uroflow EMG (electromyogram), KUB (Abdominal X-Ray).

if you have complex symptoms or symptoms that don't go away with treatment, physicians may recommend these tests:

• Urodynamic testing
• VCUG (Voiding Cystourethrogram)
• Magnetic Resonance Imaging (MRI)

All types of voiding dysfunction conditions can be successfully treated with medicine, bladder training, or both.

Overactive Bladder (OAB): The first step in treating OAB is to start a schedule of using the bathroom every 2-3 hours. Children are informed to urinate before the sense of urgency develops to help “retrain” the bladder. Medications are given to reduce the frequency and feeling of urgency.

Dysfunctional Voiding: treatments that relate to dysfunctional voiding focuses on retraining the brain and helping the bladder relax. Normal urination doesn’t involve squeezing the abdominal muscles, instead, the muscles in the pelvis and the bladder need to relax. A timed voiding schedule is a very important part of bladder retraining. Kegel exercises or pelvic floor relaxation and contractions effectively help dysfunctional voiding. Medications are also prescribed to helps the bladder relax.

Underactive Bladder: treatment for this is primarily behavioural. A timed bathroom schedule is followed whether or not you feel the urge to urinate. Medications that relax the bladder are helpful. Catheterization might be required if the person/ child is unable to urinate. Transcutaneous Electrical Nerve Stimulation (TENS) has been shown helpful for these children.