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The Role of Bladder and Bowel Dysfunction (BBD) in Pediatric Urinary Tract Infections

  • Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)
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Abstract

The child with lower urinary tract symptoms, in the absence of neurological abnormalities, represents an increasingly common source of referral to the pediatric urologist. Patients with lower urinary tract dysfunction are at increased risk of urinary tract infections (UTIs), which can be a potential source of expense, inconvenience, and even morbidity and renal impairment. Many of these patients present with concomitant bowel dysfunction in the form of constipation and encopresis. As a result, the term “bladder and bowel dysfunction” (BBD) has been introduced and refers to the close relationship of the bladder and bowel and their interrelated disturbances. An in-depth understanding of BBD and its role in recurrent UTI is the key to treatment and prevention of further morbidity in these patients. We present an updated review of the literature on BBD and UTIs in children, including its pathogenesis, evaluation, and management.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hinman F. Nonneurogenic neurogenic bladder (the Hinman syndrome)—15 years later. J Urol. 1986;136:769–77.

    PubMed  Google Scholar 

  2. Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998;160:1019–22.

    Article  CAS  PubMed  Google Scholar 

  3. Austin PF et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2014. doi:10.1016/j.juro.2014.01.110. Author's Note: Consistent use of terminology is important for future research and clinical practice. As such, it is crucial that pediatric urologists are familiar with this report.

    PubMed Central  Google Scholar 

  4. Nevéus T et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176:314–24.

    Article  PubMed  Google Scholar 

  5. Yoshimura N, Chancellor MB. “Chapter 60: Physiology and Pharmacology of the Bladder and Urethra.” In: Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 1786–833.

  6. Yeung C, Barker GM and Lackgren G. “Chapter 17: Pathophysiology of Bladder Dysfunction.” In: Gearhart J, Rink R, Mouriquand P, editors. Pediatric Urology. 2nd ed. Philadelphia: Elsevier Saunders; 2010. p. 353–65.

  7. Burgers R et al. Functional defecation disorders in children with lower urinary tract symptoms. J Urol. 2013;189:1886–91.

    Article  PubMed  Google Scholar 

  8. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997;100:228–32.

    Article  CAS  PubMed  Google Scholar 

  9. Burgers R et al. Effect of rectal distention on lower urinary tract function in children. J Urol. 2010;184:1680–5.

    Article  PubMed  Google Scholar 

  10. O’Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. 1985;23:152–4.

    PubMed  Google Scholar 

  11. Wald A, Chandra R, Chiponis D, Gabel S. Anorectal function and continence mechanisms in childhood encopresis. J Pediatr Gastroenterol Nutr. 1986;5:346–51.

    Article  CAS  PubMed  Google Scholar 

  12. Heyns CF. Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol. 2011;30:77–83.

    Article  PubMed  Google Scholar 

  13. Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child. 1991;66:232–4.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Van Batavia JP, Ahn JJ, Fast AM, Combs AJ, Glassberg KI. Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction. J Urol. 2013;190:1495–500.

    Article  PubMed  Google Scholar 

  15. Chen JJ, Mao W, Homayoon K, Steinhardt GF. A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol. 2004;171:1907–10.

    Article  PubMed  Google Scholar 

  16. Shaikh N et al. Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life? Pediatrics. 2003;112:1134–7.

    Article  PubMed  Google Scholar 

  17. Peters CA et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010;184:1134–44.

    Article  PubMed  Google Scholar 

  18. Zink S, Freitag CM, von Gontard A. Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence. J Urol. 2008;179:295–8.

    Article  PubMed  Google Scholar 

  19. Mazzola BL, Von Vigier RO, Marchand S, Tonz M, Blanchetti MG. Behavioral and functional abnormalities linked to recurrent urinary tract infections in girls. J Nephrol. 2003;16:133–6.

    PubMed  Google Scholar 

  20. Von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol. 2011;185:1432–7.

    Article  Google Scholar 

  21. Burgers RE et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013;190:29–36. Author’s Note: This an excellent reference for those who are evaluating and treating constipation and/or encopresis.

    Article  PubMed  Google Scholar 

  22. Farhat W et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000;164:1011–5.

    Article  CAS  PubMed  Google Scholar 

  23. Farhat W, McLorie G, O’Reilly S, Khoury A, Bagli D. Reliability of the pediatric dysfunctional voiding symptom score in monitoring response to behavioral modification. Can J Urol. 2001;8:1401–5.

