Incontinence and urination disorders: what can we do?

Alterations on urination are a common reason for more and more frequent consultation in Pediatrics. They can refer so much to problems of daytime voiding pattern as to incontinence. Recurrent urinary tract infections can also be an expression of these disorders. They can be due to the presence of organic anomalies such as the anatomical obstruction of the lower urinary tract or the neurogenic bladder. But there are more common the functional causes, which traditionally have been grouped under the term dysfunctional voiding and at present they are named disorders of the lower urinary tract function. Its clinical impact varies from changes in the pattern of voiding or slight incontinence, to more severe disorders that lead to irreversible alteration of bladder function. The diagnosis rests fundamentally on a good clinical history and physical examination along with the so-called voiding diary. The complementary explorations (including urodynamic evaluation) should be assessed individually.

A suitable understanding of normal and abnormal functioning of the bladder allows a satisfactory approach to the problem in the paediatric primary care. We must give great importance to the first level of treatment: healthy diet, treatment of constipation, proper hygiene and regular voiding pattern. When the initial evaluation identifies an organic problem, or when initial treatment fails, we must refer the hospital level.