Urge Urinary Incontinence

Kidney and urinary tract
1

Hello

My daughter is 11 years old and has urge urinary  incontinence since birth (we realised it when she was 6 and still wetting before reaching toilet)

We did all investigations viz- MRI, Urodynamics, Sonography etc.

Reports say the following

Sonography

Her prevoid volume is 60 ccs. No significant post void residue.

Urodynamics

Pressure flow study was done in sitting position with 2 plastic catheters, fill speed 20mls/min. There was random residue of 110mls on catheterisation.

Filling phase reveals a reduced capacity bladderwith over active contractions from bladdervolume of 145mls, with urge leak. In fact she leaked about 80mls with her last contractionand finally voiding was with over active contraction showing normal flowmetry and mildly raised P det.

this is likely to be idiopathic detrusor over activity considering the preentation since childhood.However MRI spine scan will rule out any other cause.EMG is synergic.

Main result: These tests reveal satisfactory flow, no residue and a reduced capacity bladder with detrusor overactivity and urge leak as above. Compliance and proprioception are normal and EMG is synergic.

MRI

Normal

She was on Tropan(Oxybutanin) 5mg for over a year and responded well during day time. Her night time wetting was still there.

We stopped it and after a few weeks she was back to the same problem.

Then she was on Tropan 5mg again for a few months regularly and following it whenever she was having holidays we used to skip the medicine.

Then again we totally discontinued it for about a year and she was managing ok wetting once ina while . But this year in March we realised that she was having the same problem again. So this time on the advice from another Paedeatric Urologist she was given Terol LA 2mg(Tolterodine Tartrate IP). She did not respond to it and was given Terol 4mg , to which she responded well (similar to Tropan)

Kindly advice what would be the best treatment option for her as these medicines help temporarily, once stopped the problem is back.

We have also hired a physical trainer since the past 2 months to strengthen her muscles. He says generally her core muscles appear to be weak.

Also wanted to know

* if her bladder is weak / overactive or

* is there some signalling from brain that is going wrong or

* can it be that her exterior sphincter muscle, which is voluntary, not functioning properly in her case.

Thank you very much

Regards.

2

hello my name is shona and i am 17 years old and i have an overactive bladder. i understand that i am a bit older than you daughter as shes 11. i only found out that i have an overactive bladder a year ago. this is because it can sometime be hard to notice, it depends how overactive it is. your case is a bit like mine! when i was young doctors first though that my muscles were weak and then they thought that it was bad communicatio from bladder to brain. as shes 11 it might be difficult for them to have a 100% right answer. (sorry) i have always been told that we are all different and no case is ezactly the same.

im guessing that she has had a few different types of medication by now. desmo melts were the best for me. have you tried them? they are only on perscription though!

i know there is a minor operation avalible for children with overactive bladders, had it myself. this operation is the use of botox that will calm the nerves and muscles around the bladder. its such a simple operation that your child would be out the same day as the op!  but its up to professinals!

im sorry i cant be a big help. i am only 17.

please comment if you have anything to say or any questions. im happy to share or go into detail about anything!!!

3

Hi Sonali4. I am very sorry to hear of all the difficulties your daughter is experiencing at the moment. It must be really upsetting for her and you.

My problems with urgency and leaking also started in childhood though I was a little bit older than your daughter by the time it was bad. It must help her a lot that she has your support in trying to find a solution to this now (unfortunately I, and I think many people who suffer this, didn't meet with such help and that just made things worse).

Regarding the drugs, I also take Oxybutinin (though I started this as an adult). It does help - and until I had some other gynae issues recently which have made things worse again, it had made a very substantial improvement to the problem. I had gone from needing full protection to small pads.

However, if I stopped it (eg even if I missed tablets for a few days because a prescription ran out) the problems did come back and my GP has always seen it, as far as I'm aware, as something that needs to be taken permanently. It helps whilst taking it but it doesn't cure the problem in the sense that I will be able to stop taking it. However I have to say that unfortunately I don't know about how it is used in children.

4

I also had problems when I was your age (now in my 30s). Well done for going to the doctor's and getting help already - I did not dare to seek help until I was much older. Trying to cover up the problem at school and college was very difficult. I hope that you found that your operation helped you?

5

Hi

This is a question for you. My 6 yr old daughter urinates in her pants at least 3 times a day, not to mention her full nappies at night time. We toilet trained her at 3 years old, and she was going to the toilet for approximately 6 months, until suddenly she started just weeing in her pants. We ask her to go to the toilet-and often she just pretends or ignores us-which results in wet pants. Then when we ask her to change her wet pants she causes quite a struggle. I am not certain that she is aware that she's doing it when it happens-but sometimes it appears that she does because she gets nervous and sneaky. 

I'm not sure if she is doing this as a means of getting attention (because she is 1 of 6 kids) or if she has a serious problem.

So my question is, can you (or any other repliers) please tell me what tests need to be done to confirm if her urinating problem is a result of overactive bladder, or weak pelvic muscles, or any other tests to figure it out??

6

Hi,I am 68 & have had  similar problems,worse since my  20s when sexually active in fact given up .

Had research 1969 at Royal Free that found spina bifida occulta, abnomal EEG fatty liver, scarred kidneys since neurogenic bladder and double ureters .

Had keyhole urethrotomy don't feel pain to point now getting spinal spasicity when out of control as well as different excrutiating pain  .I try to adapt the oxybutinin accordingly as often don't go for hours .

Can't catheteise & now not getting specialised assistance re rotated antibiotics due to No Appropriate Care in the Community so wondering whether a  sacral stimulator may sort out problem.This was suggested  by ProCon as NHS regards SBO as Low Priority ignoring  fact  need appropriate assistance.As a result not married , long term relationship & family .Been chaste since 1970s- when AIDS  appeared .