Download - Astra Tech

and bladder simply “grow apart” from each other.This results in decreased sensation and perception ofthese warning signals. Next, unwanted symptoms suchas urgency, frequency, urge incontinence (wetting),constipation (infrequent, large, painful poops), stoolincontinence (smearing), abdominal pain, painfulurination (dysuria), holding postures, and urinary tractinfections (UTIs) begin to present.In a majority of these cases, these poor bladder andbowel habits are purely behavioral in nature. Thereis a very small percentagechance that there is somethingstructurally wrong with theanatomy. Treatment simplyinvolves “re-potty training”the child towards good bowel,bladder, and hygiene habits.With intensive behavioralmodification, and a lot of helpfrom family, friends, school,but most importantly the child,improvements can be made.After a very detailed historyand physical is done by yourprovider, they will provide aseries of recommendations thatfollow a detailed “Bowel andBladder” program. Sometimesurine tests and x-rays willbe ordered in addition to thevisit. In short, the child mustbe compliant with a “timedvoiding schedule” (every 2-3hours), practice unhurried andrelaxed voiding posture, andhave meticulous hygiene and wiping habits. Any form ofconstipation must be managed aggressively. Eliminationof unwanted fluids (soda pop) and diet adjustments arealso recommended.When a child simply can not empty their bladderef fe c t ive ly u si ng st r ic t t i me d void i ng , dou ble void i ng(voiding again few minutes after first void), and optimalrelaxed voiding posture methods, clean intermittentcatheterization (CIC) may be recommended. Theseare obviously very rare cases and should always beinvestigated further with bladder studies (urodynamics),renal ultrasound (kidney images), and an MRI (magneticresonance imaging) to rule out any spinal cord defectsthat could alter normal bladder function. If CIC isrecommended, the use of a Lofric hydrophilic typecatheter can help decrease discomfort, minimize urethralirritation and trauma, and lower the incidence of UTIs.Positive reinforcement is obviously crucial for success.Punishment has no place in potty training and canultimately result in more resistance by the child, andin extreme cases, child abuse by the caretaker orparent. Most importantly, the family and the childmust be consistent, compliant, and motivated to wantto change the behavior. Remember, that childrenwill need constant guidance and frequent remindersto make improvements. Additionally, it often takesseveral weeks, months, oreve n ye a r s for t he s e u nwa nt e dsymptoms to present. Therefore,it will also take a significantamount of time to correct thesehabits.Unfortunately there are no quickfixes or magic pills to cure thisfrustrating problem, just lotsof hard work and patience. Thepercentage of relapse can alsobe high as families and childrensimply “fall off the wagon” andslip back into bad toileting habitsagain.References:• Schmitt, B., Getting kids outof the diaper and onto the toilet.Contemporary Pediatrics, (March2004), Vol. 21, No 3; pgs 105-116.• Walsh, P. C., Retik, A.B.,Vaughan, E. D., & Wein, A.J., 2002)Campbell’s Urology (8th ed.).Philadelphia, PA: W. B. SaundersCompany.Halverstadt Center of Excellence Pediatric Urology Clinic islocated at the Children’s Hospital, University of OklahomaHealth Sciences Center in Oklahoma City.Jake is the clinic manager and a full-time provider who seesall types of urological conditions, runs the dysfunctionalelimination clinic, performs all of the post-operative and CICteaching for the majority urinary reconstructive surgeries,as well as performs and interprets all the video-urodynamictesting.Special thanks to his attending physicians: Doctors Bradley P.Kropp, Dominic Frimberger, and William G. Reiner.5