Voiding Improvement Program (VIP)
Amy knew something was wrong when her ten-year-old daughter Julia started to have frequent bathroom accidents in school.
Then, Julia began experiencing more serious symptoms: She began straining when urinating. Her temperature would shoot up to above 100 degrees and she would vomit violently. Often, she’d be forced to miss school for up to a week.
Collecting urine samples for a doctor’s appointment, Amy noticed very little urine, even though Julia drank lots of liquids beforehand. Her hunch was that Julia was not emptying her bladder ("voiding") properly.
“It was really scary for us,” says Amy. “I kept telling every doctor and nurse that would listen until someone finally called Children’s." Julia was referred to the Voiding Improvement Program. Once there, pediatric nurse practitioner Pamela Kelly, RN, PNP, identified Julia’s main issues and then referred her to Biofeedback training in Urodynamics. These two initiatives work hand in hand.
The main function of Children’s Urodynamics Program, a hospital-based program within the Department of Urology, is to evaluate how the bladder carries out its two main functions: filling and emptying. The characteristics of how the bladder and sphincter muscles work together can give clues as to why a child may be wet, have a urinary tract infection and/or have urinary tract abnormalities.
When the Parkers arrived at Urodynamics, everything Amy suspected was validated. Julia was not emptying her bladder properly. She was holding in her urine for very long periods of time and had been experiencing urinary tract infections.
Julia was diagnosed with kidney reflux, an abnormal flow of urine from the bladder back into the kidneys that often leads to urinary tract infections. After a successful surgery led by Children's urologist-in-chief Alan B. Retik, MD, Julia stopped getting kidney infections. Yet she continued to get bladder infections due to a dysfunctional voiding pattern which further exacerbates her symptoms and her wetting. This is when she was referred to the VIP, and in turn for Biofeedback training in Urodynamics.
“When Julia is off of her medicine, she gets one urinary tract infection after another,” Amy says. “That’s why we are here.”
As part of her ongoing treatment, Julia visits Urodynamics every two to three weeks. First, her care team scans her bladder, using a painless ultrasonic probe (similar to an ultrasound machine). Next, Julia goes to the bathroom in privacy wearing a special patch, and urinates in a special toilet, which lets her team monitor how much urine flows out and how tightly or loosely she holds her sphincter muscle.
“Some steps are difficult, but everybody here is phenomenal in making Julia feel comfortable,” Amy says. “I ask a lot of questions and they are always responsive. They gave us lots of information before we even started. They tell us exactly what’s going on, and clearly explain to Julia about what she’s supposed to do to void properly.”
With the help of the Urodynamics team, Julia has shown drastic improvement in just a short while. To treat her dysfunctional voiding, the team uses Biofeedback therapy—a series of exercises and techniques that teach patients how to control their sphincter muscle in order to improve flow and be able to empty their bladders.
Julia performs these exercises at home as well. The Biofeedback program also teaches proper toileting techniques, timed voiding schedules and relaxation exercises. And the team helped the Parkers identify certain foods that were affecting Julia’s condition, recommending some helpful changes to her diet.
The Parkers hope that the urodynamics procedures will improve Julia’s voiding to the point when she will no longer require medicine.
“Urodynamics is a very important part of the whole puzzle if your child is going through this,” Amy says. “My advice to other concerned parents is to follow through with the recommendations from Urodynamics and to keep up with the exercises. Keep asking questions and keep pushing. If you get here and follow their advice, you will see significant improvements.”