Bladder-Intestinal-Sclerosis development, maturation and control sequence in children:
• Night stool control
• Daytime stool control
• Daytime urine control
• Night urine control
What is urination disorder? It occurs as a result of incorrectly acquired bad urination habits in neurologically normal children during the toilet training period. It is common in primary school age children (10%). It is the most common cause of urinary incontinence in children.
Although it is common in children, its diagnosis is overlooked. If proper follow-up and treatment is not performed, it may progress to kidney failure.
What are the causes?
• Early challenging and incorrect toilet training in young children
• Delaying urination until returning home by not going to the toilet at school and holding maneuvers > What are the symptoms?
• The bladder becomes smaller or larger
• The internal pressure of the bladder increases
• Urination is impaired
• The sphincter is closed during urination. (bladder gate) cannot relax completely.
• The bladder does not empty completely and urine remains
The consequences are severe!
• A urinary infection develops
• Severe constipation occurs
• Urine leakage occurs from the bladder to the kidney
• Kidney damage occurs
How is it diagnosed? As a symptom (complaint); In addition to urgency symptoms such as frequent urination (>7), sudden urge to urinate, and minor urinary incontinence, urinary retention (incontinence) symptoms such as crossing legs and squatting are common. In addition, important findings such as intermittent straining or infrequent urination (<4), such as not urinating at home in the morning or at school throughout the day, are observed. Diagnosis can be made in 90% of these children by detailed questioning of clinical complaints with a symptom scale, careful abdominal, back, anus and neurological examination, urinary ultrasound and voiding test (uroflowmeter). Rarely, invasive (destructive) tests such as voiding cystourethrography, urodynamics and bladder-bowel dysfunction diary may be needed.
Incontinence (Daytime urinary incontinence)
Daytime� The situation is serious in children who leak urine while awake. Kidney and urinary tract infection causes serious kidney damage and psychological problems. This problem does not go away on its own and the cause must be found and treated correctly. Children with urinary incontinence may even have bad relationships with friends at school because they smell. Most of these children live an isolated life at school and their school success may decrease.
Causes of incontinence (daytime urinary incontinence)
• Posterior urethral valve (curtain at the bladder outlet).
• Voiding disorder
• Neuropathic bladder (paralyzed bladder)
TREATMENT Purpose of treatment
• Urinary Relieving complaints such as incontinence, frequent urination and sudden urgency
• Relaxing the sphincter (pelvic floor) muscles during urination, ensuring normal urination, reducing residual urine, reducing high bladder pressure and providing normal bladder capacity
• Relieves urinary dysfunction, constipation, urinary infection and VUR and prevents renal damage
Treatment steps
• Standard Urotherapy: Education, information and behavioral treatment
• Alternative Urotherapy: Biofeedback and Neuromodulation
• Invasive treatment: Drug therapy and interventional treatment
Standard Urotherapy Training and Information
• The family should be informed and motivated by giving confidence,
• It should be stated from the beginning that the treatment will take a long time,
• Normal bladder function should be explained,
• The current problem (wrong habits) and its differences from normal should be explained.
Rational eating habits
• Fluid intake: Although it varies depending on the age of the patient, 2 drinks per day in school-age children. Liters (8 glasses) of water should be consumed. Fanta, cola and all kinds of acidic drinks should be avoided.
• Food intake: Instead of foods that irritate the bladder and cause constipation, plenty of vegetables and fruits should be consumed.
Rational toilet. habit
• Half of constipation is accompanied by urinary incontinence during the day or at night. When constipation improves, 2/3 of the patients recover spontaneously. Therefore, correction of bowel disorder is essential in the treatment of bladder disorder.
• Toilet e� Education: The child should be taken to the toilet just before going to bed and when he wakes up. He/she should go to the toilet every 2 hours during the day. In Turkish toilets (toilet), feet should be in contact with the floor. For girls, their underwear should be pulled down to their ankles so that their legs are opened while urinating.
• Toilet type: Having a sufficient number of toilets in schools, suitable for the age of the children and suitable for hygiene, is important in preventing urination disorders and in the recovery of such sick children. It keeps.
• Defecation: The intestines need to be emptied regularly and comfortably every day. If the intestines are comfortable, the risk of urinary infection and urination disorders decreases.
Alternative Urotherapy
Biofeedback (Pelvic floor muscle training) It can be applied to children older than 5 years of age when mental maturity has developed. Bladder muscle and sphincter compliance are introduced. Sphincter relaxation is taught on the computer. Thus, normal functioning of the bladder is ensured.
Electrodes are attached to the skin on both sides of the anus and on one leg. These muscles are relaxed by teaching the child to contract and relax the muscles around the urinary tract as a game. The main purpose is to ensure complete emptying of the bladder and bowel by loosening the child's bladder when he sits on the toilet. Thus, urinary disorders, urinary infections and urinary incontinence are significantly reduced.
Kegel exercise: It is the exercise version of biofeedback performed at home without a computer. The child strengthens the muscles around the urinary tract and anus by pretending to hold urine and defecate. It is a procedure performed to strengthen, relax and control the sphincter by giving a very low dose of electrical stimulation.
Invasive treatment Drug treatment
• Preventive antibiotics are given to prevent urinary infection.
• Anticholinergic drugs are given to relax the bladder by relaxing the muscle and reducing the pressure in the overly contracted bladder.
• Enemas and laxatives are given to treat and prevent constipation.
• Sleep at night to empty the bladder Drainage and TAC are performed during the day.
Read: 0
