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2017 ; 11
(1-2Suppl1
): S64-S72
Nephropedia Template TP
gab.com Text
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English Wikipedia
Bladder and bowel dysfunction in children: An update on the diagnosis and
treatment of a common, but underdiagnosed pediatric problem
#MMPMID28265323
Santos JD
; Lopes RI
; Koyle MA
Can Urol Assoc J
2017[Jan]; 11
(1-2Suppl1
): S64-S72
PMID28265323
show ga
Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary
symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily
by constipation and/or encopresis. This increasingly common entity is a potential
cause of significant physical and psychosocial burden for children and families.
BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary
tract infections (UTIs), which at its extreme may lead to renal scarring and
kidney failure. Additionally, BBD is frequently seen in children diagnosed with
behavioural and neuropsychiatric disorders such as
attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder
(ASD). Patients with concomitant BBD and neuropsychiatric disorders have less
favourable treatment outcomes. Early diagnosis and treatment of BBD are critical
to avoid secondary comorbidities that can adversely impact children's kidney and
bladder function, and psychosocial well-being. The majority of patients will
improve with urotherapy, adequate fluid intake, and constipation treatment.
Pharmacological treatment must only be considered if no improvement occurs after
intensive adherence to at least six months of urotherapy ± biofeedback and
constipation treatment. Anticholinergics remain the mainstay of medical
treatment. Selective alpha-blockers appear to be effective for improving bladder
emptying in children with non-neurogenic detrusor overactivity (DO),
incontinence, recurrent UTIs, and increased post-void residual (PVR) urine
volumes. Alpha-1 blockers can also be used in combination with anticholinergics
when overactive bladder (OAB) coexists with functional bladder outlet
obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder
injections, and recently neurostimulation, are promising alternatives for the
management of BBD refractory to behavioural and pharmacological treatment. In
this review, we discuss clinical presentation, diagnostic approach, and
indications for behavioural, pharmacological, and surgical treatment of BBD in
children based on a thorough literature review. Expert opinion will be used when
scientific evidence is unavailable.