Voiding Dysfunction

It refers to the disorders in the urination phase that occur as a result of incorrectly acquired urination habits in some neurologically normal children during the toilet training period. During the bladder emptying phase, the child urinates by contracting the sphincter (urinary tract closure) and pelvic floor muscles at the base of the bladder, which serve to hold urine, and this It is a problem that manifests itself as intermittent urination and inability to fully empty the bladder after urination, caused by the deterioration in bladder dynamics. There is increased activity in the pelvic floor muscles and sphincter, which should be relaxed during urination. In order to overcome this resistance, the child empties the bladder by using the muscles of the anterior abdominal wall. Therefore, the urine flow rate increases and the bladder cannot be emptied completely. Constipation

It is hard stool with a solid consistency. It is when a person goes to the toilet less than 3 times a week.

• Fecal incontinence (Encopresis)

Chronic constipation older than 1-2 years of age. It is a condition of fecal incontinence seen in children with fecal incontinence.

• Frequency (Frequency)

It is urinating more than the number of times one should normally urinate on a daily basis. This number, which is normally between 3 and 8, is defined as frequent urination if it is 9 or more

• Infrequency

It is defined as urinating 4 or fewer times during the day.

• Urgency

Sudden urge to urinate. It is defined as trying to hold urine by pressing one's legs together.

• Urinary Incontinence (Enuresis)

At a socially inappropriate place and time. It is a normal urination that occurs inappropriately.

SYMPTOMS SEEN IN VOIDING FUNCTION DISORDERS

REPEATED URINARY TRACT INFECTION

Within a 6-month period It is defined as the appearance of 2 or more urinary tract infections.

TOP-SHAPED URETHRA

It is especially seen in girls with urinary dysfunction. It is seen with radiological findings.

• Top-shaped urethra

VESICOURETERAL REFLUX

It is defined as the leakage of urine from the bladder back to the ureter and kidney during urination.

URODYNAMIC FINDINGS

• Increased Residual Urine Amount = Residual urine is defined as the urine remaining in the bladder after voiding.
• Bladder Capacity Changes = Bladder capacity is reduced in children with voiding dysfunction. and it increased in a very few children (Bladder capacity increased in those who were lazy to urinate.)
• Intermittent Urination = Periodic damage to the pelvic floor, which causes an increase in detrusor pressure (Detrusor muscle is the name given to the muscle in the bladder wall) along with a decrease in the urine flow rate. It is characterized by activation.
• Horizontal Voiding = Insufficient and incomplete flat plateau voiding with multiple voiding phases.
• Increased Voiding Time = Normally the voiding time is 30 seconds, but in voiding dysfunctions the voiding time is It is prolonged.
• Increased Voiding Pressure = An increase in voiding pressure may be observed in children who urinate by contracting the pelvic floor muscles.

• SYNDROMES WITH VICTURED FUNCTION DISORDER

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 *Lazy Bladder Syndrome
It is a term used to describe children who urinate infrequently. These children pee 3 or fewer times in 24 hours. When they wake up in the morning, they do not go to the toilet and do not feel any feeling of urgency. Urinary incontinence occurs in the form of overflow. Urination occurs by contraction of the abdominal muscles. They have a larger bladder than expected. Urinary infection and constipation are common.

*Laughing Incontinence
It is urinary incontinence that develops due to involuntary complete emptying of the bladder while laughing. The child is completely dry at other times.

*HINMAN-ALLEN Syndrome
It is the most severe form of urination disorder. Although there are no neurological findings, there are neurological bladder symptoms.

 *OCHOA Syndrome
In addition to the symptoms of urinary tract infection, upper urinary tract disorders and constipation along with urinary incontinence, there is a special facial shape. When these children smile, their faces look like they are crying.

*Daytime Frequent Urination Syndrome
It is especially seen in children who have received toilet training before school. It is characterized by a sudden desire to urinate at intervals of 5-10 minutes.

*Asymptomatic Daytime Urinary Incontinence
Some children between the ages of 3-5 tend to retain urine due to intense concentration on games and television. Accordingly, wetness in underwear is occasionally noticeable. This condition disappears without the need for any intervention.

*Restless Bladder of Childhood
It manifests itself with daytime wetting in preschool girls. These patients have hyperactivity and attention deficit disorder. Day and night wetting, frequent urination and urgent urge to urinate are observed. Vesicoureteral reflux, urinary infection and constipation may be observed.

*Vaginal Voiding 
It occurs in obese girls due to the reflux of urine into the vagina during urination.

HOW IS IT DIAGNOSED?

It is necessary to diagnose the physical, psychological, social and environmental factors that are effective in the urination problem in a comprehensive and multidisciplinary manner.

Tests to be Performed for Diagnosis:

*Child's History

• how the child and the family perceive the problem
• the impact of the problem on the quality of life
• the child's mental state
• functional abilities
• the problem's when it started
• how often he had problems
• presence of accompanying urinary tract infection

• *Voiding History
  Frequency of urination, whether holding maneuvers were used whether he/she uses it urgently, whether he/she needs to urinate urgently, whether he/she has pain during urination, the nature of the urine stream (continuous/intermittent, strong/weak)

  *Questionnaire Form for Specifically Inquiring about Urination Problems

  *The Child's Bowel Habit
  Constipation, abdominal pain, pain during defecation

  *Rectal Examination
  Measurement of rectum diameter
  *Physical Examination
  *Kidney, Urine Ultrasonographic Evaluation of the bladder and urinary tract

  The upper urinary system, bladder wall thickness, and the amount of remaining urine after micturition are evaluated

  *urine tests

  *Abdominal x-ray

  *Voiding Test (uroflow metri)
  A non-invasive test to measure urine flow, shape and quality

• *Uroflowmetry-EMG test
  Urinary canal obstruction (external sphincter) during urination muscle) muscle activity is measured

  *Urodynamic evaluation

  HOW IS IT TREATED?

  1-Pelvic floor rehabilitation and bladder training within the urination development program

• 2-Anticholinergic drug treatment

• Note: If there is an accompanying complaint of constipation, it should be treated first.
  
   

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