    CAS  PubMed  Google Scholar 

  24. Heaton KW et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992;33:818–24.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Glassberg KI, Combs AJ, Horowitz M. Nonneurogenic voiding disorders in children and adolescents: clinical and videourodynamic findings in 4 specific conditions. J Urol. 2010;184:2123–7.

    Article  PubMed  Google Scholar 

  26. Joensson IM, Siggaard C, Rittig S, Hagstroem S, Djurhuus JC. Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J Urol. 2008;179:1997–2002.

    Article  PubMed  Google Scholar 

  27. Tarcan T et al. The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination. J Pediatr Urol. 2012;8:55–8.

    Article  PubMed  Google Scholar 

  28. Lavallée LT, Leonard MP, Dubois C, Guerra LA. Urodynamic testing—is it a useful tool in the management of children with cutaneous stigmata of occult spinal dysraphism? J Urol. 2013;189:678–83.

    Article  PubMed  Google Scholar 

  29. Jepson RG, Williams G, Craig JC. in Cochrane Database Syst. Rev. (The Cochrane Collaboration & Jepson, R. G.). John Wiley & Sons, Ltd; 2012. doi: 10.1002/14651858.CD001321.pub5

  30. Grin P, Kowalewska P, Alhazzan W, Fox-Robichaud A. Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis. Can J Urol. 2013;20:6607–14.

    PubMed  Google Scholar 

  31. Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nat Rev Gastroenterol Hepatol. 2011;8:502–11.

    Article  PubMed  Google Scholar 

  32. Bekkali N-L-H et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatrics. 2009;124:e1108–15.

    Article  PubMed  Google Scholar 

  33. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. in Cochrane Database Syst. Rev. (The Cochrane Collaboration). John Wiley & Sons, Ltd; 2010. doi. 10.1002/14651858.CD007570.pub2

  34. Vasconcelos M et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol. 2006;21:1858–64.

    Article  PubMed  Google Scholar 

  35. Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA. Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol. 2011;7:342–8. Author’s note: This paper provides a systematic review of biofeedback as a non-invasive therapy for BBD. Nevertheless, the authors acknowledge the need for RCTs and better quality research on this topic.

    Article  PubMed  Google Scholar 

  36. Austin PF. The role of alpha blockers in children with dysfunctional voiding. Sci World J. 2009;9:880–3.

    Article  CAS  Google Scholar 

  37. Austin P et al. Alpha-adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol. 1999;162:1064–7.

    Article  CAS  PubMed  Google Scholar 

  38. Cain M, Wu S, Austin P, Herndon C, Rink R. Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol. 2003;170:1514–5.

    Article  CAS  PubMed  Google Scholar 

  39. Donohoe JM, Combs AJ, Glassberg KI. Primary bladder neck dysfunction in children and adolescents II: results of treatment with α-adrenergic antagonists. J Urol. 2005;173:212–6.

    Article  PubMed  Google Scholar 

  40. Kramer S, Rathbun S, Elkins D, Karnes R, Husmann D. Double-blind placebo controlled study of α-adrenergic receptor antagonists (DOXAZOSIN) for treatment of voiding dysfunction in the pediatric population. J Urol. 2005;173:2121–4.

    Article  CAS  PubMed  Google Scholar 

  41. Yucel S et al. Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. J Urol. 2005;174:1612–5.

    Article  CAS  PubMed  Google Scholar 

  42. Goessl C et al. Efficacy and tolerability of tolterodine in children with detrusor hyperreflexia. Urology. 2000;55:414–8.

    Article  CAS  PubMed  Google Scholar 

  43. Hjälmås K, Hellström A-L, Mogren K, Läckgren G, Stenberg A. The overactive bladder in children: a potential future indication for tolterodine. BJU Int. 2001;87:569–74.

    Article  PubMed  Google Scholar 

  44. Raes A et al. Retrospective analysis of efficacy and tolerability of tolterodine in children with overactive bladder. Eur Urol. 2004;45:240–4.

    Article  CAS  PubMed  Google Scholar 

  45. Ayan S et al. Efficacy of tolterodine as a first-line treatment for non-neurogenic voiding dysfunction in children. BJU Int. 2005;96:411–4.

    Article  CAS  PubMed  Google Scholar 

  46. Kilic N, Balkan E, Akgoz S, Sen N, Dogruyol H. Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability. Int J Urol. 2006;13:105–8.

