Page 1 - Dysfunctional Elimination in Children

Urological Health
Dysfunctional elimination
in children
Dysfunctional elimination of urine and stool in children may be corrected with the
encouragement and support of parents under the guidance of your doctor.
ody waste products are flushed out in the urine
Band stool. Urine is produced in the kidneys
and then carried through long narrow tubes, the
ureters, into the bladder. It is stored in the bladder
until emptied through its outlet, the urethra. During
emptying, the outlet control muscle (urethral
sphincter) should relax completely while the bladder
contracts to expel urine. Solid waste and unabsorbed
food is eliminated in the stool.
Female urinary tract, side view
Male urinary tract, side view
In infants, the bowels and bladder empty by
reflex. When full, the bladder or bowel empties
automatically. Normally, a child gains control of
bladder and bowel function by three years of age.
A child’s bladder normally fills and empties four to six
times daily. Bowel movements usually occur every day
or two.
Daytime control of urine usually occurs by the age
of three with nighttime control occurring a bit later.
Some children have persistent bedwetting for several
more years, but most will be dry by the age of seven.
Dysfunctional elimination
Children with abnormal voiding (urine elimination)
or defecation (bowel elimination) habits are felt
to have a dysfunctional elimination syndrome. The
cause of this condition is unknown. These children
may be prone to urinary accidents during the day
(diurnal enuresis) or night (nocturnal enuresis), bowel
accidents (encopresis) or urinary tract infections.
Some children will have an overactive bladder with
intense urges to void, frequent urination and wetting
associated with these urges. You may notice your
child dancing or squatting in an effort to suppress
urges to void and prevent wetting.
Others resist the signal to void and may do so only
two or three times daily. These children may develop
an overstretched bladder which cannot contract
and empty effectively. This may result in wetting or
infection. This is also described as a “lazy bladder”.
In some cases, a child may not be able to relax the
urethral sphincter completely when trying to void. The
partially closed sphincter causes resistance to bladder
emptying which causes, high bladder pressure. The
incompletely emptied bladder often leads to wetting
or infection. Rarely, high bladder pressure may lead to
kidney damage.
Some children may have elements of several voiding
dysfunctions at once.
Bowel function may also be a problem in children.
Constipation may be present if bowel movements
occur less than every other day or the stool is large or
very hard. Bowel accidents is usually a sign of severe
constipation.
Continued on next page