Classification of daytime LUT conditions

Overactive bladder is characterized by symptoms of urgency, with or without frequent urinary incontinence (the involuntary loss of urine associated with urgency) or nocturnal enuresis. The diagnosis of an overactive bladder does not require a test such as urodynamics. Autonomic dysfunction (detrusor overactivity) can be of crucial importance in the pathogenesis of overactive bladder in childhood and can be evaluated with cystometrics.

Underactive bladder substitutes the old term, “lazy bladder”. This condition is characterized by insufficient or unsustained detrusor contraction during emptying. Children with UAB do not feel that their bladder is full and needs emptying, resulting in incontinence due to overflow. Children may demonstrate infrequent micturition and an interrupted flow pattern. They need to strain during voiding and use high intra-abdominal pressures to initiate, maintain, or complete voiding. The residue after voiding is usually so large that recurrent UTIs occur. A diagnosis of UAB is usually confirmed with urodynamics.

Dysfunctional voiding often occurs in girls, but rarely in boys. It is associated with repeated contractions of the pelvic floor muscles or urethral sphincter during voiding. Consequently, children show prolonged staccato micturition with subsequent residual urine after voiding, increasing the risk of UTIs. Loss of feeling of the filling state of both the bladder and the rectum characterizes DV, and incontinence occurs due to overflow.

Voiding postponement has been defined as a habitual postponement of micturition by using holding maneuvers. Children may postpone because they do not want to interrupt activities like playing or gaming.

- VP can present both as a symptom, as well as a condition.

- VP includes a low micturition frequency, a feeling of urgency, and possibly incontinence from an overflowing bladder.

- VP is associated with behavioral problems.

- The most common comorbid disorder is oppositional defiant disorder.

Giggle incontinence is a sudden and involuntary episode of urinary incontinence that is provoked by an episode of laughter. Stress incontinence is the involuntary leakage of small amounts of urine upon physical exertion that increases intra-abdominal pressure, e.g. coughing or sneezing. Both are rare conditions and exact causes are unknown.

Lower urinary tract disorders | 1. Basics of lutd
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