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Current Pediatrics Reports

31-08-2024 | Elimination Disorders Free for a limited time

Bladder and Bowel Dysfunction: An Updated Guide for the Pediatrician and Pediatric Nephrologist

Authors: Kay Chua Rivera, Mandy Rickard, Abby Varghese, Michael Erlano Chua, Armando Lorenzo, Joana Dos Santos

Published in: Current Pediatrics Reports

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Abstract

Purpose of review

Bladder and Bowel Dysfunction (BBD) encompasses lower urinary tract symptoms alongside functional constipation with or without encopresis, absent a neurologic cause. It is a prevalent yet often underdiagnosed condition that is associated with significant UTI risk, morbidity, social stigma, parental stress, and treatment costs. Early identification and intervention are crucial to prevent complications like renal scarring and chronic kidney disease (CKD) and to improve overall quality of life. This review aims to provide updated clinical management recommendations pertinent to pediatricians and pediatric nephrologists.

Recent findings

While urotherapy has remained standard of care, treatment options for pediatric BBD symptoms have expanded in the last decade. This includes additional pharmacologic options, such as beta-3 agonists for overactive symptoms; minimally invasive interventions such as implantation of sacral neuromodulation devices for fecal and urinary incontinence; and surgical treatments such as onabotulinum toxin injections for overactive symptoms or dysfunctional voiding.