    CAS  PubMed  Google Scholar 

  47. Bolduc S et al. The use of tolterodine in children after oxybutynin failure. BJU Int. 2003;91:398–401.

    Article  CAS  PubMed  Google Scholar 

  48. Mungding M, Wessells H, Thornberry B, Riden D. Use of tolterodine in children with dysfunctional voiding: an initial report. J Urol. 2001;165:926–8.

    Article  Google Scholar 

  49. Babu R. Effectiveness of tolterodine in non-neurogenic voiding dysfunction. Indian Pediatr. 2006;43:980.

    PubMed  Google Scholar 

  50. Ayan S, Topsakal K, Gokce G, Gultekin EY. Efficacy of combined anticholinergic treatment and behavioral modification as a first line treatment for nonneurogenic and nonanatomical voiding dysfunction in children: a randomized controlled trial. J Urol. 2007;177:2325–9.

    Article  CAS  PubMed  Google Scholar 

  51. Mangera A et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65:981–90.

    Article  CAS  PubMed  Google Scholar 

  52. Steinhardt GF, Naseer S, Cruz OA. Botulinum toxin: novel treatment for dramatic urethral dilatation associated with dysfunctional voiding. J Urol. 1997;158:190–1.

    Article  CAS  PubMed  Google Scholar 

  53. Radojicic ZI, Perovic SV, Milic NM. Is it reasonable to treat refractory voiding dysfunction in children with botulinum-A toxin? J Urol. 2006;176:332–6.

    Article  PubMed  Google Scholar 

  54. Vricella GJ, Campigotto M, Coplen DE, Traxel EJ, Austin PF. Long-term efficacy and durability of botulinum-A toxin for refractory dysfunctional voiding in children. J Urol. 2014. doi:10.1016/j.juro.2013.10.034.

    PubMed  Google Scholar 

  55. Franco I, Landau-Dyer L, Isom-Batz G, Collett T, Reda EF. The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children. J Urol. 2007;178:1775–80.

    Article  CAS  PubMed  Google Scholar 

  56. Pohl HG et al. The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. BJU Int. 2002;89:923–7.

    Article  CAS  PubMed  Google Scholar 

  57. Silay MS et al. Twelve-year experience with Hinman-Allen syndrome at a single center. Urology. 2011;78:1397–401.

    Article  PubMed  Google Scholar 

  58. Handel LN, Barqawi A, Checa G, Furness III PD, Koyle MA. Males with Down’s syndrome and nonneurogenic neurogenic bladder. J. Urol. 2003; 169:646–649.

  59. Griffiths DM, Malone PS. The Malone antegrade continence enema. J Pediatr Surg. 1995;30:68–71.

    Article  CAS  PubMed  Google Scholar 

  60. Chait P, Shandling B, Richards H, Connolly B. Fecal incontinence in children: treatment with percutaneous cecostomy tube placement—a prospective study. Radiology. 1997;203:621–4.

    Article  CAS  PubMed  Google Scholar 

  61. Christison-Lagay ER et al. Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. J Pediatr Surg. 2010;45:213–9.

    Article  PubMed  Google Scholar 

  62. Vesna ZD, Milica L, Stanković I, Marina V, Andjelka S. The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding. J Pediatr Urol. 2011;7:336–41.

    Article  PubMed  Google Scholar 

  63. Yang SS-D, Chiang I-N, Lin C-D, Chang S-J. Advances in non-surgical treatments for urinary tract infections in children. World J Urol. 2011;30:69–75.

    Article  PubMed  Google Scholar 

  64. Rasquin A et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527–37.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Linda Lee declares no conflict of interest. Martin Koyle reports that he has previously received payment, outside of the submitted work, for his work developing educational presentations on behalf of Salix Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Urology, Western University, London, ON, Canada

    Linda C. Lee

  2. Division of Pediatric Urology, Hospital for Sick Children, Room M299, Black Wing, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Martin A. Koyle

  3. Division of Urology, Department of Surgery, St. Joseph’s Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada

    Linda C. Lee

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  1. Linda C. Lee
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  2. Martin A. Koyle
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Correspondence to Linda C. Lee or Martin A. Koyle.

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Lee, L.C., Koyle, M.A. The Role of Bladder and Bowel Dysfunction (BBD) in Pediatric Urinary Tract Infections. Curr Bladder Dysfunct Rep 9, 188–196 (2014). https://doi.org/10.1007/s11884-014-0240-0

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