Nocturia and daytime urinary incontinence in children with detrusor pseudohyperactivity syndrome and constipations
Ryszard Makosiej1, Elżbieta Czkwianianc1,2, Danuta Leśniak3, Małgorzata Niedworok1, Beata Sordyl1, Piotr Raczyński4, Anna Midel5, Ewa Małecka-Panas1,2
The aim of study was the evaluation of dependencies occurring urinary incontinence in children with chronic constipations. Material and methods: Examinations were conducted on 45 children aged between 6 and 13, including 20 girls and 25 boys, staying in the Clinic because of nocturia and daytime urinary incontinence coexisting with chronic constipations. In all children a complex diagnostic of lower alimentary tract segment and urinary system with evaluation of space behind the bladder in ultrasonography (USG) examination were performed. Also, 3 day evaluation of frequency and volume of each portion of urine, as well as urodynamic examination were performed. Results: The examinations of urinary system in all examined children did not reveal marks of infection nor coexisting urinary system anomalies and the performed USG examination revealed the pressure of overflown rectal ampulla on the rear wall of the urinary bladder of various degree. Urodynamical examinations revealed decrease of the tenesmus feel threshold during the filling of the urinary bladder. This phenomenon had a firm connection with the release of small portions of urine by children. Emptying of bowel from retenting faeces masses, diet correction and faeces loosening medications, as well as applied prokinetical medications, caused regression of constipations and nocturia and daytime urinary incontinence, which influenced the gradual increase of volume of passed urine portions. Conclusions: In the analysis of urine passing disorders in children the chronic habitual stool constipation should be taken into account. In the therapeutical management of some types of nocturia and daytime urinary incontinence (detrusor pseudohyperactivity syndrome) in children, a treatment of chronic constipation should be applied first of all.