Summary

A multidisciplinary approach involving pediatricians, clinicians, urologists, nephrologists, physiotherapists, social workers, and psychologists is essential for comprehensive management and family support. Early recognition at the primary care level and appropriate specialist referral is paramount.
Literature
1.
Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: an update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J. 2017 Jan-Feb;11(1–2Suppl1):S64–72. https://​doi.​org/​10.​5489/​cuaj.​4411. PMID: 28265323; PMCID: PMC5332240.
2.
Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015;136(1):e13–21. https://​doi.​org/​10.​1542/​peds.​2015-0409. Epub 2015 Jun 8. PMID: 26055855; PMCID: PMC4485012.CrossRefPubMedPubMedCentral
3.
Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, Rittig S, De Gennaro M, Jackson E, Fonseca E, Nieuwhof-Leppink A. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society. Pediatr Nephrol. 2018;33:2207–19.CrossRefPubMed
4.
5.
Ambartsumyan L, Siddiqui A, Bauer S, Nurko S. Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts. Neurogastroenterology Motil. 2016;28(6):924–33.CrossRef
6.
7.
8.
Cole EB, Khemmani M, Liu H, Halverson TM, Noronha MF, Forster CS, Wolfe AJ, Shaikh N. Urogenital urobiome of healthy children does not differ from that of children with bladder and bowel dysfunction. J Pediatr Urol. 2023;19(4):368.e1-368.e8. https://​doi.​org/​10.​1016/​j.​jpurol.​2023.​04.​009. Epub 2023 Apr 13. PMID: 37117081; PMCID: PMC10524508.
9.
Chang SJ, Tsai LP, Hsu CK, Yang SS. Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children. Pediatr Nephrol. 2015;30:1131–7.CrossRefPubMed
10.
11.
Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998;160(3 Part 2):1019–22.CrossRefPubMed
12.
Snodgrass W. The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol. 1998;160(5):1823–5.CrossRefPubMed
13.
O’Kelly F, t’Hoen LA, Silay S, Lammers RJM, Sforza S, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Marco BB. Neuropsychiatric Developmental disorders in Children are Associated with an impaired response to treatment in bladder bowel dysfunction: a prospective multi-institutional European observational study. J Urol. 2023;210(6):899–907. Epub 2023 Sep 25. PMID: 37747130.CrossRefPubMed
14.
Wang R, Van den Heuvel M, Rickard M, El-Bardisi Y, Mistry N, Koyle M, Farhat W, Santos JD. Neurodevelopmental and psychiatric disorders in pediatric bladder and bowel dysfunction. J Pediatr Urol. 2021;17(4):450.e1-450.e6. doi: 10.1016/j.jpurol.2021.03.032. Epub 2021 Apr 3. PMID: 33947637.
15.
Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn. 2016;35(4):471–81.CrossRefPubMed
16.
Hinman F, Baumann FW. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol. 1973;109(4):727–32.CrossRefPubMed
17.
Burgers RE, Mugie SM, Chase J, Cooper CS, von Gontard A, Rittig CS, Homsy Y, Bauer SB, Benninga MA. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013;190(1):29–36.CrossRefPubMed
18.
19.
20.
21.
Fairhurst JJ, Rubin CM, Hyde I, Freeman NV, Williams JD. Bladder capacity in infants. J Pediatr Surg. 1991;26(1):55–7.CrossRefPubMed
22.
Guerra LA, Keays MA, Purser MJ, Wang SY, Leonard MP. Pediatric Cystogram: are we considering age-adjusted bladder capacity? Can Urol Association J. 2018;12(12):378.
23.
Wolfe-Christensen C, Manolis A, Guy WC, Kovacevic N, Zoubi N, El-Baba M, Kovacevic LG, Lakshmanan Y. Bladder and bowel dysfunction: evidence for multidisciplinary care. J Urol. 2013;190(5):1864–8.CrossRefPubMed
24.
Khondker A, Ahmad I, Rajesh Z, Balkaran S, Aldaqqaq Z, Kim JK, Brownrigg N, Varghese A, Chua M, Rickard M, Lorenzo AJ, Dos Santos J. The Role of Secondary Conservative Management Strategies in Bladder and Bowel Dysfunction: A Systematic Review and Meta-analysis. J Pediatr. 2024 Jun 19:114152. https://​doi.​org/​10.​1016/​j.​jpeds.​2024.​114152. Epub ahead of print. PMID: 38906507. Importance: secondary conservative management strategies, often falling under urotherapy measures, continue to positively impact urine incontinence, infection risk, and uroflowmetry findings.
25.
26.
Assis GM, da Silva CP, Martins G. Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review. Jornal De Pediatría (Versão em Português). 2019;95(6):628–41.CrossRef
27.
Champeau A, Baskin L. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society EDITORIAL COMMENT. J Urol. 2013;190(1):36.CrossRefPubMed
28.
Bush NC, Shah A, Barber T, Yang M, Bernstein I, Snodgrass W. Randomized, double-blind, placebo-controlled trial of polyethylene glycol (MiraLAX®) for urinary urge symptoms. J Pediatr Urol. 2013;9(5):597–604.CrossRefPubMed
29.
