51% of Children With Voiding Dysfunction Have Adverse Childhood Experience

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The mental health of children is closely related to their physical well-being. Adverse childhood experiences such as neglect, abuse, divorce, adoption, multiple family relocations, incarceration of a parent, affects the mental as well as physical health of the children. A study has shown that 51% of children with voiding dysfunction has one or more of the adverse childhood experiences.

Dr Shandip Kumar Sinha, Said-Voiding dysfunction is a broader term used to describe poor coordination between bladder muscles and urethra. Children with voiding dysfunction do not empty their bladder normally and frequently develop urinary tract infections. The exact cause of voiding dysfunction is not known, however, adverse childhood experiences and neuropsychiatric disorders increase the risk of developing voiding dysfunction. Studies have also shown that children with Attention Deficit Hyperactivity Disorder have a higher incidence of voiding disorders. The condition is often accompanied by constipation and bowel episodes. Some other symptoms of the condition may include painful urination, frequent urge to pee, blood in urine, an urgent, severe urge to pee, and pain in the back.”

Based on the symptoms, voiding dysfunction can be of three main types: overactive bladder, dysfunctional voiding, and underactive bladder.

Children with overactive bladder develop a sense of urgency to empty bladder even when it’s not even full. They take more that 10 loo breaks in the day or hourly loo break in the day time. Around 22% of children between ages 5-7 years suffer from overactive bladder.

In dysfunctional voiding, the sphincter muscles do not relax completely and the bladder is never completely empty. It results in a sense of bladder fullness all the time along with other symptoms like daytime wetting, nocturnal wetting, urgency, etc. Severe cases if dysfunctional voiding is at higher risk of kidney disease.

Children with underactive bladder urinate less than three times a day. Their loo breaks can even be 12 hours apart. Urination is often strenuous as bladder muscles are weak and do not respond normally to brain signals. Wetting is often due to the overflow of the bladder.

“Management of the voiding dysfunction depends entirely on the type of dysfunction. Parents should not make it an esteem issue, they are not alone and many children suffer from voiding dysfunction. Timely management is key to successful management. Overactive bladder can be treated by putting children on a loo break schedule. They are encouraged to take bathroom breaks every 2 -3 hours before the sense of urgency develops. After a few months of training, medicines can be prescribed to avoid urgency. Children with dysfunctional voiding are taught that normal urination does not need contraction of muscles rather it required relaxation of sphincter muscles. Biofeedback and Kleagle. Medicines may be prescribed to relax bladder and surgery may be required in rare cases. The underactive bladder is managed through behavioural techniques. A regular urinary schedule is all they require; however, some children may require short term catheterisation. Apart from specific treatments, treating accompanying symptoms like constipation is also helpful”, Dr Shandip Kumar Sinha- Senior Consultant (pediatric surgery), Madhukar Rainbow Children Hospital,Delhi.

When diagnosed accurately, any type of voiding dysfunction is treatable. Children should never be punished or made fun of for bed wetting. It is a condition out of their control and irresponsible behaviours of elders can have an ill effect on child’s psychology who is already going through tough times due to condition.

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