Chapter I Prelude

Voiding dysfunction is a broad term use to describe a voiding (urination) pattern that is abnormal for the child's age. A normal bladder stretches easily as it fills with urine. It does not contract or increase in pressure as it fills. As the bladder contracts during normal voiding, the external urethral sphincter muscle should completely relax so that the urine released from the bladder flows smoothly, completely, and without interruption( 1)

The prevalence of pediatric voiding dysfunction and daytime incontinence is difficult to determine due to varying definitions of urinary incontinence (UI) and different study designs. Furthermore, few studies have evaluated the prevalence of the different types of voiding dysfunction in children. The prevalence of daytime wetting varies with age and gender. Overall rates vary from 1% to 10%. In 6 to 7-year-old children, the rate is between 2% to 4%, with a rapid decrease in subsequent years (Bloom, Seeley, Ritchey, & McGuire, 1993; Bower, Moore, Shepherd, & Adams, 1996).

Chapter II Voiding Dysfunction in Children Voiding Dysfunction

2.1 definition

Dysfunctional voiding refers to an abnormality in either the storage or emptying phase of micturition and is associated with urgency, frequency, incontinence, and UTIs. 4 A normal bladder stretches easily as it fills with urine. It does not contract or increase in pressure as it fills. As the bladder contracts during normal voiding, the external urethral sphincter muscle should completely relax so that the urine released from the bladder flows smoothly, completely, and without interruption. A problem in bladder filling or emptying is called a voiding dysfunction. 1 According to the current International Childrens Continence Society (ICCS) terminology guidelines, dysfunctional voiding is a problem of the emptying phase of the bladder and a condition where the urethral sphincter habitually contracts during voiding. Etiologi The true causes of dysfunctional voiding are unknown. It is probable that the causes are multifactorial and include learned behaviour, perpetuation of infantile patterns, maturational delay and, possibly, to a lesser extent, genetic or congenital factors.2 Bowel dysfunction is an inherent and indispensably important part of voiding dysfunction in children, as the genito-urinary and gastrointestal tracts are interdependent. They share the same embryological beginnings, pelvic location, aspects of innervation and passage through the levator ani. Stool retention, with or without faecal incontinence, is therefore an important coexisting condition with dysfunctional voiding as a result of the non-relaxation of the pelvic floor musculature