Kwon J, Kim DY, Cho KJ, Hashimoto M, Matsuoka K, Kamijo T, Wang Z, Karnup S, Robertson AM, Tyagi P, Yoshimura N. Pathophysiology of overactive bladder and pharmacologic treatments including β3-Adrenoceptor agonists -Basic Research Perspectives. Int Neurourol J. 2024;28(Suppl 1):12–33. Epub 2024 Feb 29. PMID: 38461853; PMCID: PMC10932578.CrossRefPubMed
30.
31.
Hsu FC, Weeks CE, Selph SS, et al. Updating the evidence on drugs to treat overactive bladder: a systematic review. Int Urogynecol J. 2019;30(10):1603–17.CrossRefPubMedPubMedCentral
32.
33.
Xu R, Balthazar A, Sherlock R, Estrada C. Cost analysis for mirabegron use in the treatment of children with neurogenic bladder. J Pediatr Urol. 2023;19(5):535. .e1-535.e10. Epub 2023 Jun 14. PMID: 37423791.CrossRef
34.
35.
Fryer S, Nicoara C, Dobson E, Griffiths M, McAndrew HF, Kenny SE, Corbett HJ. Effectiveness and tolerability of mirabegron in children with overactive bladder: a retrospective pilot study. J Pediatr Surg. 2020;55(2):316–8.CrossRefPubMed
36.
Nasution R, Husein A, Adhyatma KP. Efficacy and safety of mirabegron in pediatric population: a systematic review. Int J Surg Open. 2021;37:100412. Importance: mirabegron appears to be safe and effective as first line therapy for overactive bladderin children.CrossRef
37.
38.
Richter J, Rickard M, Chua M, Kim JK, Chancy M, Brownrigg N, Khondker A, Lorenzo AJ, Santos JD. Assessing safety and tolerability of super selective alpha-1 adrenergic blockers in infants under 3 years: insights from a single-center study on lower urinary tract obstruction (LUTO). J Pediatr Urol 2024 Jun 8:S1477-5131(24)00303-6. doi: 10.1016/j.jpurol.2024.06.005. Epub ahead of print. PMID: 38906708.
39.
de Abreu GE, de Souza LA, da Fonseca ML, Barbosa TB, de Mello ER, Nunes AN, Barroso UD Jr. Parasacral transcutaneous electrical nerve stimulation for the treatment of children and adolescents with bladder and bowel dysfunction: a randomized clinical trial. J Urol. 2021;205(6):1785–91.CrossRefPubMed
40.
Borch L, Rittig S, Kamperis K, Mahler B, Djurhuus JC, Hagstroem S. No immediate effect on urodynamic parameters during transcutaneous electrical nerve stimulation (TENS) in children with overactive bladder and daytime incontinence-A randomized, double-blind, placebo-controlled study. Neurourol Urodyn. 2017;36(7):1788–95. https://​doi.​org/​10.​1002/​nau.​23179. Epub 2016 Nov 21. PMID: 27868230.CrossRefPubMed
41.
Sillén U, Arwidsson C, Doroszkiewicz M, Antonsson H, Jansson I, Stålklint M, Abrahamsson K, Sjöström S. Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: a randomized controlled trial. J Pediatr Urol. 2014;10(6):1100–5. Epub 2014 May 9. PMID: 24881806.CrossRefPubMed
42.
Elkelini MS, Abuzgaya A, Hassouna MM. Mechanisms of action of sacral neuromodulation. Int Urogynecol J. 2010;21(Suppl 2):S439–46.CrossRefPubMed
43.
44.
Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM, Kamm MA. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg. 2004;91(12):1559–69.CrossRefPubMed
45.
Dwyer ME, Vandersteen DR, Hollatz P, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a 10-year single-center experience with 105 consecutive children. Urology. 2014;84(4):911–7.CrossRefPubMed
46.
Groen LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R, Vande Walle J, Everaert K. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol. 2012;188(4):1313–7.CrossRefPubMed
47.
Lambregts AP, Nieuwhof-Leppink AJ, Klijn AJ, Schroeder RPJ. Intravesical botulinum-A toxin in children with refractory non-neurogenic overactive bladder. J Pediatr Urol. 2022;18(3):351.e1-351.e8. doi: 10.1016/j.jpurol.2022.02.007. Epub 2022 Feb 18. PMID: 35283021. Importance: intravesical botox injections represent a safe treatment option for non neurogenic overactive bladder symptoms. In particular they seem to benefit those who are refractory to urotherapy and medication.
48.
Hoelscher SA, de Angst IB, Buijnsters Z, Bramer WM, Akkermans F, Kuindersma M, Scheepe JR. The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding–A systematic review. Journal of Pediatric Urology. 2023 Nov 7. Importance: intrasphincteric (NOT intradetrusor) botox injections represent a safe treatment option for dysfunctional voiding in children, and has been shown to decrease post void residuals and UTIs.
49.
Jørgensen CS, Breinbjerg AS, Rittig S, Kamperis K. Dissatisfaction with school toilets is associated with bladder and bowel dysfunction. Eur J Pediatrics. 2021;180(11):3317–24.CrossRef
Metadata
Title
Bladder and Bowel Dysfunction: An Updated Guide for the Pediatrician and Pediatric Nephrologist
Authors
Kay Chua Rivera
Mandy Rickard
Abby Varghese
Michael Erlano Chua
Armando Lorenzo
Joana Dos Santos
Publication date
31-08-2024
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