Voiding improvement program

self-cathing key


 

blue_sc_func What kind of care does the Voiding Improvement Program provide?
The kids come in, they’re still wet beyond the social age of continence and we’re trying to determine why that is happening. Is there some underlying issue that’s physiologic, or is it more about behavioral management? I do a full physical assessment on the kids who come in to find out if there’s anything else organic in nature that might be causing this. Could there be anything more drastic, any chronic underlying problem with the kidneys, or the bladder, or the ureter, or something foreign that shouldn’t be there that’s happening?

But often times a lot of the kids have gotten into this dysfunctional pattern of voiding where they’re holding their urine all day long. Maybe a few years ago they had a urine infection and it hurt, and so they learned when they were younger not to go, or they’re afraid of public toilets, and it causes this whole vicious cycle where they hold it, hold it, hold it, and then finally the bladder gives out. They can’t take it anymore, and that’s when incontinence happens.

Pam Kelly, PNP, Clinical Coordinator, Urodynamics and Voiding Improvement Program

 

With dysfunctional voiding, you want to make sure that nothing bad is really going on. Is there an anatomic problem or something like that? Is there a problem with their spine, or some real underlying neurologic problem that we need to address? Assuming all that is negative, a lot of it is behavioral. Usually you start off by making sure that these kids aren’t constipated, that the environment is positive for them, that the family understands they’re not doing this maliciously and try not to get too frustrated over every little accident that may happen.

Then you try and do behavioral changes with the child and try to get them going to the bathroom on a regular basis, taking their time, improving hygiene. Then, as opposed to starting kids on medication, I find biofeedback therapy really helpful, because it kind of puts them in control of the situation a little bit more, when they learn how to control their body. And it’s consistent, someone’s working with them — it’s small gains but they can usually see measurable gains. So that’s why I find that helpful.

Richard Lee, MD, Urologist