KidsMD Health Topics

Voiding Dysfunction

  • Voiding dysfunction means that your child is unable to completely empty her bladder.

    • In a normal cycle, your child’s bladder stretches easily when it fills with urine and then contracts fully during voiding.

    • There should be no premature contractions of the bladder or increases in pressure as it fills.

    • During the normal voiding phase, there should be complete relaxation of the external urethral sphincter muscle, so the urine released from the bladder flows smoothly and completely, without interruption, as the bladder empties itself.

    • An interrupted or intermittent flow of urine or incomplete emptying are causes of voiding dysfunction.

    Urodynamics testing

    Boston Children’s Hospital uses urodynamics testing to evaluate how your child’s bladder carries out its two main functions: filling and emptying. The results of this testing will allow your child’s physicians to better diagnose and voiding dysfunction.

    Voiding Improvement Program (VIP)

    Boston Children's Hospital
    300 Longwood Avenue
    Hunnewell 3
    Boston, MA  02115


    617-355-7796



  • What causes voiding dysfunction?

    Sometimes, the disruption of the voiding cycle may be the result of a neurological problem. This could be the result of an abnormality of the spinal cord or brain that affects how nerves help control the function of the bladder and urinary sphincter.

    However, it’s more often a learned problem. For example, your child may continually hold his urine in all day because he doesn’t want to stop playing to go to the bathroom.

    Children get into this routine for different reasons:

    • Some may be routinely too busy to break for the bathroom.
    • Others may have experienced a urinary tract infection that caused pain and as a result are afraid of urinating.
    • Sometimes the problem is related to potty training.
    • A child may have taken on abnormal urinating habits from the beginning.

    A hard cycle to break

    Whatever the reason, some children get into a pattern of not relaxing their external urethral sphincters. Their bladders can tolerate this for months and in some cases years, depending on how hard the child works to avoid urinating.

    Eventually the bladder muscle, which has to continually work against this voluntary blockage, will become so strong that it will overcome the blockage and periodically empty on its own, whether the child is sitting in a classroom or out on the soccer field.

    What are the symptoms of voiding dysfunction?

    Incontinence during the day and night may be the first sign that there is a problem.

    Other symptoms include:

    • urinary tract infection
    • frequent urination
    • urgent urination
    • pain or straining with urination
    • hesitancy
    • dribbling
    • intermittent urine flow
    • pain in the back, flank or abdomen
    • blood in the urine
  • How is voiding dysfunction diagnosed?

    If your child is experiencing the symptoms described above, it’s likely that he’ll be referred to a pediatric urologist for evaluation. The urologist will most likely take a history of your child's voiding patterns and may ask you to create a voiding diary. This is perhaps the most important component of correctly diagnosing a dysfunctional voiding pattern.

    This is usually followed by a thorough physical examination, urinalysis and urine culture. Radiologic and urodynamic evaluation (a detailed study of bladder function) may be used to both confirm the diagnosis of a dysfunctional voiding pattern and to document its aftereffects.

    Further evaluation of the urinary tract is dictated by the severity and character of your child’s symptoms. Some of the tests your child’s doctor may recommend are the following:

    • Voiding cystourethrogram (VCUG) — A specific x-ray that examines well your child’s urinary tract. The images will show if there is any reverse flow of urine into the ureters and kidneys.

    • Radionuclide cystogram (RNC) — An RNC is similar to a VCUG except a different fluid is used to highlight well your child’s urinary tract.

    • Renal ultrasound —The test is used to determine the size and shape of well your child’s kidney, and to detect a mass, kidney stone, cyst or other obstruction or abnormalities.

    • Intravenous pyelogram (IVP) — An IVP reveals the rate and path of urine flow through the urinary tract.

    • Blood tests — To see how well your child’s kidneys are working.

  • Most treatment begins with a timed voiding schedule where you'll ask your child to go to the bathroom right when he wakes up, every two to three hours thereafter, and upon going to bed at night.

    It's also important to have your child completely relax while urinating. These simple changes are often enough to help your child work through the problem.

    In some children, however, medication may be necessary to decrease bladder hyperactivity enough to facilitate attempted changes in voiding habits.

    Rarely, extensive reconstructive surgery such as bladder augmentation (adding a piece of the intestine or stomach to the bladder to increase bladder capacity) may be necessary.

    If your child was also diagnosed with vesicoureteral reflux, that condition may get better on its own. If it doesn't, it may need to be treated surgically. For more information on what that means, see our page on vesicoureteral reflux.

    Follow-up

    Your child's doctor will want to follow up with you and your child to make sure everything's going well.

    It's essential to prevent urinary tract infections and make sure that any other associated problems, such as vesicoureteral reflux, bladder dysfunction or kidney problems, are being appropriately controlled.

    The key with voiding dysfunction is to identify it early on, treat it and limit the possible negative effects it can have on your child's urinary system.

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