Abstract
Bladder Bowel dysfunction (BBD) represents a broad term used to describe a multitude of conditions associated with incontinence or Urinary Tract Infections (UTI) that commonly is seen in primary Family and/or Pediatrics care. The BBD spectrum includes lower urinary tract conditions such as overactive bladder and urge incontinence, voiding postponement, underactive bladder, and voiding dysfunction, and, importantly, also includes bowel issues, as constipation and encopresis. BBD is often not recognised by family or child or even the referring professional, but it is the secondary symptoms of wetting or UTI, that prompts the child to be evaluated by a consultant. The goal of this review is to provide a practical guideline for diagnosis and management of BBD in children, common problem in daily pediatric practice. Most importantly, considering that most of these issues are functional, is that the majority of these children are best evaluated and treatment instituted by the primary provider, with referral to a specialist, only in exceptional cases.
Highlights
Bladder Bowel dysfunction (BBD) is a broad term used to describe children who present a constellation of Lower Urinary Tract Symptoms (LUTS) associated with constipation and/or encopresis
The goal of this review is to provide a practical guideline for diagnosis and management of BBD in children, targeting mostly primary care practitioners, who very commonly have to deal with these patients in daily practice
The document standardized by ICCS for lower urinary tract function terminology states that, initial success to treatment is considered full response if 100% decrease or less than 1 symptom occurrence monthly; response is defined as a 90% or greater decrease, partial response 50% to 89% decrease, and non response is defined as a 0% to 49% decrease
Summary
Bladder Bowel dysfunction (BBD) is a broad term used to describe children who present a constellation of Lower Urinary Tract Symptoms (LUTS) associated with constipation and/or encopresis. These children usually present with low voiding frequency and urgency due to a full bladder They commonly will have constipation as an associated problem, due to the fact that the mechanism to delay defecation is similar [2,15]. Children presenting daytime frequency typically present very small voided volumes, often less than 50% of the Expected Bladder Capacity (EBC)* and micturition occurs at least once every hour [3] This diagnosis is heralded by lack of associated incontinence and nocturnal enuresis. All of the following in a child ≥ 4 years: Defecation into places inappropriate to the social context at least once per month
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