Which of the following are not associated with urinary incontinence in a child?
A. Urinary flow rate indicating an overactive bladderAnswer C
A ‘tower’ shaped flow rate can give a useful indication of an overactive bladder. The appearance of flattened buttocks is characteristic of sacral agenesis and neuropathic bladder. The ICCS definition of abnormal residual volume a little difficult to remember. For children aged 4–6 years, the residual volume is abnormal if on repeated measures it is more than 20 mL or more than 10% of bladder capacity (bladder capacity = voided volume + residual volume). For children who are 7–12 years repeated measured residual of more than 10 mL, or 6% of bladder capacity are abnormal.
If a history of faecal incontinence is volunteered then more careful evaluation is required. Most commonly faecal incontinence is a manifestation of constipation. Assessment of a child with constipation would include asking how often the child opens their bowels, whether there is associated pain or blood, examination of the abdomen for palpable stool and checking for spinal abnormality. A bowel diary kept over a week can be useful including comparison against the Bristol stool chart. Treatment of constipation will frequently result in resolution of urinary symptoms. However, faecal leaking may be a manifestation of neuropathic bladder and bowel. It is possible however that faecal leaking may be related to spinal abnormality. It is important that this is considered, other symptoms and signs of abnormality sought, and if there is adequate concern, spinal imaging arranged.
Vaginal reflux is a cause of post-micturition wetting in girls. It is effectively treated by abducting the legs widely during voiding.